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If you are experiencing perimenopause symptoms and wondering what you can do to optimise your long term health, wellbeing and longevity, then you are in the right place. We explore the 5 pillars of perimenopause health and wellbeing with tips on how to implement these health building habits into your life.
What is perimenopause?
Perimenopause is the period of 3 to 7+ years around the menopause when a woman’s hormone levels begin to fluctuate and then decline, having effects on both their physical and mental health.
During perimenopause, women may experience changes such as irregular periods, hot flashes and night sweats, fatigue, mood swings, difficulty concentrating and remembering things. Hormonal fluctuations also cause changes in body composition, with a reduction in muscle and bone mass and an increase in abdominal fat.
Some women also experience other health problems like insomnia and headaches. A Lifestyle medicine specialist can support these hormonal changes with lifestyle strategies and help to balance hormonal fluctuations with menopause hormone therapy to alleviate symptoms of perimenopause and improve overall long-term health.
What Are the symptoms of perimenopause?
There are over 34 symptoms associated with perimenopause as fluctuations and declining estradiol and progesterone levels impact the entire body including metabolism, mental health, heart, brain, skin gut and sexual health.
Sleep disturbance
Mood swings, low mood, anxiety, reduced resilience to stressful events
Altered metabolism with abdominal fat weight gain
Loss of bone and muscle mass, and joint pain
Decreased sex drive
Vaginal dryness and irritation
Recurrent urinary tract infections, urge or stress urinary incontinence
Fatigue
Impaired memory, concentration problems and brain fog
Irregular, heavy or painful periods
6 Pillars of Health For Women In Perimenopause, Menopause and Beyond
Menopause health matters! Perimenopause and menopausal hormonal changes can impact your long-term health for 30-50 years of your life.
How you treat your body and mind during perimenopause sets up the metabolic, hormonal and inflammatory environment in the body for the rest of your life. By making intentional lifestyle changes you can reduce your lifetime chronic disease risk.
1. Nutrition: Nourish Your Body
Wholefood lifestyle
The FLEMENCO project found that women who consumed a Mediterranean diet (higher consumption of whole-grain cereals, nuts, fruits, pulses, whole dairy products and olive oil, and a lower consumption of sweetened beverages) had more stable body composition during perimenopause. These women had lower waist circumferences and less abdominal fat (Flor-Alemany 2020).
Similarly pre-menopausal, perimenopausal and menopausal women who consumed diets high in plant proteins (such as beans, lentils, chickpeas, peas, nuts and seeds) improved lean/fat body composition ratio and improved HDL cholesterol and systolic blood pressure.
These studies suggests that dietary patterns high in unprocessed plant foods improve metabolic status during perimenopause.
Phytoestrogen Foods For Perimenopause
Phytoestrogens are plant-based compounds that mimic estrogen in the body. They do not bind estrogen receptors as strongly as estrogen in the body so their effects are weaker when levels are high in the body (having a lowering effect). When levels drop in the body, phytoestrogens exert a weak estrogenic effect (having an elevating effect).
In this way they act as a natural selective estrogen receptor modulator (SERM).
Common phytoestrogens include lignans and isoflavones. They are found in abundance in many plant foods including:
Isoflavones found in soy, lentils, and legumes (beans and chickpeas) pistachios, peanuts, and other fruits and nuts.
Lignans found in flaxseed, whole grains (such as barley, buckwheat, millet, oats, rye), sesame seeds, berries and vegetables (broccoli, kale, green tea).
Coumestans found in red clover, sunflower seeds, split peas, pinto beans, lima beans, and bean sprouts.
Unlike oral estrogen tablets which contribute to endometrial thickening, phytoestrogens from food or supplements do not (Mareti 2019).
Additionally a small study of phytoestrogen supplement in doses of 25-100mg daily suggests an improvement of depression symptoms among perimenopausal women (Li 2021). A diet rich in the plant foods above therefore is likely to have a beneficial effect on mood symptoms.
Additionally there are some important nutritional requirements for women going through perimenopause include:
Protein in every meal, in roughly the size of your palm.
Carbohydrates around your workouts and optimally in the morning, in roughly the size of your palm.
