Plenty of ink is devoted to the topic of menopause but many women are only vaguely acquainted with what precedes it: Perimenopause. That’s the eight to 10 years before a woman reaches menopause itself, which is classically defined as going a full year without a period. And yet, educating yourself about perimenopause is the first step towards navigating this era with ease—and even pleasure.

By the time a woman reaches her late 30s, her ovaries shift towards what I like to call a “career change.” Production of two key female hormones, progesterone and estrogen, begins to decline, and with this arrives a host of symptoms. At this point in a woman’s life, she may consider the symptoms of PMS, such as bloating and breast tenderness, part and parcel of being female. Perimenopause, however, can bring on a litany of other complaints that may feel foreign, including heart palpitations, brittle nails, sleep disturbances, memory problems, and achy joints.

Sound familiar? Read on to learn how you can achieve hormone harmony—and sail through this life transition with ease…

1. Nail the Four Pillars of Health

As a naturopathic physician, I don’t look at a single symptom or diagnosis. Rather, I view the whole person. This is an important task when it comes to finding relief from perimenopause symptoms, as everything impacts, well, everything.

With this in mind, it’s critical to concentrate not only on your hormones during this often-fraught time but also on your entire person. Why? Your hormones, which are produced by your endocrine system, are secreted by glands throughout your body and affect everything from cognitive function to digestion to pain tolerance. Treating a solitary symptom instead of your complete system may keep you from finding the equilibrium and well-being you’re after.

To this end, work towards securing what I’ve identified as the four pillars of health: Diet (which should be packed with whole, organic foods), movement (and the quality of it), detoxification (more on this below), and mental/emotional health. Improvements in all of these areas can bolster your ability to cope with the hormone fluctuations that arise during perimenopause. As with most things associated with your health, positive lifestyle changes are the single most effective way to enrich your wellness, and this extends to your hormones.

2. Assess Your Hormones

While it may be tempting to review a few blog posts and determine yourself estrogen dominant or deficient, getting your hormones tested is key to creating hormone balance.

A blood test can be taken to evaluate your levels of hormones, but other methods of testing can be even more valuable. A saliva test will look at free hormone levels, and a urine hormone test will tell you how much hormone you are breaking down. I generally test estradiol, estriol, estrone, total estrogen, progesterone, DHEA-S (an adrenal hormone) and testosterone (both free and total testosterone).

Do note that your hormone levels change throughout the day and throughout your cycle, but there can be dramatic highs and lows particularly during the unpredictable time of perimenopause. Nonetheless, knowing where you stand will empower you to make specific changes. (For more on this, check out my book, Growing Younger Every Day.)

3. Call Upon Nature’s Bounty

Hormones govern much of who you are, influencing your mood, feelings of goodwill, facility to manage life’s stressors, and even creativity.

During perimenopause, hormone levels that may have been balanced in your 20s or30s may get out of whack, no matter how much effort you’ve put into achieving #1 on this list. Fortunately, our planet is rich in botanicals that can alleviate the intensity of perimenopausal symptoms. Here are the herbal medicines and nutrients I most frequently recommend—and why. Consider taking one or two of the recommendations below and see if these work for you, but it is best to see a licensed naturopathic doctor to get the right prescription for you.

  • Red Clover: As mentioned, estrogen dips during the latter part of perimenopause as your ovaries slow down the production of this feminine and feel-good hormone. Complications may ensue from this, including hot flashes, night sweats, headaches, and insomnia.

Red clover can help mitigate these symptoms, in part because it contains phytoestrogens—plant compounds that mimic estrogen in the body. In addition, red clover supports bone health. This is critical, as the drop in hormones at perimenopause contributes to bone loss.

To take red clover as a supplement, look for a standardized extract of isoflavones and take 80 mg to 160 mg a day. Alternatively, drink a lovely tea of red clover—one cup three times a day.

