Menopause and Perimenopause, the what, when, and how.

When is this likely to happen?

Just as you never knew when your first period was going to start, you can’t predict when your last one will be. If the average age of menopause is 51 then some perimenopause symptoms may be starting at 41. But remember 51 is just the average, so if you are having symptoms that you can’t quite put your finger on at 35 then it may be worth talking to your GP about your hormones (although do some research, take some NICE guidelines and book in with one who specializes in women’s hormones as menopause training isn’t mandatory). If you were thinking of starting or extending your family during perimenopause then don’t panic, you can still get pregnant, you just may need to be diligent with your lifestyle and routines. If starting or extending your family is a big fat NOPE then you’ll need to be diligent about contraception for a year after your menopause anniversary.

What exactly is going on?

It is useful to have a rough idea of what is happening with your endocrine system so you can better understand your body during this turbulent time. If you are in a natural menopause rather than a surgical one then your ovaries will slow down the release of estrogens, testosterone, and progesterone. Together these hormones affect your: cognitive health, bone health, cardiovascular system, serotonin, endorphins, digestive health, cholesterol levels, urinary tract, pelvic floor muscles, serotonin, libido, energy levels, mood, and of course your uterus, vagina, vulva, and breasts.

The reduction in the production of these hormones is rarely a smooth steady decline, this is your most erratic time with fluctuating levels making life hard for you, and making it difficult for your GP to give you a diagnosis via a blood test because it will be so different day to day. If you are younger than 45 then your GP may give you a blood test to determine where you are, but if you are over 45 they will diagnose you off your symptoms.

Although your ovaries slow down the release of these hormones, your fat cells and adrenal glands will pick up the slack (which is where a few extra pounds can come in handy!) and can make a small portion of a type of estrogen and testosterone - this is why perimenopause can be so harsh, because if your adrenals are already burnt-out at midlife (and whose aren’t?) then there is not enough battery life left for them to pick up where the ovaries left off.

How about menopausal symptoms?

Perimenopause is likely to affect you on many levels and in ways that may not seem like they are connected. The symptoms we all know about are changes in your menstrual cycle, hot flushes, and night sweats, but you can take your pick from this shortened list:

Body: Palpitations, tinnitus, headaches, joint/muscle pains, exhaustion, digestive problems, urinary tract infections, dryness of the skin, hair, eyes, nails, mouth, vagina, or vulva.

Mind: Anxiety, insomnia, difficulty concentrating, panic attacks, poor memory, brain fog, rage, low libido.

Spirit: Wanting to give everyone the middle finger, run away and leave everything behind so you can live in a field, count butterflies, dance in the rain, and swim naked in the river.

So the perimenopause/change in your hormones during this part of your life may be the root cause of some of your symptoms - although it is always worth asking your GP for blood tests, especially a full thyroid panel to rule out a thyroid issue.

Sounds like a lot right?

Menopause is a rite of passage. In the first half of your life, you have the hormones that will help you care for children, look after ageing parents, birth work projects, and give and give of yourself. And now, that energy output is no longer sustainable and a part of you (the self) is demanding that you turn your awareness inward and get your own needs met - although for some, recognising that you even have needs may be the first step. This is what we call self-care. And what better way of slowing you down than giving you crippling symptoms that make it difficult for you to function. Perimenopause is that time when giving to yourself becomes non-negotiable, but it comes at a time when you are at peak wonder-woman and have run your adrenals into the ground through decades of multitasking.

So, don’t worry if you feel overwhelmed or out of control, this time in your life is supposed to be messy. Any unresolved issues are supposed to come to the surface so that you can process them and move into your next 30 years free of the burden of carrying them around. Your self-care is supposed to become non-negotiable because your level of giving is unsustainable.

What are your options?

HRT can be a flexible option as you and your healthcare provider can choose which hormones to supplement and in which way. These days hormones are body-identical rather than synthetic and can be worth exploring. There may be some trial and error, but for some women, this is the exact thing they need to thrive.

Regardless of whether or not you try HRT, you’ll need to look after your body holistically. Our Five Fields Assessment of nourishment, movement, rest, emotions and connection is relevant at this stage of your life, with the emphasis on finding what feels kind for you right now. What feels right for most women is slowing down, resting, retreating, editing, connecting with your tribe, and finding out how to be yourself in a world that still asks you to go at 100 miles per hour 100% of the time. You will become more sensitive, to noise, food, temperature, sex, or the demands that others place upon you. What you used to count as self-care may no longer fit. You may need to take your focus inwards to listen to what it is that your body is asking of you. That is your journey to make to help you cope with the shift in your hormones.

How can I help?

Acupuncture obviously! Modern medicine looks at replacing lost progesterone, oestrogen, and testosterone. Traditional Chinese medicine looks at what has made those hormones become so depleted, and we explore this through the theory of yin and yang. Activity is considered yang - at midlife we have reached peak ‘doing’, and if we don’t balance that with yin (rest, nourishment), then we can run into trouble. Acupuncture can help to promote the balance of yin, reduce inflammation, and regulate your nervous system, but we can also use somato emotional release to help you explore where you may have been suppressing your own needs, or where you might be giving too much without being supported yourself. I can also point you in the direction of websites, books, or podcasts to support your specific needs.

Post-menopause

In Chinese medicine, we call the post-menopausal years ‘Second Spring’. This is a much more rounded view of the potential for new beginnings once we are freed from the need to please everyone around us. At this point, we have edited our lives enough to give us the energy for another 30 years of living life to the full. So if you have been bombarded with the idea that menopause is a loss of fertility, collagen, or worth then you could take the Chinese approach and think of it as a rebirth rather than a death.