What’s Really Happening in Perimenopause? Naturopath Kath McFarlane Answers Your Questions
Question : How do I know if I’m starting menopause? I’ve been noticing some weird changes.
Kath : Perimenopause can sneak up on us with a slow onset of often subtle and random symptoms that don’t immediately scream “hormones !” For some of us, it might be dry, itchy skin that feels like insects are crawling on you at random times. For others, it’s feelings of overwhelm or irritability that seem to come out of nowhere. Weight gain around the belly when diet and exercise is the same as it’s always been is another common symptom.
Some of the less obvious signs can include:
- Swollen or sore gums
- An increased tendency to injure yourself – eg sprains or fractures
- Allergic reactions that feel more intense (such as bigger reactions to insect bites or skin irritations like eczema or hives)
- Changes in taste or food preferences
- Burning or dry eyes
- Changes in body odour
The more obvious signs often appear as changes in your menstrual cycle, such as missing a period or having them more often or having much lighter or heavier bleed. This is typically due to fluctuating hormones, but for many women, it’s the slow, creeping symptoms that are generally the hardest to spot and come first.
For some, however, menopause can hit with intensity—think sudden hot flashes or mood swings that feel like a steam train has hit you. In fact, it’s been reported that there can be up to 100 different symptoms associated with perimenopause, and it can feel like you’re becoming a completely different person until you get a handle on it.
It can feel isolating, exhausting and frightening. And it’s exactly in these times I recommend seeking professional support because the good news is, help is available and there are numerous ways a Naturopath can support you during this time.
Question : Can we test for menopause ?
Kath : Yes we can. Hormonal testing is a good way to get insight into what’s happening. The standard tests look at estrogen, progesterone, LH, and FSH. These hormones fluctuate throughout perimenopause, so it’s often helpful to take multiple tests over time to get a clearer picture. Other tests to consider include AMH (which indicates ovarian reserve) and cortisol, which can be a big player in many perimenopausal symptoms.
As hormonal changes unfold, they often trigger other metabolic changes in your body. That’s why additional tests like bone density, cardiovascular and metabolic assessments (cholesterol, blood glucose, insulin), liver function tests, and checking levels of vitamin D and calcium are also useful for staying ahead of the curve.
Question : What about naturopathic tests for perimenopause?
Kath : Great question. Standard medical tests can help identify hormonal changes, but as naturopaths, we often dive a bit deeper. For example, we might use a microbiome map to assess gut function, especially if you’re struggling with unexplained bloating or weight gain.
Another useful test is the DUTCH hormone test, which helps us identify estrogen into its metabolites. This is particularly helpful for women with a family history of estrogen dependent cancers or those who have estrogen dominance.
We can also consider neurotransmitter profiles that look at brain chemistry. We know that perimenopause can impact brain chemistry, which in turn affects mood, cognition and focus, and mental health in general. With estrogen receptors in the brain, fluctuating estrogen levels can cause noticeable mental health changes. Personalized testing can provide valuable insights to guide treatment.
Question : You mentioned menopause that can affect my bones and heart. Sounds like perimenopause is a time to review my whole health ?
Kath : Absolutely. Perimenopause is an excellent opportunity to take a holistic look at your health. Many conditions are “silent” and develop over years, so perimenopause is an ideal time to get ahead of things by reviewing key health areas. Whether it’s your bone health, cardiovascular function, or gut health, it’s all connected. Using this time to be proactive means you’re setting yourself up for a healthy future and tackling any issues before they become problems.
Question : Many women say they’re still eating the same and exercising but are gaining weight around their belly. Why does this happen ?
Kath : Weight gain during perimenopause is unfortunately common and often linked to metabolic changes. One of the main reasons is that as estrogen drops, the way your body stores fat changes. More fat tends to accumulate around the belly rather than the hips and thighs. It’s also common to experience a kind of insulin resistance where you may find yourself craving carbs more than usual and feeling unsatisfied after meals. In addition to this lower progesterone can feel like PMS, causing bloating and water retention contributing to that feeling of the meno belly.
Question : What role does cortisol play in perimenopause ?
Kath : Cortisol is stress hormone produced in the adrenal gland and it can be a huge factor during perimenopause. As estrogen levels fluctuate, many women experience feelings of stress and anxiety, which can trigger an increase in cortisol. When cortisol is high, the body goes into “fight or flight” mode and stores fat as a protective measure to accumulate energy reserves. This leads to weight gain, especially around the belly, and can also exacerbate hot flashes and night sweats.
That’s why a big part of naturopathic treatment for perimenopause focuses on adrenal support. Herbal medicines like Rehmannia, Siberian ginseng, and Withania help support adrenal function and keep cortisol in check. Nervine herbal medicines such as Lemon balm and Passionflower can also help.
Question : What’s the best way to handle hot flashes without medication?
Kath : Hot flashes are one of the most common and frustrating symptoms of perimenopause. Thankfully there are natural ways to manage them. One key to reducing hot flashes is getting cortisol under control. The body’s thermostat is located in the hypothalamus, a part of the brain that directly communicates with the pituitary and adrenal glands (this is called the HPA axis). So, when cortisol levels are high, it can impact your thermostat and trigger hot flashes and night sweats.
Naturopathic treatments for hot flashes therefore focuses on supporting the HPA axis, using herbs that calm the nervous system and support adrenal gland. We also focus on regulating blood sugar, as fluctuations in blood sugar levels can worsen hot flashes. So, eating balanced meals and avoiding going to bed hungry are key. Certain foods like spicy foods, alcohol, caffeine, and sugar can worsen hot flashes. Dietary recommendations will also form part of a Naturopath treatment plan.
Question : Can herbs increase estrogen naturally?
Kath : Yes, there are certain herbal medicines that can support estrogen and progesterone naturally. These include herbs such as black cohosh, red clover, shatavari and chaste tree, which have been traditionally used to help alleviate menopausal symptoms. However, it’s important to remember that every woman is different, and what works for one person may not be right for another. Some women have health conditions or family histories that require a more personalized approach. It’s always best to consult with a professional before starting any new herbal regimen.
If you’re navigating perimenopause and dealing with symptoms like hot flashes, weight gain, or mood changes, please reach out to me. With the right support, it can be a lot more manageable – look forward to hearing from you.
For information on some of the functional tests mentioned see –
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