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what is?


Perimenopause is often referred to as the “change before the change.” With it, starts the gradual transition of bodily changes, both physical and emotional, that can occur up to ten years before menopause even sets in. Feeling irritable, forgetting things, having a hard time sleeping, and wondering where those extra pounds came from {when you really haven’t changed anything in your diet} are just a few of the symptoms that many women report as they approach their late thirties and early forties.

With each passing decade, our bodies become less efficient at burning calories. What you eat, and how you eat, can have a major effect on how you feel. Typically, women begin to complain about having such symptoms as mood swings, irritability, anxiety, hot flashes, night sweats, short-term memory loss, weight gain, constipation, insomnia, and hair loss. When that isn’t enough, then there’s the headaches, loss of sexual libido, irregular periods, wrinkling, skin dryness, frequent urination, and word finding difficulties.

Perimenopause literally means “around the time of menopause” and has been described by {women’s health expert}, Dr Susan Love, as “ the mirror image of puberty.” Think of it more as a decade long hormonal coaster ride, giving your body ample time to adjust to the hormone shifts. While the medical community has treated it as a “disease,” it is simply a transition. It is important to first understand what changes are occurring in your body, so let’s review some of the major hormone players. 

Hormones 101

Estrogen levels peak at puberty and will plateau between the ages of 25 and 40. One of estrogen’s roles is to stimulate tissues to grow, build and multiply in the uterus, endocrine, bone, and nervous systems. It also regulates the hypothalamus, which acts as your body’s thermostat, and stimulates the production of serotonin, which helps to control such functions as sleep and emotions. It also protects your heart by lowering the bad cholesterol. Estrogen levels go up and down throughout perimenopause. 

Progesterone is produced in the ovaries and adrenal glands and helps to keep the uterine lining in tact. Low levels of progesterone at the end of menstrual cycles signal the lining to shed. It has a calming effect on the central nervous system, acting as a mood stabilizer. It also stimulates bone growth and enhances thyroid function. The irritability and headaches that often accompany menstrual cycles is generally due to low levels of progesterone. This hormone plummets to almost nothing before menopause and often contributes to the common complaints of women of being anxious or short-fused.

Testosterone is better known as the “male” hormone but it also has a function in the female body. Specifically, in females it helps to block the overgrowth of tumor cells in the ovaries. It also helps to control facial and body hair growth, deepens voice, enhances muscle mass, stimulates bone growth, increases sexual libido, and acts as a mood elevator. It, too, begins to decline during perimenopause.

Leutenizing hormone (LH) and follicle stimulating hormone (FSH) are produced by the pituitary gland. LH stimulates the ovarian follicle to release eggs at ovulation and the FSH stimulates the eggs to mature and the follicle to burst. Often, physicians will monitor these levels during the change, but the results are not a guarantee that you are in perimenopause. As estrogen levels decrease, these hormones increase, so they tend to be consistently higher after menopause.


Hot Flashes and Phytoestrogens


Hot flashes are a common complaint of perimenopause but not all women experience them. They are generally caused by sudden drops in estrogen and not necessarily low levels of the hormone. As noted above, estrogen plays a significant role in regulating the body’s thermostat. A hot flash, like sweating, is simply the result of your body trying to cool itself down. Blood vessels in the skin dilate, bringing blood to the surface where it is cooler. A hot flash may often start with an aura, or warning signal, where you feel anxious and your heart rate starts to accelerate. The blood vessels in you upper body, head, and nape of the neck are most often affected. Slow, controlled breathing may help moderate these symptoms.


Such things as caffeine, spicy foods (especially chili peppers), alcohol, hot beverages, stress, excessive climate heat, tight clothing, heavy bedding materials and cigarettes smoke can often aggravate hot flashes, so try to avoid these if you are experiencing hot flashes. Many women do not experience any hot flashes, while others continue to battle them well past menopause.

Phytoestrogens are natural hormones found in over three hundred plants and which mimic estrogen’s activity in the body. They consist of isoflavones and lignans and may help to decrease the incidence of hot flashes. They work by binding at estrogen receptor sites all over the body and exert a balancing effect on your body’s own estrogen levels. Foods high in phytoestrogens include soy products such as tofu, tempeh, soymilk, miso, as well as flax seeds, lentils, and chickpeas. Bioflavonoids, which are found in green tea, cherries, cranberries, and citrus fruit rinds are also good sources of phytoestrogens.

Herbals such as black cohosh, chasteberry, dong quai, ginseng, valerian, licorice root, red sage, wild yam and Saint John’s Wort are reported to help ease some perimenopausal symptoms but should only be used with the consent of your medical practitioner, as many have possible drug interactions and/or adverse side effects.

