The Chinese euphemistically refer to menopause as the “second spring.”  However, before reaching this stage, one must first endure a long, tumultuous summer full of thunderstorms and high humidity. Welcome to the turbulent world of perimenopause!

The Shrinking Secret: How Menopause Changes The Female Reproductive System

Do you know what the words “Menopausal involution” mean? No, this is not the title of a new film.  Menopausal involution sounds like a fancy way of saying that your lady parts are shrinking. Yep, you heard that right. As your oestrogen levels drop, your vagina, uterus, cervix, tubes, and vulva get smaller and drier. I admit, I was stunned when I learned that. This phenomenon can affect your sexual health, urinary health, and quality of life or in other words, sex less enjoyable, peeing more annoying, and life less fun. This condition is also called vaginal atrophy or GSM (which is short for genitourinary syndrome of menopause, as it is way too long to remember).  And this is just the tip of the iceberg when it comes to the many symptoms of perimenopause and menopause.

But don’t worry, you’re not the only one going through this. Half of the women who have reached menopause have GSM. Although this problem affects more postmenopausal women, it can also be present in women in their early forties. Yet  many of them are too scared to get help because they feel embarrassed or they don’t know about it. That’s a shame, because there are ways to make things better, such as using creams, gels, oestrogen pills, or other treatments.  You should see your doctor if you have any signs or worries about your vaginal health and happiness.

What Perimenopause and Menopause Mean for us Women

Sixteen years ago, I went through a phase where I felt like I was losing my mind. My emotions were all over the place, from depression to irritability. My energy levels were low, and I wasn't sleeping well. I was putting on weight without any explanation, or so I thought. The woman I saw in the mirror was unrecognizable to me.

Even when my menstrual cycle started to become irregular, I didn't think much of it, even though it is an early sign of perimenopause. It wasn't until I had my first hot flush that it all clicked into place.

I had a hard time accepting that this was happening to me. It didn't seem possible that I was already “that old” and experiencing perimenopause.

Naively, I believed that one day my periods would end and menopause would set in permanently. Unfortunately I soon realised that before we get there, we must first endure perimenopause and that we don't just wake up in menopause overnight. That would be too good to be true!

Perimenopause: The Long and Winding Road to Menopause

Contrary to popular belief, menopause is not an overnight occurrence. The process is much more complex than that. Initially, women must go through perimenopause, a phase where periods become irregular before ultimately stopping altogether. This is when well-known symptoms such as mood swings, hot flushes, and insomnia begin to appear. However, many women seek medical advice for various symptoms without realizing that the root cause could be hormonal fluctuations associated with this phase of life. Symptoms such as migraines, chronic fatigue, joint pain, depression, anxiety, attention problems, and memory loss are common, to the point where some may even question whether they have early-onset Alzheimer's.

Please be reassured.  For those of you who find themselves somewhere, wondering what they are doing there... No, you are not senile. Your sex hormones are just playing yo-yo. A bit like a second adolescence, and I know something about it, having experienced my perimenopause at the same time as some of my children were going through their teenage crisis... It had a huge impact on my mood. I transformed from a caring mother to Hulk! The only time the kids got actually scared of me!

Hot Flushes and Cold Truths

Perimenopause, or pre-menopause, is the time before menopause when your body starts to change (peri means "around" in Greek). You might not be familiar with this term, because people often mix up perimenopause (the transition time) with menopause (the time after your last period). This is when you notice the first effects of changing hormones, mainly lower levels of oestrogen and progesterone. These hormones keep dropping until they reach their lowest point, which is when menopause starts.

Perimenopause can be very short or last up to 8 years. On average, it lasts about 4–5 years, but sometimes, women have messed up periods up to 10 years before menopause kicks in.

Perimenopause is not talked about much, but it can cause a lot of symptoms like hot flushes and sweating, sore breasts, worsened PMS symptoms, lower sex drive, feeling tired and sleeping badly, forgetting things, dry and itchy vagina, pain during sex, leaking pee, mood swings, anxiety, headaches, and more.

Perimenopause can also make you gain weight. This can happen for different reasons, such as burning less calories, having more fat and less muscle as you get older. Furthermore, PMS can get worse and make you eat more.

The intensity of perimenopausal symptoms can differ from woman to woman of course. While some experience few or no symptoms (the lucky ones!), 20% to 30% face moderate or severe symptoms. Speaking from experience, it's not easy to be in that category.

