Peri-Menopause – we should be thinking about this earlier than we do
In July last year, I began feeling really unwell—extreme night sweats, shortness of breath, and profound fatigue. My first thought was, “Here it is, menopause.” However, it turned out I had post-COVID pneumonia, which led to a week in the hospital and six months on prednisone. Fast forward to this July, and I was still struggling with the same symptoms. Much of it I attributed to Long COVID. But during a hike with my daughter—a hike I had done many times before—I felt dreadful. Those three hours felt like three days, and I had to spend the rest of the day recovering on the couch.
At 50, working in healthcare and having been on steroids for six months, you might wonder why it took me so long to test my hormones. Honestly, I don’t know. But that hike finally pushed me to do it. The results showed I had hardly any oestrogen, extremely low progesterone, and very low testosterone. As you can imagine, I was desperate to feel normal again.
It’s crucial to emphasize the negative impact chronic stress has on our hormones, especially as we age. Before jumping into hormone therapy, it’s essential to address the HPA axis and make necessary dietary and lifestyle changes, or at least do it in conjunction with other treatments.
Am I taking hormones? Yes! Absolutely. I couldn’t wait to start applying them to my wrists and upper arms. And as for progesterone, I eagerly start taking it on day 14 of my cycle. Yes, that’s right—I’m still menstruating every 28 days. That’s also one reason I delayed testing my hormones.
Facing the reality of my hormone levels forced me to take a long, hard look at my diet and lifestyle. I began focusing more on cognitive health, as it’s crucial at this stage of life. I didn’t drastically change my diet, but I made enough adjustments to feel the benefits. I also made exercise a daily priority whenever possible.
Am I feeling better? Yes, much better. Am I back to my pre-40 energy levels? Not quite. Has my brain fog lifted completely? I wish, but it has improved significantly.
What I’m really trying to say is that we, as women, should take a much more proactive approach to peri-menopause. By the time we hit our 40s, we should monitor our hormones and make lifestyle changes to address chronic stress. We need to anticipate fluctuating hormone levels and their potential ripple effects. The slowdown in ovarian hormone production can have a massively detrimental impact on both physical and emotional health. We don’t have to reach a crisis point if this is managed well.
From a functional nutrition perspective, we always address the whole person and all the factors that affect health and wellness. The context of your life—sleep, stress, movement, nutrition, and relationships—is extremely important.
Testing Options
- DUTCH Complete or DUTCH Plus: The gold standards for functional hormone testing, these tests examine sex hormones and their metabolites, the overall diurnal pattern of free cortisol, and the total distribution of cortisol metabolites. They also include Organic Acids Tests (OATs), which provide insights into nutritional deficiencies, oxidative stress, gut dysbiosis, melatonin, neuroinflammation, and more.
- Serum Levels: If the DUTCH test is cost-prohibitive, serum hormone tests for oestrogen, progesterone, testosterone, FSH, and LH are the next best option, and likely what your doctor will recommend.
- Fasting Glucose & Fasting Insulin: As we age, the risk of insulin resistance increases, making these tests essential.
- Lipogram: It’s crucial to test cholesterol levels. Low levels of HDL (good) cholesterol are associated with inflammation.
- Blood Pressure: This often increases after menopause, so making dietary changes now is crucial.
- Vitamin D, ferritin, B12: it’s important to know the status of these nutrients as deficiencies can be associated with depression, anxiety and insomnia.
- Gut Health: Depending on your history (PCOS, endometriosis, autoimmune disease) and symptoms, it may be necessary to investigate gut health with a GI Map test. Specifically, we look at beta-glucuronidase levels to assess how well you are detoxifying hormones through the bowel.
Dietary Modifications
Dietary changes depend on the individual. At this stage, I’ve implemented Dr. Kara Fitzgerald’s Younger You program and am really enjoying it. So much so that I am now a Younger You Trained Practitioner. I’m also practicing intermittent fasting, which isn’t for everyone but works well for me at this stage. Ultimately, you must find a diet that suits your body and supports you through these hormonal fluctuations.
HRT, BHRT, and Supplements
There are many options available for peri-menopausal and menopausal women, and there’s no reason to suffer. If you choose HRT or BHRT, it’s always a good idea to support oestrogen detoxification. The DUTCH test is helpful here as it indicates whether you are metabolizing oestrogen down the 4-OH pathway. Although 4-OH has minimal oestrogenic effects, its metabolism can lead to the formation of reactive 3,4-quinone metabolites. These metabolites can induce DNA damage by generating reactive oxygen species (ROS), including superoxide anion, hydrogen peroxide, and hydroxyl radicals, which may contribute to carcinogenic processes, particularly in hormone-dependent cancers like breast cancer.
If you’re in the early stages of peri-menopause or prefer herbal options, some herbs can be beneficial, such as wild yam, chasteberry, black cohosh, red clover, and dong quai extract.
Lifestyle
Lifestyle modifications, like daily exercise and mindfulness practice, should form the foundation of any intervention you undertake. These practices directly address stress, allowing you to naturally support your HPA axis and manage stress levels.
In conclusion, don’t suffer. Take action early if you can, and if you haven’t, now is the time. We don’t need to suffer as we age—longevity is not about chronological age but about addressing biological age so we can continue living life as we should.
The image below has been taken from One Women Health and basically sums things up!
