Perimenopause, Menopause and Post-Menopause for the Mature Woman:

Menopause is not a medical condition. It’s a normal female function which women have experienced as a natural part of life for millennia. But for many women, perimenopause, menopause and post-menopause is a scourge rather than a beautiful doorway opening to a new phase of life to be embraced and enjoyed. This is easy to understand when we observe just how much women are negatively affected by the physiological and hormonal changes going on within their bodies.

Perimenopause or Menopausal Transition

Perimenopause, also called the menopausal transition, is the time leading up to menopause, very often beginning between ages 45 and 55. The menopausal transition period is quite long, usually lasting about seven years but it can be as long as 14 years. How long this period lasts can depend on lifestyle factors such as smoking, the age it begins, and also race and ethnicity.

As women approach menopause, the production of estrogen and progesterone hormones in their ovaries starts to decline causing the lining of the womb to become and remain thin. Their periods now become irregular and then eventually stop. This process doesn’t happen overnight.

Some women get confused and concerned by a range of what seems to them to be unconnected symptoms and which they don’t associate with perimenopause because they’re still having periods. Hormonal changes are going on in the background and progesterone is typically the first hormone to decline triggering emotional symptoms like anxiety, loss of confidence, and tearful moodiness.

These are first signs that menopause is on its way.

During perimenopause, the body's production of estrogen and progesterone varies wildly. Women have estrogen receptors all over the body and this hormone plays a part in all our body systems which is why the symptoms of perimenopause can be so diverse.

The fluctuation of estrogen and progesterone production may cause mood swings, memory problems, profound negative emotions, brain fog, moodiness and irritability, depression, aches and pains, headaches, heart palpitations, and in many cases, a combination of a number or all of these symptoms.

Changes in a woman’s period is probably the symptom noticed first. Irregular periods including duration of time and amount or type of bleeding are hallmarks signaling a woman has entered perimenopause.

Many women have hot flashes related to changing estrogen levels—a sudden feeling of pronounced heat in the upper part or all of her body including some or all of these: face and neck flush, red blotches on the chest, back, and arms, heavy sweating and cold shivering.

Hot flashes can be very mild or strong enough to disrupt sleep in which case they are called night sweats. Hot flashes last anywhere from 30 seconds to ten minutes, occurring several times an hour, a day, or just once or twice a week.

During this transition phase, some women begin having trouble getting to sleep or maintaining a good night’s sleep. Night sweats wake many women up and then they have difficulty falling back asleep. Consistently getting proper sleep is vital to a woman’s health, especially at this time of life.

Another unpleasant symptom of perimenopause is incontinence—a loss of bladder control where women feel a sudden urge to urinate or urine leaks when exercising, sneezing, or laughing.

A woman’s body seems different. During perimenopause, the female body begins to utilize energy differently. Her skin may become thinner. Her fat cells change. She may gain weight more easily and her body shape and composition change. She may notice she’s developing a larger girth as she loses muscle and gains fat. Her joints and muscles may feel stiff and achy. She may also notice changes in her physical function and bone and heart health, too.

No two women experience perimenopause the same way and many women experience symptoms that are mild enough to be managed by lifestyle changes. The severity of symptoms tends to vary greatly around the world and according to race and ethnicity.

Post-Menopause

Once menopause has occurred, a woman enters post-menopause and this phase lasts for the rest of her life. Post-menopausal levels of estrogren and progesterone will continue to be low, the ovaries have stopped releasing eggs, the menstrual cycle has ceased and pregnancy is no longer possible. Post-menopausal women may still experience side effects caused by low hormone levels.

At this point, women begin to find themselves at an increased risk for health conditions like osteoporosis and heart disease.

Now, eating a healthy diet is more important than ever before as is being active through exercise. Because bone health becomes such an issue, post-menopausal women need to ensure they are performing enough exercise and getting enough nutrients like calcium, vitamin D, protein, magnesium, phosphorous, and potassium for their bone health.

In the run up to menopause, a sophisticated communication system made up of the hypothalamus, pituitary and adrenal glands—the HPA axis—works hard to keep all physiological systems in balance. When and if relatively in balance, a woman in menopause will tend not to experience too many, if any, unpleasant symptoms.

The adrenal glands take over as a backup system.

These small glands which sit just above the kidneys are vital players during menopause because they produce a weak form of estrogen that helps to keep a woman fit and well not just through mid-life but into old age.

The only caveat is that the adrenal glands are also responsible for producing our stress hormones—cortisol and adrenaline—and if they are overworked because of stress, estrogen production in the adrenals can’t happen.

Stress is the enemy of menopause.

