Perimenopause & Menopause

Perimenopause & Menopause

Perimenopause is the transition period leading up to menopause. Symptoms such as hot flashes are due to fluctuations in estrogen and progesterone. This starts as early as one’s mid-30s, meaning that symptoms can occur for may years before the period stops. Menopause occurs when there have been at least 12 consecutive months without a period.

Many patients may be told that their symptoms are normal and expected. However, estrogen and progesterone do not operate alone. These hormones affect your immune system, your stress response, your sleep pattern and your liver’s ability to clear hormones efficiently. If any of these systems are under strain then the estrogen and progesterone fluctuations can cause more pronounced side effects.

Common Symptoms

  • Hot flashes or night sweats

  • Disrupted sleep or waking up in the middle of the night, unable to fall back asleep quickly

  • Brain fog and difficulty with concentration

  • Menstrual headaches or migraines

  • Joint pain, aches and inflammation

  • Irregular or heavier menstrual cycles

  • New-onset histamine reactions: allergies, flushing, hives, itching

  • Weight changes, especially around the abdomen

  • Low libido

  • Vaginal dryness and other urinary changes

  • Fatigue

  • Worsening symptoms the week leading up to menses

How I Assess Perimenopause & Menopause

I start with a detailed history and I get a thorough clinical picture. I look at your cycle, symptom timeline, sleep, stress and any treatments that you have tried. I also look at:

  • Hormone levels (including estradiol, progesterone, LH, FSH, testosterone)

  • Thyroid function

  • Iron levels

  • Cortisol patterns

  • Liver function

  • Inflammatory markers

My Approach to Naturopathic Support

Nutrition & Botanicals: I use targeted nutrient support and supplements to support your hormone fluctuations, energy, sleep, mood, inflammation & metabolic health.

Bioidentical Hormone Therapy: As a naturopath with prescribing rights for topical estradiol and progesterone, we discuss whether bioidentical hormones are suitable for your health concerns. I will also consult with your primary health provider in the event that other forms of bioidentical hormones are better indicated (e.g. oral micronized progesterone instead of topical progesterone). Bioidentical hormones are given along with a monitoring plan and regular follow-ups.

Addressing inflammation: Estrogen has anti-inflammatory effects. As it fluctuates and declines, symptoms driven by inflammation become more noticeable. Symptoms can include joint pain, skin flares or worsening immune reactions. We work to support inflammation in the body to reduce these symptom flares.

Liver metabolism: The liver is responsible for metabolizing and clearing estrogen through detoxification pathways. When these pathways are sluggish (due to factors such as a poor diet, stress, alcohol), estrogen can recirculate rather than clear properly, which can worsen symptoms such as heavy periods and mood changes. Supporting liver function is a a key factor in hormone support for all patients.

Cortisol: Most people in perimenopause are also in a demanding stage of their life. Chronically elevated cortisol can increase symptoms such as hot flashes, nightsweats, insomnia and mood changes. We work together to address support your stress response with dietary & lifestyle changes, as well as other interventions listed above.

Mast Cells & Histamine: Mast cells have estrogen receptors, meaning that fluctuations in estrogen levels can trigger histamine reactions. Symptoms can include food reactions, flushing, hives, brain fog, migraines, etc. Many individuals notice new or worsening reactions in perimenopause compared to when they were younger. I screen all patients for mast cell symptoms and this guides how I build your care plan.