Thankfully, we seem to be in an age where it’s no longer taboo to talk about periods and perimenopause. This is important, because with aging populations around the world, 50% of them having a uterus – generally speaking, these are important topics. Perimenopause marks a significant transition in a person’s life. It’s hard to say when perimenopause starts, because it’s a big range, but it could start as early as your mid 30s and take you into the mid-50s. However, it typically begins in the 40s. This isn’t just about your body changing, though. It’s about preparing and understanding these changes so you can continue to thrive. Despite its inevitability, many find themselves unprepared. If you aren’t already in the know, here’s what you need to know about perimenopause in your 40s.
Understanding perimenopause
Perimenopause is the transition phase leading up to menopause. To be clear, menopause is the point when a woman no longer has menstrual periods for a period of 12 consecutive months. During perimenopause, your body begins to produce less estrogen, although these changes can be erratic, leading to fluctuating hormone levels. This is why many cultures and groups refer to this as “the change.” This phase often starts in your 40s but can begin as early as the late 30s for some women [1]. Early stage is considered between 40-44 and late stage is late 40s to early 50s [2]. Common signs may include irregular periods, changes in menstrual flow, and hot flashes, but that is not all-inclusive[2].
How do I know if I’m perimenopausal
Recognizing perimenopause is often tricky because each woman’s experience varies widely. However, there are several signs that may indicate the onset of perimenopause [3]:
Irregular periods
One of the first signs is a change in your menstrual cycle. Periods may become longer, shorter, heavier, or lighter, and the time between each period may vary.[3]
Hot flashes
Also known as hot flushes, or power surges if you’re cute. It’s as if you stepped outside of a cold Texas movie theater at 2PM in August, to get into your baking hot car. In other words, flashes of intense heat come over you suddenly. Sometimes they are subtle and you get a little warm, and sometimes they are accompanied by a flop sweat. It’s as if the room suddenly got about 20 degrees hotter.
Sleep issues
This is often related to hot flashes and night sweats, but irregular hormone fluctuations can make sleep difficult. There is something called menopausal insomnia that is even treated differently than standard insomnia, in herbal medicine traditions.
Mood changes
Menopausal depression is not uncommon. Neither is increased irritability or weepiness. Similar to ovulation, you may experience shifts in mood and behavior, due to hormonal variability. Keep in mind, if you aren’t sleeping, that’s enough to make anyone cranky, so menopause isn’t necessarily the only cause of irritability [4]. After all, everything is connected and we are complex creatures.
Vaginal Dryness
During perimenopause, your estrogen levels decrease, which leads to reduced lubrication and the thinning of the vaginal tissue. This can all lead to discomfort during intercourse, so having a tender partner that takes their time to get you warmed up is the best. Don’t be afraid to use all the non-silicone based lube to make sex more fun and enjoyable for both of you. Also, lube is amazing, regardless of life stage. If you are particularly uncomfortable, vaginal estrogen creams are highly effective and may warrant a conversation with your doctor [4].
Urinary Changes
It’s not just in your head that you know the location of every toilet in a 10 mile radius. During perimenopause and menopause, as your estrogen declines, so does your bladder strength. This is because estrogen plays a supporting role in bladder strength, so the decline of one leads to the decline of the other [5]. This may result in more frequent urination during the day, and nocturia, which is needing to pee throughout the night.
Hormone fluctuations
There are tests measuring hormone levels, particularly fluctuations in estrogen, estradiol, and follicle-stimulating hormone (FSH), to confirm if you’re indeed perimenopausal. This is critical if you are outside the age range for what is considered “perimenopausal,” but have symptoms. Talk to your doctor if it makes sense to do a complete hormone panel. Keep in mind, lab testing can be expensive, so chat with your doctor about what works best for you.
Common symptoms and management strategies
So what else do you need to know about perimenopause, in your 40s? As mentioned before, there are several symptom patterns mentioned above. They vary quite a bit in frequency and strength among women, but they are pretty consistent. There are ways to manage the symptoms and your overall wellbeing, though.
