Lindsay Christensen



Life as a woman can be simultaneously extraordinary and tumultuous thanks to a unique aspect of our physiology – our ever-changing hormones! Our hormones, particularly estrogen and progesterone, yield wonderful benefits, such as enabling us to carry a baby, keeping our minds sharp, and our bones and muscles strong. However, numerous women are plagued by hormone issues during their premenopausal years and during the turbulent times of perimenopause and menopause.

Even though menopause is an inevitable stage of life that all women face as they age, there are few solutions offered to ease the numerous symptoms and discomforts that go along with it.

Fortunately, there is a growing, genuine interest in helping women flourish hormonally through the menopause transition. Nutrition and lifestyle strategies can help women proactively support their hormones across their lifespan and maximize their health and vitality.

In this blog, we’ll discuss the hormonal changes women experience in perimenopause and menopause and offer seven proactive steps you can take to flourish throughout this inevitable life transition.

Navigating Hormonal Shifts in Perimenopause and Menopause

We often hear the terms “perimenopause” and “menopause” thrown around by the media and medical professionals, yet many of us lack a firm understanding of what these terms mean.

Perimenopause refers to an extended transitional state towards the end of a woman’s “reproductive life cycle” in which her ovaries gradually stop working. In very early perimenopause, a woman’s menstrual cycle may still be regular, but ovarian function is slowly declining. Over time, perimenopause is characterized by irregular menstrual cycles, such as having a cycle shorter than 28 days or longer than 35 days. During perimenopause, progesterone begins its steep decline and estrogen fluctuates dramatically.

Menopause is the life stage that begins one year after your last period; in other words, it starts when a woman between 45-55 years of age hasn’t had a period in 12 consecutive months. Note that women below the age of 40 can go without a period for 12 or more months for various reasons, but this is not considered menopause.

In menopause, estrogen stops fluctuating and takes a final downward turn. Progesterone levels continue to decline. In total, the entire menopause transition, encompassing perimenopause and menopause, can last 10 years or more. The menopause transition encompasses a significant portion of a woman’s life!

Why do estrogen and progesterone decline in perimenopause and menopause? Estrogen and progesterone decline during this life stage as ovarian follicles, the tiny sacs in the ovaries that have the potential to release an egg for fertilization, decrease in number. By the time menopause occurs, ovarian follicles are virtually absent. ( Source )

During a woman’s “reproductive years,” ovarian follicles form a structure called the corpus luteum after ovulation; the corpus luteum releases progesterone. Therefore, as the number of ovarian follicles declines and the corpus luteum is no longer produced during the menopause transition, progesterone levels decrease. In addition, estrogen release from the ovarian follicles also declines as follicle-stimulating hormone (FSH) signaling from the brain to the ovaries wanes and ovarian follicle numbers dwindle.

As if the changes in estrogen and progesterone weren’t enough, testosterone levels also decline during the menopause transition. Altogether, these hormonal shifts can do a number on a woman’s quality of life, especially if she doesn’t take proactive steps to manage her health.

Perimenopause and Menopause Symptoms

Symptoms of perimenopause and menopause run the gamut! The types of symptoms a woman experiences can vary depending on whether she’s in perimenopause or menopause, and whether estrogen is still fluctuating or on the decline.

During perimenopause, when estrogen and testosterone levels are variable, women may experience the following symptoms:

  • Irregular menstrual cycles
  • Hot flashes and/or night sweats
  • Low mood
  • Difficulty focusing
  • Hair loss
  • Loss of skin elasticity due to a significant loss of collagen
  • Loss of bone density

( Source , Source , Source )

Estrogen levels can also swing too high at times during perimenopause due to inconsistent stimulation from follicle-stimulating hormone (FSH) in the brain. Elevated estrogen, or estrogen that isn’t properly balanced by progesterone can cause symptoms such as:

  • Irregular cycles (both low and high estrogen impact the menstrual cycle)
  • Breast tenderness
  • Irritability
  • Sleep difficulties

Symptoms of low testosterone during the menopause transition can include:

  • Lower muscle mass
  • A lower subjective sense of wellbeing
  • Fatigue
  • Decreased motivation
  • Reduced libido

( Source )

5 Strategies for Flourishing During “The Change”

As a woman, balancing your hormones is truly a lifelong process. While the following are steps that women should be thinking about BEFORE entering perimenopause, but if you’re already experiencing these transitions, there’s no time like the present to begin taking these steps!