Healthy whole food fats in your meals in the size of your thumb.
Greens and other veg in roughly the size of your cupped palms with each meal.
An anti-inflammatory diet means eating foods in your diet that are high in phytonutrients, anti-oxidants and fiber. The best way to ensure your diet contains plenty of phytonutrient s and antioxidants is to eat a variety of colorful plant foods.
Reducing inflammatory foods such as processed foods, fried food, trans fats, lollies or candy and refined carbs supports better metabolic and hormone health.
Gut microbiome and Perimenopause
The gut microbiome is essentially an additional organ system in your body. It produces many hormones and chemicals which support your body's healthy functioning. Estradiol and progesterone maintain the gut barrier and protect from gut injury.
They support a more diverse and health promoting gut bacteria. They also protect the gut immune system from low grade chronic inflammation stimulated by disease promoting gut bacteria.
Perimenopause alters the gut microbiome which plays a role in the changes to perimenopausal metabolism.
Eating diverse plant foods as part of a healthy diet promotes bacteria diversity in your gut. Additionally you can support your gut health by eating fermented foods such as sauerkraut, kimchi, kefir, and non-sweetened yoghurt.
Plant fibers are prebiotics, foods that feed the microbiome. Food has been shown to be one of the strongest influencers on the gut microbiome. Eating a variety of plant foods contributes to a diverse gut microbiome.
Some examples of prebiotics and colonic foods include:
Inulin – found in dandelion greens, garlic, Jerusalem artichokes, leeks, chicory root (coffee substitute)
Fructo-oligosaccharides (FOS) – found in yacon root, garlic, onion, leeks, chicory root, Jerusalem artichokes, asparagus, bananas
Galacto-oligosaccharide (GOS) – found in legumes, including beans, chickpeas, and lentils.
beta-glucan fiber – found in raw oats
Pectin – found in apples.
Overall the research indicates significant health benefits from eating a dietary pattern rich in whole plant foods.
2. Movement: Exercise and Menopause
Regular physical activity is important for health at every age and especially during perimenopause and menopause. It helps maintain healthy weight and muscle mass, strengthens muscles and bones and lowers the risk of chronic diseases like heart disease, diabetes and high blood pressure.
Dr Stacey Sims, a New Zealand-based exercise physiologist and nutrition scientist promotes three key types of movement for perimenopausal and menopausal women to incorporate into their week. These are;
Sprint interval training
Lifting heavy weights
Jumping exercises
This combination supports the maintenance of physical strength, stamina, body composition and cardiovascular health.
Sprint Interval Training For Perimenopause
Sprint interval training (SIT) is a quick and efficient form of exercise. It means working faster and harder for shorter periods of time. Women who do sprint interval training alternate periods of high intensity effort with rest or low intensity.
For example, on a bike sprinting at full speed for 20-30 seconds then recovering either at rest or doing an easy pace for 70-90 seconds before repeating the cycle approximately 10 times.
If you are an endurance athlete, or are used to doing moderate to higher intensity exercise regularly you can transition 1 or 2 sessions of SIT per week.
If you are just returning to or beginning to exercise you should see a exercise or health professional to help create a program to build up to SIT to avoid injury.
Lifting Heavy Weights To Build Muscle
Lifting weights is important to maintain muscular strength, bone density and improve
Building muscle can help women going through menopause by reducing symptoms such as fatigue, hot flashes, and night sweats. Muscle mass decreases naturally as we age, which can lead to increased fat around the abdomen area and decreased mobility in general.
Building muscle can help counteract these changes and improve overall health by increasing metabolism and reducing stress levels.
Additionally, resistance training has been shown to reduce symptoms associated with menopause by increasing blood flow to the pelvic region, which helps relieve pain associated with vaginal dryness and atrophy.
Jumping Exercises or Plyometrics
Jumping exercises provide gravitational stress to the joints and bones which stimulates maintenance of the structure of bones. This is especially important for your spinal vertebrae and your hips. Jumping with a jump rope 2 minutes a day, doing jumps squats, or jumping jacks (star-jumps) helps to maintain bone mass, osteoporosis and bone fractures.