Sleep routine
Establishing a regular sleep routine to combat insomnia. Keep the room as cool as you can, to reduce the impact of hot flashes. Sleep with layers so you have options for covers in the night.
Healthy diet
Maintain a healthy diet rich in Omega 3 fatty acids, as that contributes to healthy hormone production and balance. Studies also show that diets high in Omega 3s have inverse relationships to depression, helping beat the menopausal blues [6]. You can find these in deep. cold water fish, like mackerel and salmon. The body doesn’t make these, so you have to get them in your diet or supplement. You can also find them in smaller amounts in nuts and seeds like walnuts and flax seeds. If you’re looking for supplements, I’m a big fan of Metagenics OmegaGenics EPA-DHA 720, and you always get a 20%, or more, discount on my Fullscript site. As always, reducing processed foods and eating a diet rich in vitamins and minerals is always best.
Hormone Replacement Therapy (HRT)
Talk to your gyno about HRT to see if it may be right for you. Depending on your age, you may be a great candidate, but this is a very personal decision, so get the facts. I love Dr. Jen Gunter’s take on HRT and if it’s right for you.
Herbs
Herbs are also great allies during perimenopausal transition. From Tree Peony Bark (Mu Dan Pi) for hot flashes [8], to Shatavari [7] for vaginal dryness, nature is loaded with natural allies. Every person is different, so if you want to learn more about navigating your perimenopause journey with herbs, let’s talk.
Health and nutrition during perimenopause
It’s no secret that nutrition plays a crucial role in managing perimenopause symptoms. It’s important to focus on foods that can help stabilize your hormones, along with preserving bone health. For example, soy products, which are high in phytoestrogens, can provide some natural hormone regulation. Calcium and vitamin D are critical for maintaining bone strength as estrogen levels drop, with leafy greens and dairy as excellent sources. It’s important to have healthy levels of both, because you need vitamin D to absorb calcium [9]. Toss in a little vitamin K while you’re at it, because vitamin D and K work synergistically to process calcium for bone and cardiovascular health [10]. Diets low in simple carbs and processed foods also help support sleep, energy, and overall general health.
Professional life and perimenopause
Navigating perimenopause while maintaining a career can be challenging. I will never forget the time I had a hot flash while talking to a client at a work event. He was cute, but he wasn’t “where is my fainting couch,” swoon worthy. Here are some things to know in your 40’s, to navigate perimenopause more comfortably:
- Keep a fan at your desk in case of hot flashes.
- Eat as many fruits and vegetables as you can stand, to help regulate hormonal dips.
- Stay hydrated and eat cooling foods.
- Pair protein with carbs to avoid blood sugar dips and hormone spikes. including insulin.
- Use apps to track your symptoms and identify patterns and triggers.
- Have an open dialogue with HR about your needs. Go into the conversation with specific accommodations you need to effectively support for your situation.
- No taboo in the tube. Use lube often and liberally to make sex enjoyable and fun for all partners involved. No shame here!
- Avoid endocrine disruptors.
Cultural significance of perimenopause
It’s easy to believe that perimenopause means the end of life as you know it, in Western society. The truth is that in many Western societies, including the US, women seem invisible after 40. We see it in the movies, in magazines, and all over social media. We are scared to even acknowledge when a woman is *gasp* perimenopausal or menopausal. The absolute travesty!
Even still, perimenopause, and menopause, carry profound cultural significance around the world and it isn’t an ending. Before we were ruined by patriarchy and capitalism, the crone stage was celebrated. Many societies still celebrate this phase as one of empowerment and increased social stature. For instance, in Japan, this period is often associated with “kanreki,” a traditional celebration that marks the transition to a revered elder status.[11] In some Native American cultures, women who no longer menstruate are called “wise women” and are highly valued for their wisdom and experience. They retain their “wise blood,” following reproductive years [12]. We have an opportunity to redefine our journey through this phase of life and it doesn’t have to be what society deems “appropriate.”
