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Understanding perimenopause

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This natural stage of life can last from two to 10 years, with a grab bag of possible symptoms from negligible to severe. But don’t worry, help is out there.

A couple of months after my 40th birthday I start waking up at night in a sweat and my clothes aren’t fitting the same. The luxury of a solid sleep has vanished and constant fatigue has ensued. My periods used to be manageable—now I have the flood gate open once a month. My mood? Well, let’s just leave it at “I’m moody!” Is it perimenopause already? Am I too young for this?

A woman has not started menopause until she has had one full year without a period. Perimenopause, on the other hand, is an ill-defined period of time lasting anywhere from two to 10 years. It often starts in the mid-40’s, but for some women it starts in the 30’s.

During these final years of a woman’s reproductive life, hormonal changes create an array of symptoms that can range from bothersome to distressing, and decrease quality of life. The grab bag of perimenopause symptoms causes many women to seek healthcare providers for advice on how to cope.

The physical, mental, and emotional changes of perimenopause are rooted in hormonal fluctuations, particularly variations in the level of circulating estrogen. During peak reproductive years, estrogen levels rise and fall predictably throughout the menstrual cycle. Contrary to popular belief, as women approach perimenopause, estrogen levels do not just gradually decline. There is a roller coaster of rapid highs and lows, which in turn cause surprising and unwanted symptoms.

All definitions of perimenopause and menopause are menstrual-based milestones. It’s important to know this because often this is not what most women experience first. Instead menstrual-cycle changes are a small piece of the overall symptom picture of perimenopause.


• Irregular menstrual cycles: changing to heavy bleeding—a leading contributor to excess fatigue

• Night sweats and hot flashes

• Vaginal dryness and atrophy: causing itching, irritation and painful intercourse.

• Mood changes
• Increased PMS symptoms


  • Cognitive changes: brain fog, difficulty concentrating, short-term memory concerns
  • Insomnia: especially between the hours of 1am and 3am.
  • Extreme fatigue: a combination of poor sleep and heavy menses
  • Depression: as well as cycling low mood swings
  • Anxiety: sometimes with panic attacks
  • Bloating: sensitivity to foods, acid reflux
  • Fine motor skills: dropping things can occur more often
  • Palpitations: with or without hot flashes; get checked by your GP if concerned
  • Joint aches: less often reported but estrogen plays a role in the maintenance of bone health
  • Increase vaginal infections: estrogen deficiency acidity, making some women more susceptible
  • Headaches and migraines
  • Loss of libido
  • Urinary symptoms: leakage, recurrent UTI’s, overactive bladder

As with many other health concerns, perimenopause symptoms are intertwined. For example, hot flashes exacerbate sleep disturbance. This results in extreme fatigue, which in turn reduces concentration, the ability to cope with daily stressors and overall mood.The above lists are by no means comprehensive. Each woman will experience perimenopause symptoms in unique ways, with varying intensities, and will respond individually to treatment and support methods.It’s an asset to know about the condition and to have access to a healthcare team that uses many different treatment modalities.


To prevent estrogen spikes, excess estrogen can be managed by supporting detox pathways, reducing alcohol, maintaining a healthy hormone diet and introducing supplements that target your body’s ability to clear excess estrogen. High estrogen can create heavy bleeding, breast tenderness, irritability and weight gain. Low estrogen can result in depression, hot flashes and night sweats.

Natural progesterone helps support hormone balance, calms your nervous system, stimulates metabolism and protects uterine lining. Unfortunately, this hormone declines in perimenopause, leaving estrogen imbalance more prevalent.

A pelvic floor specialist may be a physiotherapists or osteopath who has completed additional training. Treatment includes exercises that help not only with the vaginal symptoms described earlier, but with urinary concerns as well.

This time of hormone transition is a challenging period for many women. They are often in the prime of their careers, while simultaneously caring for both children and aging or ill parents, let alone the usual daily stressors. Then add perimenopause hormone changes to the mix!

These physical, mental, and emotional symptoms need to be anticipated and talked about. Many women will need a strategy to improve their quality of life while experiencing both the common and less common symptoms. For guidance, talk to your MD, naturopathic doctor and pelvic floor specialist.

More Insights: You might also enjoy this article on using yoga to treat chronic pain.

Author: Dr. Samanda Verdun, BSc, ND has been on a journey with Naturopathic Medicine for over 10 years, providing care to those in her community. Her focus is to find and treat the root cause, remove obstacles to healing and guide patients on their own wellness path.

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