Bone Health

Bone health is an important concern during perimenopause as osteoporosis or “thinning of the bones” begins to appear. Peak bone-mineral density occurs between the ages of 35 and 40. After age 40, women lose 1⁄2 to 1% bone mass per year. Eight to ten years after menopause, they lose 2-5% a year. Strength training can help build bone, and more specifically, the load weight is more important than the number of repetitions or “reps.” Eight to twelve reps is a good goal but if you can’t do eight in a row, then the load weight is too high. Always consult an exercise expert to ensure proper form when lifting weights. 

Calcium is an important nutrient for bone health. Women ages 19-50 require 1000 mg a day, while pre-menopausal

women over 50 need 1200 mg. There are different forms of calcium commercially available on the market. Calcium carbonate (Oscal, Caltrate, Tums) needs an acidic environment to be broken down so it is best taken with food. Individuals that are on some medications to reduce their stomach acid due to reflux disease should choose another

ensure proper form when lifting weights.

Calcium is an important nutrient for bone health. Women ages 19-50 require 1000 mg a day, while pre-menopausal

women over 50 need 1200 mg. There are different forms of calcium commercially available on the market. Calcium carbonate (Oscal, Caltrate, Tums) needs an acidic environment to be broken down so it is best taken with food. Individuals that are on some medications to reduce their stomach acid due to reflux disease should choose another calcium supplement such as calcium citrate (Citracal). It is an easier form to digest and doesn’t need to be taken with food. Do not take more than 500 mg of calcium at a time as your body can only absorb a limited quantity. Caffeine and foods high in oxalates, such as green vegetables, may also interfere with the absorption of calcium. Calcium rich foods include milk, fortified soy, almond and rice milk, yogurt, sardines, cheese, and fortified juice. To determine the calcium content of calcium in a food, drop the % sign and add a “0.” Example 20% DV calcium = 200 mg per serving. Note that the nutritional information is for the serving size listed on the label.

Vitamin D is another important nutrient for bone health. Vitamin D enhances the absorption of calcium. Current recommendations are: 200 IU for women <50 years of age and 400 IU for women 51-70 years old. Many experts support increasing supplementation amounts to 800-1000 IU day but no changes have been made as yet. Foods such milk, cereal, juice are usually fortified with Vitamin D, while herring, salmon and tuna are naturally good sources.




For every decade after the age of 50, women lose 6% of muscle mass and 10-15% of muscle strength. When muscle mass decreases, so does your metabolism, leaving the door open for fat stores to increase. By the time you have lost five pounds of muscle mass, your body is storing 250 calories a day in fat.

Key components to an exercise program include: endurance, strength training, and stretching. To develop endurance and cardiovascular fitness, exercise aerobically for thirty minutes a day (run, walk, swim, jog, etc). You may have heard about the 10,000 Steps Program, which complements the Surgeon General's recommendations of exercising for 30 minutes a day. 10,000 steps per day measures out to approximately five miles. A sedentary person averages about 1000 to 3000 steps a day. A reasonable goal is to increase your average daily steps each week by 500 per day until you can easily average 10,000 steps. Purchasing a pedometer will help you to gauge your distance and success.


As noted earlier, strength training three times a week builds muscle and bone. Since muscle is an active tissue it consumes energy. One pound of muscle burns thirty-four calories. Fat, on the other hand, is inert tissue so its energy needs are low. One pound burns two calories. Include a variety of upper and lower body exercises. Enlisting the help of a professional such as a certified personal trainer, physical therapist or exercise physiologist is a good investment if you have never been trained in a strength-training program. One can be designed specifically with your individual needs in mind.

Stretching increases agility, flexibility, and range of motion. Stretching at least 5-10 minutes before and after your workout will also help to prevent injury. Hold each stretch for at least 30 seconds, and up to 60 seconds for tight muscle groups, but do not bounce, as this can lead to muscle tears. Stretching everyday is a good goal to keep your muscles healthy and flexible.

Weight Control

Weight gain is a common complaint of women in perimenopause. A steady gain of five pounds a year can translate to fifty pounds in the decade before menopause if you don’t stay on top of your weight. It’s important to know that one pound of fat equals 3500 calories. After the age of 35, a sedentary person can gain 11⁄2 pounds of fat and lose 1⁄2 to 1 pound of muscle each year. As you age, the amount of muscle that has been lost plays an important role in weight gain. While muscle weighs more than fat, it raises your metabolism to burn fat more effectively. By menopause, females need only 60% of the calories they needed at age twenty to maintain a constant weight. At Healthy Living Revealed, Sophie can develop a menu plan to ensure an adequate balance of essential nutrients and sufficient calories to help you better achieve your weight goal.

Living and sustaining a healthy lifestyle should be one of your most important priorities as you enter perimenopause. Exercising regularly, maintaining a healthy weight and diet, stopping smoking, and learning to manage stress should all support an easier and successful transition into menopause. Even small lifestyle changes can make a big difference in helping you to reclaim the rest of your life 

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