For some women, going through perimenopause, balancing work, childcare and caring for aging parents, can be a daunting task. With so many responsibilities, adapting to this new phase of life can be challenging, especially when there is a lack of information and understanding out there.

Perimenopause: The Taboo Topic That Affects Millions of Women

Yet we need to talk about aging and perimenopause openly, because unfortunately, in our society, aging is often stigmatized, and the pressure to remain young, beautiful and desirable is overwhelming. It is no surprise that perimenopause can come as a shock, and denial is a common response.

As a result, women rarely discuss their issues with each other, except perhaps in online forums. Even medical professionals are often tight-lipped about the topic. Personally, at the time I experienced my first symptoms, I visited my family doctor and a gynaecologist, but neither identified that my symptoms were related to perimenopause. Instead, I was prescribed microdose anovulants (contraceptive) to alleviate PMS symptoms, which were taking a toll on my life.... and that of those around me, it seemed.

Additionally, I started putting on weight.  When you've always been thin, gaining over 35 plus pounds in a couple of year is a difficult reality to accept, on top of everything else. I went from a size 10/Small, to a size, uh, Extra Curvy 14. Fortunately my husband still found me hot (and no, it had nothing to do with the hot flushes!). However, many women face this same challenge and struggle to accept their changing bodies. So, be aware, you may need to invest in a new wardrobe!

Thank goodness, I discovered nutrition and fasting around about the same time as I was going through perimenopause so it only took me a couple of years (whilst I was studying), to start making changes to my eating and lifestyle habits, and another year or so to start seeing positive results. 

What I Wish I Knew About Perimenopause

Seriously, I wish someone had told me then what was going on with me, and how lifestyle and nutrition can make such a difference in balancing hormones and managing moods, weight and well-being. It’s not easy to figure all this out by yourself.

It is important to recognize that oestrogens are not merely sex hormones, but they have multiple roles in the female physiology.

They are essential for the maturation and function of the central nervous system, they support bone health and renewal, and they modulate the activity of the brain, the gastrointestinal system, the skin, and other organs. Therefore, it is understandable that their decline during perimenopause can cause a range of symptoms that affect our quality of life.

Many women have a lot of questions about their symptoms and want an open discussion about their options when it comes to hormone therapy. Should I take hormones? Are they safe? Are bioidentical hormones* better? When should I start them? How long should I take them for? It takes a lot of time to explain all this, and doctors usually don’t have time – with some exceptions of course - unless you go private and pay big bucks to get some attention and understanding.

Hormone Therapy: A Complex and Controversial Choice for Perimenopausal Women

The decision to use hormone therapy is not straightforward, and it depends on various factors, such as the severity of symptoms, personal and family history, and individual preferences.

Despite the benefits, hormone replacement therapy is still controversial and can still cause anxiety for many women. If you ask around, you'll find that a lot of women are apprehensive about the treatment. This is because of the  infamous Women's Health Initiative study. The WHI study was a US-funded long-term health study of over 160,000 postmenopausal women. It tested the effects of hormone therapy, diet, and supplements on various health outcomes and was published in 2002.  Unfortunately, the WHI study showed that using oestrogen plus progestin hormone therapy after menopause raised the risk of heart disease, stroke, blood clots, breast cancer, and dementia. The health risks of long-term use of combination hormone therapy persisted even a few years after stopping the drugs and clearly outweighed the benefits.

Although several studies have refuted these findings, many doctors are still hesitant to prescribe hormones to their patients.

The Society of Obstetricians and Gynecologists of Canada (SOGC) and the North American Menopause Society (NAMS) recommend hormone therapy as the first-line treatment for vasomotor symptoms, such as hot flushes and night sweats, for both menopausal and perimenopausal women. They also state that hormone therapy can improve other symptoms, such as mood changes, sleep disturbances, and vaginal dryness. However, they also acknowledge that hormone therapy is not without risks, and that the benefits and harms should be weighed individually for each woman, taking into account her personal and family history, preferences, and values.  Therefore, it is not accurate to say that hormone therapy is a safe and effective treatment for all women, but rather that it is a possible option that should be discussed with a health care provider.

No wonder some women are still hesitant to try hormonal therapy and it is definitely not a cure-all or a fountain of youth.

