The Ups and Downs of Perimenopause


Perimenopause is a confusing time as there is a lot of variation of when and what can happen. Often referred to as “second puberty,” it is used to describe the 2-12 year time period that precedes menopause (the absence of a menstrual cycle for 12 consecutive months).  It can range from as early as age 35 to as late as age 59.  Though cycles may remain regular, there are definitive hormonal changes that occur. 

A normal menstrual cycle is marked by ovulation (the release of an egg), followed by menstruation 2 weeks later. In the first half of the cycle, there is increased production of estrogen, with progesterone  predominating post-ovulation. Both hormones are needed for optimal health as their actions balance each other out. A normal cycle typically occurs every 21-35 days and can last between 2-7 days, with an overall fluid loss of approx. 15-80 mL (or 1-5 Tbsp).

Ovulation is necessary not only for successful pregnancy, it is also key as it leads to the production of the cycle’s second important hormone—progesterone.  During perimenopause, ovulation happens in more sporadically, so progesterone is on a steady decline. Simultaneously, estrogen levels fluctuate wildly, with dramatic highs and lows, which leads to very unpredictable levels and ratios of both estrogen and progesterone.

Though we think of estrogen and progesterone primarily as reproductive hormones, there are receptors on many different types of tissues – including your heart, lungs, brain, breasts, bones to name a few. Both estrogen and progesterone have many functions, which is why there are so many symptoms that accompany this time of hormonal flux.


Irregular periods. Irregular ovulation can alter the length of time between periods and amount of flow. You may also experience random spotting or skip cycles altogether.

Hot flashes/night sweats. Hot flashes and night sweats are perhaps the most common symptom, with varying intensity, length and frequency. Often, they are triggered by dietary and lifestyle factors such as stress, alcohol intake and tobacco use.

Vaginal dryness and thinning. Vaginal tissues are susceptible to becoming thinner, drier and less elastic due the decrease in estrogen. For some, this can make intercourse painful. Sometimes, there is also an increased susceptibility to vaginal infections, urinary tract infections, and urinary incontinence.

Skin changes. Changes such as brown spots, dryness, easy bruising, and increased wrinkling may occur. Collagen is a key component of skin, and it is estimated that 30 percent of skin collagen is lost during the first five years after menopause.

Fatigue/sleep disturbance. Sleep is often affected by hot flashes and/or night sweats. Since progesterone is calming to the nervous system and can act as a brain neurotransmitter, its decline can also contribute to sleep problems and lowered ability to deal with stress.

Decreased libido is often reported during perimenopause which may be attributed to decreased estrogen levels, changes in mood and/or stress resilience.

Depression, anxiety and/or mood swings. Estrogen increases serotonin and the number of serotonin receptors in the brain, which can influence the experience of depression/anxiety/mood swings. Lowered levels of progesterone typically result in increased feelings of anger and irritability.

Bone loss is caused by declining estrogen levels, and can increase your risk of osteoporosis and bone fractures.

Changing lipid profiles. Decreasing estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — decreases in many women as they age. Other symptoms associated with perimenopause can include: changes in memory and cognition, scalp hair loss, facial hair growth, acne, palpitations, nausea, and headaches.

Doesn’t sound like much fun, right? Don’t worry, there is hope. There are a number of supportive therapies and strategies available to help transition through this phase of life more comfortably. Here are a few suggestions to get you started:

Nutrition and diet. This is truly a time to renegotiate your relationship with sugar and starchy carbohydrates, especially processed foods for optimal body composition and blood lipids. Avoid excessive alcohol (no more than 4 servings/week), center meals around whole foods such as meats, vegetables (that grow above the ground) and healthy fats like olive oil and avocadoes, with the addition of whole grains/legumes/root vegetables as condiments to round out the meal.

Manage stress. Re-evaluate your commitments (and cut back where you can) and supplement magnesium, a very calming mineral that soothes your nervous system. Not only does it facilitate better sleep, improves insulin and thyroid function, as well as as activates vitamin D for better bone density¹, for many women, magnesium on its own helps to soothe hot flashes by 50%.

