In this short article, James offers an overview of perimenopause, what the main symptoms are and which nutrients have been proven to have a positive effect on symptoms.
What is perimenopause?
Perimenopause is the transitional phase leading up to menopause, the permanent end of a woman’s menstrual cycles. It’s important to note this as people get really confused about some of these terms. Medically, you are deemed to be in menopause on the 12-month anniversary of your last period. So menopause really only lasts for a day. Before then you’re perimenopausal, after that day you are post-menopausal.
It’s important to make these distinctions as symptoms ‘cluster’ around the day of menopause and are weighted towards the perimenopausal phase, although for many women symptoms will continue after menopause as hormones still fluctuate.
Perimenopause typically occurs in a woman’s 40s, though it can start in the 30s or 50s and symptoms can last for up to 10 years.
Unsure whether you are perimenopausal? Check out James’ e-book 17 Signs You Are in Perimenopause. It comes with a symptom tracker you can use too to monitor your symptom load over time.
Hormonal changes in perimenopause
Oestrogen fluctuations: Oestrogen levels can become erratic during perimenopause, with periods of both higher and lower levels than usual. As perimenopause progresses, oestrogen levels generally decline.
Progesterone decline: Progesterone levels tend to decrease during perimenopause, leading to an imbalance between oestrogen and progesterone.
Follicle-stimulating hormone (FSH) increase: As oestrogen levels decline, FSH levels increase in an attempt to stimulate the ovaries to produce more oestrogen.
Symptoms of perimenopause
Symptoms can include, but are not limited to:
- Irregular periods
- Hot flashes
- Night sweats
- Mood changes
- Sleep disturbances
- Vaginal dryness and discomfort
- Decreased libido
- Brain fog
Other systems at play
How we eat, move, relax, sleep and think all play a role in our overall health but are crucial at this important life stage.
Stress in particular is the enemy of perimenopause and there are clear links between an increased severity of menopausal symptoms and women who experience high levels of stress.
To explain… The adrenal glands produce your stress hormones such as cortisol and adrenalin to help us deal with stress (1). As oestrogen production starts to decline from the ovaries, the adrenals take over some of the work to help supplement oestrogen production… but the adrenals will always prioritise survival, meaning oestrogen production gets shunted to the back of the queue.
It follows then that at perimenopause and into post-menopause, if you are overly stressed, the adrenals can become worn out. Given we know that stress and anxiety can increase during this life stage, putting a strain on the adrenal glands can therefore worsen symptoms.
Stress can also be a key factor in causing hot flushes and night sweats through the release of adrenaline. Adrenaline causes increased heart rate and narrowing of elements of the circulation system such as veins and arteries – in turn, this can lead to an increase in temperature. A hot flush is the body’s reaction to an increase in temperature, which it attempts to cool down by sweating.
Optimum adrenal function is therefore important and hence support for the adrenal glands is a necessary consideration for menopause transition (2, 3).
Oestrogen also plays a role in bone mass in women, and so declining levels can cause a brittling of the bones which develops into osteopenia followed by osteoporosis. As such, supporting bone strength by both nutrition and weight-bearing exercise is important.
Nutrients to support perimenopause
Eating a balanced diet can help you maintain a healthy weight, reduce the risk of chronic diseases, and alleviate perimenopause symptoms. Here are some key nutrients to think about.
Vitamin B6 may support hormone related depression as it helps with the metabolism of various neurotransmitters. Deficiencies in vitamin B6 have been reported in women with hormone related depression such as premenstrual syndrome (PMS) and premenstrual dysmorphic disorder (PMDD).
It is thought that vitamin B6 may be useful in supporting hormone related depression based on an association between B6 deficiencies and symptoms of depression, as well as its role in the metabolism of carbohydrates and sex steroid hormones.
B6 is important for both the production of serotonin and oestrogen, however folate (B9) and B12 play a further role when it comes to mood. B vitamins also help to support the functioning of the adrenal glands, provide energy and regulate mood swings. Studies have shown that pantothenic acid (B5) in particular, can boost adrenal hormone production. Vitamin B1 and B6 have been shown to be beneficial in reducing hot flushes and mood swings. B3 and folate (B9) are needed for the production of oestrogen (3).
