written by Dr Ji Woon Min

Menopause is often dreaded by women. The gradual loss of period can feel like our womanhood is being taken away. This sense of loss is often compounded by loss of hair, skin firmness, and clothes that no longer fit.

Not only that – perimenopause, the transitional phase that occurs before menopause, can be uncomfortable and disruptive.

Hormonal fluctuations can cause a host of symptoms such as night sweats, hot flushes, mood swings, headaches, weight gain, low sex drive, sleep issues, heavy periods, and sore breasts.

Being a woman isn’t easy – from starting your period, to menstrual problems, and then perimenopause and menopause. But – there are ways you can support your body through the transition of perimenopause.

Listen to your menstrual cycle

One of the earliest signs of perimenopause is a shorter menstrual cycle.

You might start your period two to four days earlier, which can result in 2 periods in one month. This is a normal phenomenon – described as ‘the ovary’s grand finale’ by Jerrilyn Prior, a lead researcher in the field of menstrual cycle, perimenopause and menopause. It’s your body’s attempt to clear all the follicles in the ovaries, getting ready for menopause.

Each and every ovulatory cycle contributes to your long term health. When women ovulate, the female body makes progesterone. Healthy levels of progesterone help women have an easier transition during perimenopause and supports better heart, bone, brain and breast health after menopause.

Irregular, heavy and light periods as well as PMS symptoms like mood swings, headache and sore breasts are all common during perimenopause. Taking time to listen to your symptoms can help you understand where you are in your perimenopausal journey and start addressing hormonal imbalance.

Eat a balanced diet

Focus on a nutrient-rich, whole foods diet to support hormone balance and overall health.

Include plenty of vegetables, adequate protein (think tofu, lentils and beans if you’re vegetarian) healthy fats, whole grains and fruits.

Avoid processed foods, refined sugars, and excessive caffeine and alcohol, as they can aggravate hormonal imbalances.

Lift weights

Women experience the greatest bone mineral density loss of 7% from one year before, to two years after their final period.

Building strength prior to menopause can help protect your bone health as you age – particularly weight bearing exercises.

Walking, jogging, dancing, squats, planks and weight lifting have many benefits. They help increase bone density, muscle strength, joint stability, coordination and balance. They also help manage mood and stress and support weight management – two challenges of perimenopause.

Test your hormones

Testing for hormonal imbalances can confirm the origin of perimenopausal symptoms.

The DUTCH test is a comprehensive hormone test that assesses the levels of oestrogen, progesterone, testosterone, DHEA and cortisol. It also tests oxidative stress markers, melatonin, and six organic acid markers, including biotin – which can be low in those experiencing hair loss or thinning during perimenopause.

DHEA is produced by the adrenals and converted to testosterone and oestradiol. DHEA declines with age. Low DHEA and testosterone are important markers that can contribute to stubborn weight and low sex drive.

A biomarker for breast cancer risk can be measured through this test tool.

Complete Thyroid Panel

Hypothyroidism and perimenopause share similar symptoms – fatigue, sleep problems, mood swings, and weight gain. Hypothyroidism can mask or exacerbate symptoms of perimenopause.

Hypothyroidism is ten times more prevalent in women than men. It tends to affect women between childbearing age and menopause.

Assessing your thyroid health – including TSH, free T3, free T4 and thyroid antibodies can help identify any imbalances.

Metabolic Panel

Menopause significantly increases the risk of cardio metabolic conditions like obesity, type 2 diabetes, high blood pressure, high cholesterol, and non-alcoholic fatty liver disease (NAFLD).

Perimenopause is the time to take care of your health by evaluating fasting glucose, HbA1C, lipid panel, liver enzymes and kidney function. This can provide insights into your overall metabolic health.

Comprehensive Stool Test

The bacteria in your gut plays a vital role during perimenopause and menopause, affecting oestrogen metabolism, inflammatory response and carbohydrate metabolism.

Declining levels of progesterone and oestrogen in late-stage perimenopause and menopause can reduce the diversity of good bacteria in your gut and worsen leaky gut.

Both imbalances in hormones and gut bacteria can contribute to digestive problems like bloating, diarrhoea and constipation. They can also affect your mind, weight and skin health.

A comprehensive stool test can help identify the cause of these symptoms and guide targeted treatment for better overall health.

Seek professional support

It’s important to consult with a qualified naturopathic doctor or healthcare provider to discuss which tests are most appropriate for your specific situation. They can guide you through the testing process, interpret the results, and support you during perimenopause and beyond.

Re-thinking menopause

Many people see menopause as a life sentence. They fear it, dread it, curse it. But you don’t have to view it this way.

Yes, it is okay to be frustrated by the symptoms. It’s okay to grieve being no longer able to have kids, or letting go of your previous identity and lifestyle.

But – menopause also means no more missing out because of your period, no more mood swings, no more cramps or sore breasts.

Nature and nurture define women as givers. We often take care of others at the expense of ourselves. The discomfort and shifts that come with perimenopause may serve as an invitation to put ourselves first and take better care of us.

Change is hard. But often necessary to create new ways of living and being.

Every woman will go through (peri)menopause but not all women will experience symptoms. May your perimenopause pave your way to more freedom, ease and stability.

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Guay AT, Jacobson J. Decreased free testosterone and dehydroepiandrosterone-sulfate levels in women with decreased libido. J Sex Marital Therapy. 2002; 28

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Peters BA, et al. Spotlight on the gut microbiome in menopause: Current insights. International Journal Women’s Health. 2022; 14:1059-1072.

The centre for menstrual cycle and ovulation research, Perimenopause: The Ovary’s Frustrating Grand Finale, 2023

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