Exercise regularly. Exercise will help with stress management, reduce the intensity and severity of hot flashes, increase your endorphin production for improved mental health and depending on the kind of activity, improve bone density (we’re talking weights here) and body composition.

Despite the physiology, is it really possible to age the same, or even better, with the same energy and vitality of your younger years? Absolutely. The big difference is now you need to pay closer attention and more importantly, take care of yourself. Women are known for putting the needs of others ahead of themselves (hmmm….traits that are really needed to raise a family). Women spend 1/3 of their lives in menopause, which is why supporting our health through this phase is so essential. For many women, this time of life is very empowering, as the focus of life moves away from childbearing/childrearing and becomes more about finding one’s path/voice/calling. Getting older is a chance to live life on your own terms – embrace it!


  1. Uwitonze, A. M., & Razzaque, M. S. (2018). Role of magnesium in vitamin D activation and function. J Am Osteopath Assoc118(3), 181-189.

The Importance of Vitamin D

What is vitamin D? Originally credited with helping the body with calcium and bone metabolism, more recent studies show that vitamin D has many other influences on keeping the body healthy. It is thought of as a prohormone more than just a vitamin because it is only after D3 is metabolized in the liver and then into other forms in the kidneys that the active forms are produced. To date, some thirty-seven forms of Vitamin D3 have been isolated and chemically characterized. Continue reading

Thyroid 101: The Ins & Outs of Thyroid Function

Recent studies suggest that 1 in 10 Canadians suffer from some kind of thyroid disease, of which 50% are undiagnosed! One in eight women will develop a thyroid disorder in her lifetime, with the number of affected people continuing to rise each year. Until this gland goes awry, very little attention is given to its small, butterfly shaped presence at the base of the neck – yet the hormones it secretes are essential to all growth and metabolism. Continue reading

The Many Benefits of Far Infrared Sauna Therapy

What is sauna therapy?
Sauna therapy has been a part of healing practices for centuries as part of many different traditions – the Greeks and Romans historically used bathhouses to both cleanse and detoxify, and many indigenous peoples use sweat lodges as a means of both spiritual and physical purification. Continue reading

Kick Start the School Year with Probiotics

I remember being excited as a kid, every September meant new clothes, school supplies, teachers and classes…a fresh start to a new year. The more I learn about health and wellness, the more I realize that one of the most important factors to success in school starts with the our humble microbe populations that live in our digestive tracts.

It is said we are 10% human, and 90% microbe…a healthy gut houses over 100 trillion friendly bacteria, which is a ratio of 10:1 to the number of cells in your body. Why are these critters so important? The reality is that without these friendly bugs, your digestion, brain health and immune function would simply not function. At any given time, you have around 160 bacterial species (types) in your gut out of over 1000 species of bacteria. The digestive tract is one of the most complex eco systems to understand and study. The individualized bacteria composition found in each body play a vital role in keeping us healthy. Having the right strains, in the right amount and in the right part of the digestive tract are critical to our overall sense of well-being, and should therefore, be a part of our daily health practice. Continue reading

5 Important Reasons You Need Magnesium


As many of you already know, when it comes to supplementation, I adhere to the philosophy that less is more. However, one mineral that is often overlooked and usually deficient in most people is magnesium…used in over 300 reactions in the body, you can see why it is so important. Here is how it is used by the body, in a nutshell… Continue reading

What you should know about the pill…

About 100 million women worldwide currently take birth control pills, and hundreds of millions of women have used them since they were first introduced in 1960. In the United States alone, 16 million American women are using birth control pills, fueling a $2.8 billion industry. A whopping eighty percent of U.S. women have used oral contraceptives at some point in their lives, and often, women are on them for years at a stretch, stopping only to conceive and have children. Continue reading

The Benefits of Salivary Hormone Testing

Healthy Weight Loss, Hormone Health, Stress, Thyroid Health

Good health has a lot to do with maintaining balance: the right balance of work and play, the right balance of nutrients in the diet, and the right balance of hormones. What people don’t often realize is how complex the effects of hormones are in the body. Hormone imbalance may be a result of illness, or may produce symptoms and biochemical changes that eventally lead to illness. Getting your hormone levels checked regularly can be instrumental in determining these issues before it leads to the development of disease. Continue reading