Perimenopause Strategies to Help Women Thrive

Strength training helps with declining bone density during perimenopause.

Source: Karolina Grabowska/Pexels

Here I was, a “woman of a certain age” desperately asking my doctor for help as I approached menopause.

Here she was, a woman of a younger age, brushing me off by saying I needed to go find a women’s health clinic for that.

Here we both were, two women clueless about a transition that half the population undergoes, all because this life transition has been cast in the shadows.

Since fits of rage can come naturally to women having hormonal changes in midlife, I could easily rant about the medical field ignoring women’s biological changes in midlife, or how women are rendered invisible in society once they’re no longer considered youthful and perky. But, instead, I’ll share what I’m learning and what I wish I’d known about thriving during this life stage.

5 Tips for Perimenopausal Women (or what I like to call "seasoned" women):

1. Know the basics of perimenopause to manage expectations. On average, perimenopause is the 3 to 10 years leading up to menopause. Menopause is defined as 12 months in a row without menstruating, with the average age being 51. Menopause is not only something that happens to the ovaries; it's considered a "neuroendocrine active state," meaning your brain is impacted just as much as your ovaries. There are typically two phases to perimenopause, the first being one of excessive estrogen, with common symptoms including agitation, mood swings, weight gain, fatigue, and anxiety. The second phase typically presents with a deficit of estrogen, with symptoms of hot flashes, night sweats, trouble concentrating, depression, and vaginal dryness. Both phases can cause mood fluctuations, insomnia, libido changes, and mental fog. Symptoms of attention-deficit/hyperactivity disorder (ADHD) can also present during this time, as I described in a past Psychology Today post. This is not an exhaustive list of symptoms, and every woman’s journey and timeline can vary.
2. Hormone replacement therapy can be safe and effective for many. Current research on hormone replacement therapy (HRT) debunks older research claiming that it causes breast cancer. This is referencing the Women’s Health Initiative (WHI) study, which is now understood to have a flawed study design, but, unfortunately, it really derailed women’s health. HRT can mean any combination of estrogen, testosterone, estradiol, and progesterone with the most popular being an estrogen patch or progesterone lotion. HRT is particularly helpful for vasomotor issues such as hot flashes and night sweats. Research is also showing it may prevent cognitive decline that can lead to Alzheimer's disease if taken early enough. If you have a history of blood clots or estrogen-based cancers, or are beyond your first 10 years of perimenopausal symptoms, you are not a candidate for HRT.
3. HRT is not the answer for everyone and is not the only answer. HRT may vastly improve symptoms for some, but it could worsen symptoms (and introduce additional side effects) for others. I was one of those unlucky people, and my prescribing doctor—one who claimed to specialize in perimenopause—threw her hands up once hormones didn’t work because that was the only treatment she knew. This is why a holistic, whole-body approach to perimenopause is called for. For example, acupuncture and Chinese herbs may help balance hormones. Lifestyle changes are invaluable such as managing stress with exercise, most notably adding strength training to offset bone loss and moderate cardiovascular activity for brain health. Eating more antioxidants and fiber is also shown to help the changing brain during perimenopause. Spending time in nature and having solitude, as well as saying no to others so you can prioritize yourself, are all essential during this time.
4. Beware of medical gaslighting so you can advocate for yourself. Women, people of color, and anyone disenfranchised from the medical system tend to be discounted at their doctor’s office throughout their lifespan but especially during perimenopause because of the way medicine has ignored it until recently. If one doctor is unhelpful, keep looking for another one who is trained in women’s health throughout the lifespan. Also consider other licensed holistic practitioners outside of the standard Western medical model who understand the whole body and whole person and can factor in your entire lifestyle.
5. Honor the transition. As much as people love the quick fix of a pill, we need to tend to the emotional, psychological, and spiritual aspects of this change. Whenever we throw medication at something and don’t take time to process what’s happening, we lose an opportunity to awaken and understand ourselves on a deeper level. Perimenopause is a powerful transformation. And with all transformation, there is a letting go in order to create space for what's new. Menopause is a symbolic death, and grieving is natural. And, yet, with that loss also comes an opportunity to shed the unhealthy programming that came with youth. I personally had a mic drop moment as I recently approached 50: I realized I’d wasted too much time on low-vibration crap. I sighed thinking of all that striving to be who I thought I was supposed to be to fit in. Hitting midlife has been a wake-up call, a call that told me, "Now is the time to live more authentically. This is not a dress rehearsal." Now is the time for higher consciousness, dropping any facade, having loving self-regard, and settling into the ease of being totally myself. Midlife now means to me wisdom, intuition, empowerment, and letting go of vanity, people pleasing, needing approval from others, trying to fit in, or doing things according to antiquated traditions. May women realize they can stop taking responsibility for things that aren’t theirs, that they can flush youth-obsessed cultural programming down the toilet, and that they can step away from the herd mentality to be their bold selves.

My hope is women can move through this transition with more confidence, grace, and belonging. Talking to other women about our experiences and cultivating community allows us to support and witness each other through this remarkable rite of passage.