  • Chaste Tree Berry: Also known as Vitex, Chaste Tree Berry can be a gold mine for perimenopausal women who are experiencing a drop in their progesterone production. Progesterone affects GABA receptors, which play a huge role in tamping down anxiety. Too little progesterone and you may experience anxiousness, insomnia, and irritability. Chaste Tree Berry has been shown to stimulate progesterone production while also decreasing levels of prolactin, a protein that can contribute to breast pain (another common side effect of perimenopause). The recommended dose of chaste tree berry is 215 mg once a day of a standardized extract containing .6% aucubin. I recommend the brand Vitanica.
  • Zinc: An essential trace element and mineral, zinc energizes your mind and body and enlivens your libido—a wonderful thing, given that many women experience a precipitous decrease in their sexual interest at certain stages of perimenopause, and particularly post-menopause.

How does it work? Zinc blocks the enzyme that converts free testosterone to estrogen, meaning you may experience higher levels of this muscle-building hormone. You can find it in foods such as pumpkin seeds, seafood, and spinach, or as a supplement. The recommended dose is 50 mg of zinc picolinate taken orally with food. Note that taking zinc on an empty stomach can cause stomach upset.

4. Shore Up Your Adrenals

When your ovaries slow the manufacturing of sex hormones, your adrenals take over. That said, these glands, which sit on top of your kidneys like little party hats, are also prone to feel the effects of stress. Chronic stress—from work, relationships, finances, and more—can deplete your adrenals and inhibit their ability to boost hormones. In turn, symptoms of perimenopause can become exacerbated.

To shore up your adrenals, first and foremost take into account how you are managing stress. While another hormone produced by your adrenals, cortisol, can be a good thing—it gifts you with alertness, helps your brain make memories, and regulates blood sugar levels—it becomes elevated under chronic stress, which further taxes your adrenals.

In other words, it’s essential to ensure that you’re taking time for yourself daily, cutting out activities that flood you with anxiety, refraining from overworking, and engaging in stress-reducing behaviors, such as yoga, walking, leisure reading, and meditation.

Furthermore, consider supplementing with Rhodiola rosea (200 mg twice a day), an excellent adaptogen that helps the body adapt to stress. Ashwagandha, an Ayurdevic medicine and another powerful adaptogen, normalizes the production of cortisol and bolsters the body’s ability to manage stress. Take 250 mg of the herb once or twice a day. Other considerations: Siberian Ginseng (take 200 mg twice a day), which naturally enhances energy…Pantothenic Acid (or Vitamin B-5—take 250 mg twice a day), which encourages adrenal function…and Vitamin B-12 (1 mg a day methylcobalamin), which can help increase your resistance to stress.

5. Hone Your Body’s Ability to Detox

Once your hormones have served their purpose, they’re eliminated from the body, primarily through your liver and kidneys.

This process is imperative—if hormones aren’t eliminated, they can build up. For example, if your body is unable to break down estrogens and remove them from the body through your liver (in what’s known by some as “estrogen clearance”), they might remain in your body and become toxic.

Meaning, it’s important to keep your liver healthy, as this organ is your number one detoxifier. In addition to staying active, getting adequate sleep, minimizing alcohol consumption, hydrating, and dodging trans-fats, think about nutritional support. Vitamin C (1000 mg a day), alpha lipoic acid (200 mg a day), and selenium (200 mcg a day)all organically support liver function. Specific foods can also help protect your liver, including blueberries, cranberries, avocados, greens, walnuts, and oatmeal.

What’s more, consider adding DIM(diindolylmethane)to your list of supplements or your diet. The compound, which is derived from indole-3-carbinol (found in cruciferous. vegetables such as broccoli and cauliflower) modulates estrogen metabolism. The recommended dose of DIM as a supplement is 300 mg a day.

6. Strengthen Your Gut Microbiome

According to a report in the FEMS Microbiology Reviews, your gut microbiome—the vital ecosystem of bacteria and microorganisms that exist in your intestines—is critical for hormone balance. Indeed, your gut microbiome not only produces estrogens but also metabolizes them.

To heal and “tone” your gut microbiome, reach for pro- and prebiotic foods, as well as foods rich in quercetin, such as apples, onions, berries, pomegranate, and green tea—the beloved beverage has been shown to decrease bad bacteria and improve good gut flora.

Furthermore, make a commitment to avoid sugar and artificial sweeteners, both of which have been linked to gut dysbiosis (an imbalance of gut microbes), and take antibiotics only when necessary.

Lastly, consistently return to #1 on this list. An overall healthier you will naturally lead to greater hormone balance—during perimenopause, and in the often-beautiful years that follow.

Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.

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