Things to take with you
So what else do you need to know about perimenopause in your 40s? I love providing actionable information that is useful now. In this world of AI where our bots are greeting each other on social media instead of connecting, it’s easy to just throw some facts and data against a wall and run. However, that helps nobody and honestly, it kinda sucks. So, with that in mind, here are a few questions that might help during your next OB/GYN visit:
- What symptoms should I expect?
- What tests can we run to confirm if I am perimenopausal?
- What lifestyle changes can help manage symptoms?
- Should I consider hormone replacement therapy?
- How can perimenopause affect my sexual health?
- What can I do to protect my bone health during perimenopause?
- Are there any supplements you recommend?
- How will perimenopause affect my mental health?
- When should I be concerned about irregular menstrual cycles?
- What follow-up appointments will I need?
Perimenopause is a natural part of aging, but there are things to make it smoother and more comfortable. By understanding what to expect and how to manage the changes, you can take proactive steps towards maintaining your health and wellbeing. If you’re looking for more personalized strategies or just need someone to talk to, sign up for a breakthrough session, with me! I have been there and I can help you navigate the ups and downs. For more wellbeing content, don’t forget to subscribe to Wellspiration, where you can find the latest insights on all things health and wellness and a bit more about me.
Medical Disclaimer:
These statements have not been evaluated by the Food and Drug Administration (FDA). Information provided in this blog post is for educational and informational purposes only and should not be considered as medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, treatment, cure or prevention of any disease. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.
References
- Cleveland Clinic. “Perimenopause.” https://my.clevelandclinic.org/health/diseases/21608-perimenopause
- Mount Sinai. “Menopause.” https://www.mountsinai.org/health-library/report/menopause
- Mayo Clinic. “Perimenopause.” https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
- North American Menopause Society. “Menopause 101: A Primer for the perimenopausal.” https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal
- National Association for Incontinence. “Bladder Health During Perimenopause and menopause.” https://nafc.org/bladder-health-during-perimenopause-menopause/
- Chae, M., & Park, K. (2021). Association between dietary omega-3 fatty acid intake and depression in postmenopausal women. Nutrition research and practice, 15(4), 468–478. https://doi.org/10.4162/nrp.2021.15.4.468
- E. Steels, M. Steele, M. Harold, L. Adams, S. Coulson, “A double-blind, randomized, placebo-controlled trial evaluating safety and efficacy of an ayurvedic botanical formulation in reducing menopausal symptoms in otherwise healthy women.” Journal of Herbal Medicine, Volume 11, 2018, Pages 30-35, ISSN 2210-8033, https://doi.org/10.1016/j.hermed.2018.01.001.
- Li, M., Hung, A., Lenon, G. B., & Yang, A. W. H. (2019). Chinese herbal formulae for the treatment of menopausal hot flushes: A systematic review and meta-analysis. PloS one, 14(9), e0222383. https://doi.org/10.1371/journal.pone.0222383
- National Institute of Arthritis and Muskuloskeletal and Skin Diseases. “Calcium and Vitamin D: Important for Bone Health” https://www.niams.nih.gov/health-topics/calcium-and-vitamin-d-important-bone-health
- van Ballegooijen, A. J., Pilz, S., Tomaschitz, A., Grübler, M. R., & Verheyen, N. (2017). The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review. International journal of endocrinology, 2017, 7454376. https://doi.org/10.1155/2017/7454376
- Daniel Morales. Japan Times. “Life begins at 60 (or at least it starts anew).” https://www.japantimes.co.jp/life/2020/01/14/language/60-kanreki-zodiac/
- Women’s Health Network. “Menopause in different cultures.” https://www.womenshealthnetwork.com/menopause-and-perimenopause/menopause-in-different-cultures/