3. Relax: Soothe your nervous system
Stress and anxiety can lead to many physical and emotional health issues during perimenopause. Women in perimenopause due to fluctuating hormonal levels often feel less resilient to stress and By soothing the nervous system, women can reduce stress levels and improve their overall well-being.
By practicing techniques such as deep breathing, visualization and meditation regularly, women can reduce their stress levels and improve their mental well-being during menopause. These practices also help them get a good night's sleep which is essential for overall health during this time of life.
Breathe Deeply
A deep breathing practice deeply can help women going through menopause by reducing blood pressure, encouraging relaxation, calming the nervous system and heart rate and managing stress.
By practicing diaphragmatic breathing on a daily basis, women going through menopause can benefit from its restorative effects on the body and mind. It can also help them cope with the changes associated with menopause by providing a sense of relief from stress and anxiety. It can be used anywhere you feel the nervous system becoming agitated or aroused.
Progressive Muscle Relaxation
Progressive muscle relaxation is an effective technique to help reduce physical and emotional tension in the body. It involves tensing and relaxing different muscles throughout the body, starting from your head and working down to your toes.
By focusing on one muscle group at a time, and tensing them for 10 seconds followed by relaxation for another 10 seconds, women can reduce tension and stress in their bodies. This technique also helps to improve sleep quality, which is essential for overall health during this time of life.
Yoga For Menopause
Yoga is a great way to manage the physical and emotional symptoms associated with perimenopause and menopause. It combines physical postures with breathing exercises and meditation, making it an effective way to reduce stress and anxiety.
Yoga can help increase flexibility, improve posture, and encourage mindfulness. It helps with vasomotor symptoms such as hot flashes by reducing body temperature and improving blood circulation. Additionally, yoga can also help promote a sense of balance in the mind and body which is important during this transition period.
Time In Nature
Sunshine and nature have been shown to have a positive effect on human health. This includes lowering stress levels, improving sleep quality, increasing energy levels and reducing the risk of certain diseases such as type II Diabetes, heart disease and high blood pressure.
Ensuring 20-30 minutes of sunlight exposure per day plus spending time in nature (forests, parks or beaches), increases your vitamin D levels which helps regulate your immune system, nervous system and hormones.
Additionally getting outside in nature allows you time to disconnect from daily life stressors, unplug from technology and reconnect with yourself, your environment and community if you are also spending time with friends or family.
Read More: Top 10 Mind-Body Wellness Practices
4. Sleep: Rest and Recovery
Adequate sleep during menopause helps reduce stress, improves memory and cognition, reduces the risk of stroke and heart attack, aids in weight management, and strengthens bones.
Many women find their sleep disturbed and need support to improve their sleep. Although most people need seven to eight hours of sleep per night some women do feel refreshed in the morning with fewer hours of sleep.
The relaxation techniques can calm down the nervous system and calm the mind and body for sleep. Additionally keeping the room cool and dark, or using a fan can help if you have hot flashes at night.
Some women need additional support with supplements such as tart cherry, magnesium or by using hormone replacement therapy which supports the circadian rhythm, reduces hot flashes and if micronised progesterone (Utrogestan) is used, converts to allopregnanolone a calming neuro-steroid for sleep.
Read More: 10 Tips for Great Sleep
5. Live with intention, purpose and connection
Living with intention, purpose and connection can help you experience for joy, satisfaction and pleasure during menopause. Perimenopause can be a time to take stock of your life, explore your values and dreams, nurture yourself with self-care and connect with those around you.
It can be helpful to have time each day for reflection and setting intentions, writing in a journal or focusing on activities that will bring you joy. Connecting with others can also be beneficial, whether it’s through supportive conversations or activities such as yoga classes and walking groups.
Engage With Community
Engagement with the community can help women going through menopause by providing them with support, understanding, and connections. These relationships provide an outlet for emotional support and a sense of belonging that can help reduce stress and boost happiness levels.
By connecting with others through social activities such as volunteering or attending community events, women going through menopause can develop close relationships that provide them with the support they need during this time of life transition. This helps them cope better with any changes in their physical health or emotions caused by menopause.