Several large studies have demonstrated an inverse correlation of omega-3 or fish intake and improvements in depressive symptoms or disorders in women but not in men. This gender specific association could be explained by the oestrogen–associated effects of omega-3 fatty acids (4). Studies on 500mg of evening primrose oil taken twice daily have found it can reduce the severity of hot flashes compared to a placebo (5)
Low zinc levels have been associated with depression. It is also essential for regulating hormone production as well as modulating the stress response (3).
Vitamin D deficiency had been attributed to low mood associated with seasonal affective disorder. It has been suggested that vitamin D influences nerve growth factors, acetylcholine, serotonin, testosterone and thyroid hormone all of which have implications in the pathogenesis of depression (3).
In the body, the highest concentration of vitamin C sits in the adrenal glands and is used there for the production of the adrenal hormones, including cortisol. Stress increases the demand for vitamin C and chronic stress can rapidly deplete levels, so it is important to ensure there are plenty of vitamin C rich foods in the diet, such as leafy green vegetables and citrus fruits to help support oestrogen production.
Another necessary nutrient for addressing stress. Stress can deplete magnesium and when levels are low symptoms can occur such as lack of energy, sleep disturbances, anxiety and depression. Vegetables can boost levels and help relieve symptoms. Oral magnesium supplementation was found to be an effective treatment for symptoms of menopause and perimenopause (6).
Magnesium deficiency is also a risk factor for osteoporosis and obesity. Magnesium has calming effects on the nervous system, and several studies have found magnesium to be an effective intervention for insomnia and improving sleep, as well as supporting cortisol production (3).
Ashwagandha is an adaptogenic herb used traditionally in Ayurvedic medicine and has demonstrated great results for lowering cortisol and balancing hormones in small trials (7). Clinical trials on Ayurvedic herbs including ashwagandha concluded that it was beneficial for mild to moderate physical and psychological symptoms of menopause (8).
Some recommended food sources
- Leafy greens: Rich in calcium, magnesium, and iron
- Nuts and seeds: Good sources of healthy fats, magnesium, and B vitamins
- Lean protein: Provides essential amino acids and iron
- Whole grains: High in B vitamins and fibre
Phytoestrogens and perimenopause
Phytoestrogens are plant compounds that can mimic oestrogen in the body, which may help alleviate some perimenopause symptoms. Food sources include Soy products, flaxseeds, sesame seeds, and some legumes.
Foods to avoid or limit.
Cut back on processed foods, caffeine, alcohol, and excessive sugar to prevent exacerbating perimenopause symptoms.
Want to know more and get a perimenopause/menopause plan for life?
Check out our 3-hour masterclass to be held on April 27, 2023
1. Gordon JL, Girdler SS, Meltzer-Brody SE, et al. Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: a novel heuristic model. Am J Psychiatry. 2015;172(3):227-236. doi:10.1176/APPI.AJP.2014.14070918
2. Wartzman LC, Edelberg R, Kemmann E. Impact of stress on objectively recorded menopausal hot flushes and on flush report bias. Health Psychol. 1990;9(5):529-545. doi:10.1037//0278-622.214.171.1249
3. Bland J et al. Textbook of Functional Medicine.; 2008.
4. Ciappolino V, Mazzocchi A, Enrico P, et al. N-3 Polyunsatured Fatty Acids in Menopausal Transition: A Systematic Review of Depressive and Cognitive Disorders with Accompanying Vasomotor Symptoms. Int J Mol Sci. 2018;19(7). doi:10.3390/IJMS19071849
5. Kazemi F, Masoumi SZ, Shayan A, Oshvandi K. The Effect of Evening Primrose Oil Capsule on Hot Flashes and Night Sweats in Postmenopausal Women: A Single-Blind Randomized Controlled Trial. J Menopausal Med. 2021;27(1):8. doi:10.6118/JMM.20033
6. Porri D, Biesalski HK, Limitone A, Bertuzzo L, Cena H. Effect of magnesium supplementation on women’s health and well-being. NFS Journal. 2021;23:30-36. doi:10.1016/J.NFS.2021.03.003
7. Chandrasekhar K, Kapoor J, Anishetty S. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. Indian J Psychol Med. 2012;34(3):255. doi:10.4103/0253-7176.106022
8. Modi MB, Donga SB, Dei L. Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of menopausal syndrome. Ayu. 2012;33(4):511. doi:10.4103/0974-8520.110529