Perimenopause is a transitional period marked by significant hormonal fluctuations. It can last anywhere from 2 to 10 years.
Many women experience this phase with varying degrees of discomfort, which can significantly affect their quality of life—mood swings, weight gain, irregular cycles—often without knowing how to manage it.
However, by identifying the symptoms and their root causes, it is possible to take effective action and significantly reduce the severity of these manifestations, making this period much more manageable.
Before diving into practical advice, it’s helpful to review some basic physiology.
Many women, even at the end of their reproductive years, don’t fully understand how their cycle works. Yet knowing how to identify ovulation and understanding the roles of key reproductive hormones is essential. Being in tune with your body and ovulatory signs allows for better understanding of perimenopause and therefore better care.
Understanding the Menstrual Cycle to Better Navigate Perimenopause
The menstrual cycle is divided into two main phases:
- Follicular phase: starts on the first day of menstruation and ends at ovulation.
- Luteal phase: begins after ovulation and ends at the start of the next period. This phase usually lasts 11–16 days and remains relatively stable throughout reproductive life, barring hormonal disorders or perimenopause.
Follicular Phase:
FSH (follicle-stimulating hormone) stimulates the growth of several ovarian follicles. One (or occasionally two) matures and begins producing estradiol, the most biologically active form of estrogen.
Ovulation:
Triggered by a surge in FSH and LH (luteinizing hormone), ovulation occurs when the mature follicle releases an egg.
Luteal Phase:
The ruptured follicle transforms into the corpus luteum and secretes progesterone and a small amount of estradiol. If no fertilization occurs, hormone levels drop sharply, triggering menstruation.
📌 Note: Ovulation—not menstruation—is the key indicator of a healthy cycle. In fact, it’s more accurate to speak of an “ovarian cycle” than a “menstrual cycle”.
Hormonal Fluctuations in Perimenopause
Perimenopause is characterized by major hormonal shifts and typically unfolds in two main stages:
1. Progesterone Decline:
Initially, there’s often relative estrogen dominance (due to low progesterone) or true estrogen excess. Ovarian follicles become less responsive to FSH, leading to “ovarian resistance.” In response, the brain produces more FSH, which may overstimulate the ovaries, sometimes triggering early ovulation.
This leads to dysovulation (irregular ovulation), with weaker corpus luteum function and less progesterone. The luteal phase shortens, and cycles become shorter.
2. Estrogen Decline:
Over time, the ovaries become less responsive to FSH and LH. Follicles fail to mature, and ovulation becomes rare or absent. This leads to prolonged follicular phases with extended estrogen exposure but no progesterone production.
Cycles become longer and more irregular. Low estrogen symptoms appear: hot flashes, vaginal dryness, insomnia, fatigue, etc.
Eventually, the brain stops signaling the ovaries, and cycles cease altogether—this is menopause.
⚠️ Fertility persists as long as ovulation occurs. Conception during perimenopause is still possible.
Key Takeaways:
- Perimenopause begins with progesterone decline, contributing to more pronounced PMS and shorter cycles.
- Later, estrogen levels also drop, causing typical menopausal symptoms.
- Cycles may become shorter, longer, or irregular.
- Relative estrogen dominance is common, with symptoms like heavy periods, mood swings, insomnia, anxiety, and pronounced PMS.
Perimenopause Symptoms
In the early stage (progesterone decline), symptoms reflect estrogen dominance:
- Worsened PMS: breast tenderness, mood swings, water retention, headaches.
- Sleep disturbances, spotting, low motivation or energy.
- Shorter cycles due to shorter luteal phase.
As estrogen declines, symptoms more commonly associated with menopause emerge:
- Hot flashes, vaginal dryness, thinning or wrinkling skin, weight gain…
How to Support Your Body During Perimenopause
1. Early Perimenopause Goals:
- Modulate estrogen exposure (production, receptor sensitivity, detox pathways).
- Boost progesterone: ensure adequate precursors and ovulation support (with plant-based therapies where appropriate).
2. Later Stage:
- Use nutrition and herbal medicine for estrogen-like support, as appropriate.
Lifestyle, diet, micronutrition, and herbal therapies are essential tools during this time.
Physical Activity
Exercise plays a key role by boosting endorphins (natural mood-lifters).
Estrogen and progesterone also enhance serotonin, dopamine, and GABA (a calming neurotransmitter). As these hormones decline, mood becomes more unstable.
Exercise helps offset these changes and reduces the risk of cardiovascular disease and bone loss, both of which increase after menopause.
Regular physical activity is essential for preventing osteoporosis, heart disease, and joint pain.
Nutrition & Micronutrition in Perimenopause
Goals:
- Regulate estrogen levels (production, receptor activity, and detox via liver and gut).
- Support progesterone production with adequate precursors: cholesterol, B6, vitamin C, magnesium, zinc.
- Anti-inflammatory diet rich in fiber, omega-3s, and antioxidants is key.
Herbal Medicine & Perimenopause
Phytotherapy can be a powerful ally:
- To support progesterone production (Vitex, for example).
- To support declining estrogen with phytoestrogens (only when safe).
⚠️ Always personalize based on medical history, especially in cases of hormone-sensitive cancers.
Weight Gain in Perimenopause: Why It Happens
Several mechanisms contribute:
- Lower levels of mood-regulating neurotransmitters → cravings and emotional eating.
- Shorter luteal phase → lower energy expenditure (normally ~100–150 kcal increase in this phase).
- Estrogen decline → changes fat distribution (from hips/thighs to abdomen).
- Estrogen regulates leptin, the satiety hormone. Less estrogen can lead to increased appetite.
- Muscle mass declines from age 35, reducing basal metabolism.
💡 Strength training is essential to preserve muscle mass and metabolic rate.
🌿 Want support navigating perimenopause or preparing for menopause?
Book a consultation to explore individualized support by email at digestharmony@gmail.com