For this reason, if a woman struggles with chronic stress, her menopausal symptoms will be likely more severe. Her adrenal glands are just too distracted and this deprives her body of the vital estrogen it needs.

Unfortunately, transitioning to relying on the adrenal glands for estrogen production occurs at a time of life when women tend to be subject to more stress. This is often a time of reassessing relationships, juggling the strains and pressures of a growing family, caring for children and/or elderly relatives, dealing with financial stresses as children go off to college as well as many more challenges of life.

Very often, a menopausal woman will notice that when her ability to resiliently respond to stress is compromised, uncomfortable symptoms show up in her body as an outward sign. The key is to reduce levels of stress hormones in the body so the adrenal glands have the time and space to produce vital estrogen.

Optimum nutrition and good lifestyle practices can support the adrenal glands to better equip the woman in menopause to manage stressful situations. The right nutrition mix will ensure her body isn’t producing extra stress hormones which will overburden the adrenals.

But if a woman in later life is subjected to prolonged stress, this overloads the adrenals and they can’t produce vital estrogen. This triggers a whole range of postmenopausal symptoms.

Weight gain is one of the principle results. This is because estrogen can also be produced by fat cells and if the body senses that the adrenal backup system is compromised because it’s dealing with stress, it will start to store food consumed as abdominal (visceral) fat. This then becomes incredibly hard to shift because the source of the fat is hormonal and not related to overindulgence.

Women later in life must be vigilant about keeping stress in check. This will positively make an enormous difference in their health and well-being throughout all three phases of life associated with menopause.

Nutritional Support for Dealing with Stress

Every time our blood sugar drops, the body releases the stress hormones cortisol and adrenaline, therefore consume a diet that maintains blood sugar balance. This will support adrenal function and your adrenals can manufacture needed estrogen.

The body is programmed to keep blood sugar levels within a specific range and if it goes above or below the range, a state of emergency is created because whether blood sugar is low or high, this poses a risk to your health. (For the complete science on this topic, read Jackie Lynch’s book, The Happy Menopause: Smart Nutrition to Help You Flourish.)

Essentially, the body needs two key nutrients to balance blood sugar:

Mature women should consume a combination of protein and complex carbohydrates with every meal and snack, avoiding sugary foods and refined carbohydrates like cake, cookies and candy.

Proteins to Consume

meat, fish, seafood, eggs, lentils, garbanzos, beans, soy, dairy, Greek yogurt, quinoa, nuts, seeds, nut butters

Complex Carbohydrates to Consume

vegetables, fruits with an edible skin, whole grains including grains in bread and pasta, oat-based products; sweet potatoes

Drink water, vegetable juices and herbal teas.

Exercise During the Post-Menopausal Phase of Life Is Vital

Research shows that a minimum of two and a half hours of vigorous weight bearing exercise per week plus another two and a half hours of standard exercise (walking from point A to point B, taking the stairs, housework) are required for maintaining vitality throughout this stage of life for women.

Osteoporosis(2) is closely related to estrogen deficiency. The years immediately following menopause are normally a time of rapid bone loss. During the menopausal transition period, decline of estrogen production leads to more bone resorption than formation resulting in osteoporosis.

Weight bearing exercise provokes the necessary impact required for bones to grow. Putting the bones under stress this way encourages the bone renewal process.

Studies also show that regular exercise significantly reduces hot flashes.

Exercise is also crucial for heart health. It works to lower blood pressure and improve cholesterol levels. The heart benefits from being in shape and exercise directly and positively affects the heart. It also increases blood supply to the brain to support cognitive function. Exercise can help reduce brain fog associated with perimenopause.

Exercise can help keep weight under control. Many women think that weight gain during menopause is only associated with hormonal changes, but studies have found that women who are physically active are less likely to gain weight than sedentary women.

Exercise during the postmenopausal period not only causes us to burn more calories, it helps combat muscle loss associated with aging. By building muscle through exercise, metabolism and the rate at which the body burns calories each day are increased to fight weight gain.

Exercise also helps mitigate belly (visceral) fat.(3) Belly fat is the type of fat that hugs our organs. An accumulation of fat around the organs increases the risk of developing metabolic syndrome, heart disease, diabetes, non-alcoholic liver disease, and obesity.

Especially for women in post-menopause, your physical activity program should have variety blending the three types of exercise: exercise for 1) endurance (cardio), 2) strength (weight-bearing) and 3) balance (yoga).

Good Lifestyle Practices Make the Journey From Perimenopause to Post-Menopause Easier

Lifestyle practices are key to a better, more enjoyable life once perimenopause has begun. These practices include positive attitude, adequate good sleep, reduced stress levels, exercise and really good nutrition.

Our next article dives deeper into nutritional approaches for the different hormonal phases of a mature woman’s life.

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