Additionally, many women find support in Facebook groups, online forums, or via coaching.
Finally, it is essential to seek help if needed. Don’t be afraid to talk to a doctor or health care provider about your symptoms and how best to support your transition through menopause.
6. Avoid Toxins That Harm Your Health
Alcohol
Alcohol is a neuro-toxin, meaning it poisons brain cells. You may have had the resilience to cope with this in your younger years, but as you age, most women find they want to preserve their brain health as long as possible. Of particular concern are the increased rates of dementia and stroke associated with regular alcohol intake.
Alcohol is a carcinogen and associated with increased risk of breast, mouth, throat, and stomach cancers.
High consumption also damages the liver.
To reduce your long-term risk of chronic disease, limit your alcohol consumption to 10 standaard units per week and 2 units of alcohol per day with at least 2 alcohol free per week.
Many women find as they approach perimenopause alcohol does not make them feel great either.
Caffeine
Some women tolerate caffeine well, but for some, caffeine can aggravate bladder symptoms including urgency and pain, as well as hot flashes. If in sufficent quantities or later in the day, because caffeine has a long half-life, it can interfer with sleep onset.
Additional Perimenopause Natural Treatments
These health habits are beneficial for all women to incorporte into their lives.
Despite these, some women continue to have significant perimenopause symptoms that disrupt sleep, mood, causes fatigue, hot flashes and can impact work, relationships and self-confidence.
Hormone replacement therapy is an effective and safe treatment for most women to ease symptoms, improve quality of life, support sleep, regulate cortisol and insulin levels and support energy so that you can get on with feeling like yourself, and living your best life.
Using menopause hormone therapy does not replace these hormones to levels you previously had, but does provide you with a small amount of these hormones can have significant impact on quality of life.
There are a number of types of menopause hormone therapy, including body identical versions of estradiol and micronised progesterone.
Read more about Hormone Replacement Therapy.
Making Lifestyle Changes
The best way to make sustatinable lifelong lifestyle changes is to make small incremental change, establish them as a habit, and progressively add more changes as these habits become part of your life.
What small change can you make today? How about
eating 1 extra piece of fruit per day
adding nuts to your snacks
having 1 meal per week that contains beans/legumes
increasing your steps each day
starting to do some simple body weight exercises such as squats and push-ups.
What lifestyle change are you going to make today?
__________
Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you with the 5 lifestyle pillars of perimenopause/menopause.
She practices Lifestyle Medicine and Integrative Medicine in New Zealand and Menopause health coaching internationally. She has a passion for supporting women adapt to their changing female physiology for optimum health and wellbeing.
Dr Deb Brunt | Ōtepoti Integrative Health | www.otepotiintegrativehealth.co.nz/book-now
FAQ
Where can I read more about the pillars of lifestyle medicine? Here.
Where can I read more about holistic menopause treatment? Here.
How can I book to work with Dr Deb Brunt? Here.
Where can I read more about hormone replacement therapy? Here.
What are some healthy food swaps?
1. Instead of refined carbs like white bread and pasta, opt for whole grain lower carb options such as sourdough bread, quinoa or lentil pasta instead.
2. Swap out processed meats like bacon and deli meats for lean proteins such as fish, chicken or legumes.
3. Instead of sugary snacks or baked goods, choose a piece of fruit, a boiled egg, some nuts, carrots and hummus or a non-sweetened yoghurt with fruit.
4. Drink plenty of water throughout the day and limit your intake of sugary beverages such as soda or juices. Try a herbal tea (warm or cold) instead if you are still wanting some flavor.
6. Choose healthy fats like olive oil, avocado and nuts instead of saturated or trans fats found in processed foods.
7. Limit your intake of processed snacks and opt for whole, natural foods like fruits, vegetables and legumes instead.
8. Choose whole grains like brown/black/red rice, quinoa or buckwheat instead of refined grains such as white rice and pasta.
12. Instead of deep-fried foods, opt for baked or steamed alternatives to help reduce your intake.
13. Choose plant-based proteins like tofu or tempeh instead of red meat a few times per week
References
The Institute for Functional Medicine Phytonutrient Spectrum: Comprehensive Guide 2015
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