Step 1: Balance Blood Sugar

Balancing your blood sugar is essential during “the change.” Balancing your blood sugar refers to eating and living in a way that keeps your blood sugar, an essential energy source, in the right range for fueling your body without lots of highs and lows. /p>

Blood sugar imbalances and insulin resistance, a reduced ability of the hormone insulin to usher glucose into cells, are linked to worsening menopausal symptoms. Insulin resistance can become particularly pronounced in menopause. As a result, many women’s bodies become less capable of efficiently handling dietary carbohydrates during menopause; if they don’t adjust their carbohydrate intake accordingly, an excess of carbs can promote weight gain.

Here are several ways to help balance your blood sugar:

Optimize protein intake

Protein intake may be especially important for women going through menopause. Research shows that women experience a net loss of protein in their bodies, primarily from muscle, during the menopause transition. Women who don’t eat enough protein to compensate for the increased protein breakdown may experience blood sugar imbalances and weight gain. (Source)

So, how much protein should you eat to support healthy blood sugar control during the perimenopausal years, menopause, and beyond? Aiming for 30-40 grams of protein per meal for three meals daily is an excellent place to start.

Focus on whole-food carbohydrates

A simple and effective way to balance blood sugar is to cut out processed carbohydrates, including flour-based foods such as bread, pasta, cereal, and crackers. Instead, focus on vegetables, whole fruits (not fruit juice), and moderate amounts of whole grains and legumes. These whole-food carb options are digested more slowly than processed carbohydrates, leading to a gentler blood sugar response.

Other tools

Continuous glucose monitoring (CGM) is growing in popularity outside the world of type 1 and type 2 diabetes. It allows people to see how their blood sugar responds in real-time to their diet, exercise, and lifestyle. CGMs can be a fantastic way for women struggling with hormone imbalances to identify potential problems with their blood sugar and take proactive steps to regulate it.

Step 2: Try a Fasting Protocol

Fasting can be a powerful tool in your hormone balance tool kit! Studies show that fasting can help women going through the “transition” improve their health in large part by improving blood sugar control at the cellular level, allowing the body to burn fat efficiently.

Daily time-restricted eating (limiting consumption of food to 4-6 hours each day) is most notably effective with postmenopausal women looking to maintain healthy weight levels. Arguably, fasting for this long is not sustainable over the long term, but it may be a reasonable place for some women to begin. Furthermore, animal models of menopause also show benefits of intermittent fasting for reducing insulin and improving breast health, a promising and exciting feature of fasting that goes beyond healthy weight maintenance benefits! ( Source , Source )

The key is to strike the right balance between fasting and “feeding.” While fasting is wonderful, more is not necessarily better! Excessive fasting can make it difficult to meet your protein and micronutrient needs, and may leave you feeling tired, weak, or sluggish.

Dr. Mindy Pelz, a renowned expert on women’s hormones (specializing in the “transition” years) recommends most women start by aiming for a 13 to 15-hour overnight fast each day. This intermittent fasting pattern leaves plenty of time for you to meet your macro- and micronutrient needs during your eating window. Once you’re accustomated to daily intermittent fasting, Dr. Pelz explains that you may graduate to longer periods of fasting. Longer periods of fasting (24 hours or more) may be best performed under the supervision of a healthcare provider.

Step 3: Develop a Sustainable Workout Program

There’s no doubt about it – exercise is essential for a healthy life. Specific types of exercise – especially high-intensity exercise and weight training – may be particularly helpful.