Perimenopause and Menopause: A New Beginning, Not an End

There is no doubt that as we age, we face a range of losses, including fertility, youthful energy, and more. Perimenopause prepares us for menopause, despite the night sweats and discomfort along the way. Women may feel invisible as they enter the category of menopausal women, which can be unsettling. However, there are ways to navigate this transition with confidence.

Writing this article might seem like a bold move or a revelation to some of you.  I did it because it is important, in my view, that women enlighten others about what perimenopause really involves. It is time that we stop thinking that this period of life marks the beginning of the end.  We need to stop thinking that this time of life indicates our downfall and that we are unworthy of public attention.

People often tell me that I look younger than I am. People don't believe me when I say I'm 62. But what do you think we should look like at 62? What do you think a menopausal woman should look like?

By 2030, there will be over a billion women in the world who are older than 50, and while we used to live as long as the typical age of menopause, now we can expect to live for another 30 or 40 years after it, so we definitely need to rethink how we view menopause.

A New Passion at 51: How I Learned to Love Myself and Live Better

After dedicating myself to work, studies, and family for many years, I reached a turning point at 51 years of age. I discovered a new passion – myself - thanks to yoga, meditation, hiking, and the benefits of nourishing the body with whole foods. Fasting and intermittent fasting have also been life-changing for me during perimenopause. It was eye-opening to discover all those things that I was previously unaware of, and that could make such a difference in my life and the life of others. Before, I was ignorant of their impact, and now I'm eager to share what I've learned.

Intermittent Fasting (IF) during Perimenopause

IF can be good for women during perimenopause, but you  need to be careful and know what you're doing.

Pros of IF for perimenopause:

• Helps you lose weight and body fat by eating less and boosting your metabolism.

• Helps your hormones by improving your insulin levels and blood sugar control, which can affect your hunger and energy levels.

• Helps with menopausal symptoms, like hot flushes, by lowering inflammation and stress in your body.

• Helps your brain, mood, and memory by making your brain work better and grow new cells.

Drawbacks of IF for perimenopause, especially if you're over 40:

• It can mess up your sex hormones, such as oestrogen and progesterone, which can make perimenopausal symptoms worse and increase the risk of bone loss and heart problems.

• It can make you binge eat, crave, and emotionally eat, which can lead to weight gain and unhealthy eating habits.

• It can disturb your sleep quality and body clock, which can in turn affect your mood, metabolism, and immunity.

• It may not be safe or effective if you have some health issues, such as diabetes, thyroid problems, or eating disorders.

 Some tips on How to do IF right during perimenopause:

• Pick a fasting method that you will enjoy because it suits your lifestyle and goals.

• Learn to time your fasting windows and intensity around your cycles.

• Know which healthy foods to eat when to support your health and hormones.

• Drink lots of water, herbal teas, during your fasting hours to stay hydrated.

• Eat with awareness and to satiety during your eating window but don't overeat or under-eat.

• Take it easy with exercise around your cycle and don’t do hard workouts a week or so before your period.

Remember, IF is not a magic solution for weight loss or health, and it may not work for everyone. The best way to achieve your goals is to follow a balanced, varied, and enjoyable diet that meets your nutritional needs. Before starting on any IF routine, it is best to talk to your doctor to see if it would be right for you depending on your health and symptoms and find out for yourself how to do it safely and effectively.

From Fear to Freedom: How to Take Charge of Your Well-being and Thrive during Perimenopause

There is a prevailing belief out there that perimenopause means you are officially old. Society will tell us that this is the end of our femininity, sexuality, beauty, and vitality, but none of this is true. 

The only thing menopause ends is your ability to make a baby — that’s it!

If you are in your perimenopausal journey, you can take control of your well-being.  If you are feeling lost or don’t know where to start, consider joining me on my “The Fast Way to Embracing Perimenopause” online program, where I’m going to help you to reframe what menopause really means for you.

Knowledge is power. The more you understand about this life change, the more in control you will feel. Understanding hormones is complex, and that’s where we’re going to start.

I want you to know that you can thrive through perimenopause and menopause. It’s absolutely possible and I can show you how in my 12 week long course!  Take control of your health and navigate this awesome phase of your life with confidence!

* Bioidentical hormones are hormones that are just like the ones your body makes naturally. They are used to help with perimenopause symptoms, like hot flushes, night sweats, mood swings, and dry vagina, by replacing the hormones that drop during perimenopause.

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