Perimenopause is a natural phase in a woman’s life that signals the gradual shift toward menopause. It generally occurs in the 8-10 years leading up to the final menstrual cycle, during which the body undergoes significant hormonal changes. As a practitioner of functional medicine in Singapore, Dr. Radhika Kamat has helped countless women understand symptoms and support better health through natural means. If you would like to schedule a consultation, please get in touch.
What is Perimenopause?
Perimenopause refers to the transitional stage before menopause when a woman’s hormone production begins to slow down. The term “menopause” technically refers to the point when a woman has had no menstrual cycle for one full year, but perimenopause starts much earlier. During this phase, the ovaries gradually produce less estrogen, and the menstrual cycle becomes less regular. Hormonal shifts during this time often lead to noticeable changes in the body, emotions, and overall well-being. According to the North American Menopause Society, these hormonal changes are part of a process known as the Stages of Reproductive Aging, which outlines how cycles and hormone levels evolve as menopause approaches.
For most women, perimenopause brings subtle changes at first. However, over time, many experience more obvious signs like irregular periods, mood swings, and physical changes such as weight gain or difficulty losing weight. Understanding what’s happening to your body during this phase can help you to manage it more effectively.
What’s the Average Age for Perimenopause?
Perimenopause typically begins in a woman’s 40s, although it can start as early as the mid-30s for some. On average, this phase lasts about 4 years, but for some, it can extend up to 10 years. Most women enter menopause, marking the end of perimenopause, between the ages of 45 and 55. According to a 2019 review from the Mayo Clinic, most women experience the bulk of their perimenopausal symptoms in the four years leading up to menopause, but individual experiences vary significantly.
It’s important to remember that every woman’s experience with perimenopause is unique. While some may have noticeable symptoms early on, others may not experience significant changes until closer to menopause. Monitoring your cycle and symptoms can help you recognize when perimenopause starts for you.
How Do You Know If You’re in Perimenopause? What Happens?
The early signs of perimenopause can be subtle and vary from person to person. One of the most common indicators is a change in your menstrual cycle. If your cycle shifts by more than 7 days—either becoming shorter or longer—this may signal the onset of perimenopause. According to the Stages of Reproductive Aging Workshop + 10 (STRAW+10), these cycle changes are one of the first and most reliable signs of perimenopause.
Changes in the volume of menstrual flow also happen. Some women experience heavier periods, while others notice lighter ones. In addition to changes in menstruation, perimenopause often brings other symptoms like hot flashes, night sweats, and difficulty sleeping. These symptoms may appear all month long or only during certain phases of your cycle. Estrogen and progesterone are at their lowest levels right before your period, so you may find that symptoms like poor sleep or hot flashes peak during this time.
Other signs include mood changes, vaginal dryness, and weight gain, especially around the waist and hips. Fatigue is also a frequent complaint, often stemming from a combination of hormonal fluctuations, poor sleep, and changes in body composition. Some women may notice their body has more difficulty shedding excess weight, which is largely due to the decrease in estrogen. The American Heart Association notes that lower estrogen levels can lead to an increase in body fat, particularly around the abdomen, which also raises the risk of cardiovascular disease.
Mood changes can range from mild irritability to more pronounced symptoms of anxiety or depression. Up to 40% of women experience mood shifts during this phase, according to research published by the Journal of Women’s Health. A history of depression or anxiety may increase the likelihood of experiencing these symptoms during perimenopause.
How Can You Treat Perimenopause With Natural Remedies?
While perimenopause is a natural phase, its symptoms can sometimes interfere with daily life. In partnership with a naturopathic doctor, you can pursue natural remedies that may help ease discomfort and promote balance during this transition.
Dietary Changes To Support Perimenopause Health
Nutrition plays an important role in managing perimenopausal symptoms. According to a 2022 study from the Cleveland Clinic entitled “Diet and Hot Flashes: What Helps?,” women who consume foods rich in phytoestrogens, like soy, flaxseeds, and legumes, experience relief from hot flashes. These foods mimic estrogen in the body and help reduce the severity of symptoms. A balanced diet with plenty of fruits, vegetables, lean proteins, and healthy fats supports overall health and helps maintain stable energy levels.
Reducing sugar, caffeine, and alcohol can also help alleviate symptoms like hot flashes, mood swings, and insomnia. The Cleveland Clinic study also highlighted the benefits of including more whole grains, healthy fats like omega-3s, and calcium-rich foods to support bone health and aid in weight management during perimenopause.
Herbs and Supplements
Herbal remedies like black cohosh, red clover, and evening primrose oil are often used to relieve symptoms of perimenopause, particularly hot flashes and night sweats. These herbs contain compounds that may help balance hormone levels. Adaptogenic herbs like ashwagandha or rhodiola can help reduce stress and improve energy levels.
Supplements such as magnesium, vitamin D, and calcium can support bone health and improve sleep quality. According to the National Institutes of Health, omega-3 fatty acids found in fish oil supplements help reduce inflammation and support heart health, which becomes increasingly important during perimenopause as cardiovascular risks rise.
Exercise and Movement
Regular physical activity benefits women going through perimenopause by promoting better sleep, reducing stress, and managing weight. According to a study published by the International Menopause Society, both strength training and aerobic exercise help counter the loss of muscle mass and fat redistribution around the waist. Practices like yoga or Pilates can also improve flexibility, support mental health, and provide relief from anxiety or depression.
Exercise also supports heart health, reducing the risk of cardiovascular disease, which becomes more of a concern during perimenopause due to the drop in estrogen levels.
Sleep Support
Sleep disturbances are common during perimenopause, but creating a calming bedtime routine may help. Limiting screen time, avoiding caffeine in the afternoon, and practicing relaxation techniques such as deep breathing or meditation can promote better sleep. According to the Sleep Foundation, herbal teas like chamomile or valerian root can have calming effects and may assist in winding down at the end of the day. Prioritizing sleep is very important for managing other symptoms of perimenopause, like mood swings and fatigue.
Stress Reduction
Managing stress through mindfulness, meditation, or breathing exercises helps alleviate mood swings and improves overall well-being. Taking time for self-care and relaxation can reduce the impact of perimenopausal symptoms.
In addition to these natural remedies, it’s a good idea to stay in touch with your healthcare provider to monitor your progress and make adjustments as needed. Though hormone replacement therapy (HRT) may be an option for some women, a careful discussion with a hormone health expert is essential before deciding on any treatment plan.
Move Forward With Confidence
Perimenopause doesn’t have to be overwhelming. With a better understanding of the process and the support of natural remedies, many women navigate this phase with confidence and greater ease. While every woman’s experience is different, finding what works for you and making gradual lifestyle adjustments can help you manage symptoms and feel more in control of your health.
References:
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Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
Allshouse, A., Pavlovic, J. & Santoro, N. Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms. Obstet. Gynecol. Clin. North Am. 45, 613–628 (2018).
Hale, G. E., Hughes, C. L., Burger, H. G., Robertson, D. M. & Fraser, I. S. Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause N. Y. N 16, 50–59 (2009).
Timur, Sermin, and Nevin Hotun Sahin. “The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women.” Menopause (New York, N.Y.) vol. 17,3 (2010)
Xiang, Du et al. “Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress.” Oxidative medicine and cellular longevity vol. 2021 5523516. 28 Jun. 2021, doi:10.1155/2021/5523516