For example, one study found that three months of high-intensity exercise training (HIIT) significantly improved insulin sensitivity in a group of postmenopausal women. In other words, while gentle movements like walking and yoga are great, higher-intensity activity should also be included in your lifestyle for healthy hormones. ( Source , Source )

Strength training is also vital. Strong evidence indicates that strength training counteracts the loss of bone density and adverse metabolic changes in menopause.

Step 4: Cover Your Nutrition Foundations

The brain, muscles, bones, skin, and hair – hormone fluctuations affect nearly every aspect of the female body! Fortunately, optimal nutrition can help keep these systems healthy even as hormones fluctuate throughout your menstrual cycle and perimenopause and eventually wane during menopause.

A good place to start is to eat a whole-food diet that balances plant and animal foods. Emphasize high-quality animal protein, low-mercury seafood, organic dairy products (if you tolerate dairy), vegetables, fruits, nuts, seeds, and moderate amounts of whole grains and legumes.

Even the healthiest diets can fall short on certain micronutrients due to lower levels of nutrients in our soil (and thus in our food) and the depleting effects of stress on numerous vitamins and minerals. A high-quality multivitamin that provides bioavailable forms of vitamins may be a valuable nutritional “insurance” for many women.

Step 5: Prioritize Community and Relationships

Focusing on your blood sugar control, exercise, nutrition, and routine lab work is essential. Yet, these strategies can fall short if you lack nourishing relationships and community.

Social isolation and loneliness are nearly epidemic in our society; together, these factors increase stress and are associated with heightened cortisol. When the body is busy prioritizing cortisol production, it may be less capable of balancing sex hormones like estrogen, progesterone, and testosterone. ( Source , Source )

Interestingly, research has found that women who have strong social connections are more likely to view menopause in a positive light. Participation in group activities is also associated with reduced menopause symptoms, especially mental health symptoms. ( Source )

There are many ways to find community – at work, through Meetup groups, or a rock-climbing gym – just to name a few examples. Follow your interests and you’ll likely find community.

Step 6: Seek Out a Hormone-Literate Provided and Get Regular Lab Work

How your body feels and functions is a crucial barometer of your health. However, there are some things we can only know about our health with lab testing. Doing lab work at least twice a year can help you check in on markers of your blood sugar, nutritional status, and hormones, helping you stay in charge of your health!

Some labs to ask for from your healthcare provider include:

  • Hemoglobin A1c
  • Fasting insulin
  • Fasting blood sugar
  • hs-CRP
  • Vitamin D
  • Thyroid panel that includes TSH, free T3, free T4, total T3, total T4, thyroglobulin (TG) antibodies, and TPO antibodies
  • Hormone labs: FSH, LH, estradiol, progesterone, testosterone, and DHEA. Work with your healthcare provider to determine the optimal time(s) in your cycle for you to do these labs because timing matters.

If any of your biomarkers are off in your labs, work with a hormone-literate healthcare provider to determine the optimal strategy for bringing your body back into balance.

Step 7: Consider Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy (BHRT) can synergize with nutrition, exercise, and lifestyle changes to help women thrive through menopause.

BHRT involves taking hormones, including estrogen, progesterone, and DHEA, that are identical on a molecular level to the body’s own hormones. Research shows that BHRT can support vaginal health and comfort, help regulate vasomotor symptoms (such as hot flashes) and support healthy cardiovascular function in menopausal women. BHRT can be a powerful and highly effective part of your toolkit for thriving during the “transition!” ( Source , Source )

The Bottom Line on Thriving Through Menopause

Perimenopause and menopause are natural processes; yet these stages of life trigger significant physical and emotional distress in many women. You don’t need to suffer through this phase of life! Taking proactive steps to balance blood sugar, develop a sustainable exercise routine, optimize nutrition, check “beneath the hood” with consistent lab work, and maintain strong social ties can help you navigate your menopause years and flourish throughout the second act of your life.

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