Navigating the Perils of Perimenopause

Perimenopause is a process, not a disease.

Let me say that again: Perimenopause is a natural process, a stage in the journey of a woman’s life. It is NOT a disease state that requires medical intervention.

Like puberty.
Like pregnancy.
Like labour & delivery.

In my practice, it shows up as

  • the 40-year-old who can’t get pregnant;
  • the woman who’s tried everything to lose the 20 lbs that showed up overnight and refuse to leave;
  • the woman who can’t sleep at night, yet can hardly keep her eyes open all day;
  • the confidant woman paralysed with anxiety;
  • the woman who wants a new job and can’t stand the site of her husband…let alone have sex with him;
  • the woman who walks into a room and…wait a sec, what was I saying?

She’s anywhere between 35 and 50, yet she feels like you may as well just buy her a flowered hat and sign her up for shuffleboard.

“Nobody talks about this,” my girlfriend complained the other day. And yet, we’re all (not so) silently suffering through its effects.

Is this all you have to look forward to?

Not at all.

Perimenopause is a transition. Depending on your attitude and willingness to work with the waves, it can be navigated smoothly, albeit not always gracefully.

As a holistic nutrition student, I learned that menopause is “simply” puberty in reverse.


  1. Ovaries produce estrogen (boobs, pubic hair, curves + uterus develops + bleeding starts)
  2. Progesterone kicks in (ovulation + body ready to maintain a pregnancy)

Perimenopause (= around menopause):

  1. Progesterone production declines (ovulation stops)
  2. Estrogen dwindles (stop bleeding = menopause after 1 year without a period)

But we aren’t simple creatures, as the men in our lives like to remind us: we’re complicated. (I prefer the word complex.)

First of all, puberty got rolling a good 3 years before you actually got your period and continued to fine-tune for a few years after. (Remember all those years of feeling more like a moody alien than a normal teenager?) The transition out of child-bearing mode takes its time as well, with just as many mood swings. About 10 years, and you might even start feeling the symptoms of hormonal shifts in your 30s.

The complexity comes from the fact that these processes involve much more than just your 2 female hormones.

All the glands of the endocrine system work in concert. (Skip the green box if you’re already familiar with this system.)

Endocrine System

The Endocrine System – Click on the image for easier reading

If other aspects of your endocrine system’s out of whack, your sex hormones won’t be able to do their job properly. (Which impacts periods & pregnancy as well as perimenopause.)

When your sex hormone production begins to wane in your 40s, the other hormones change their tune to create a new harmony. Generally, that interplay happens most dramatically with the thyroid and adrenals. If those two musicians aren’t feeling their best: the perils of perimenopause.

The key players in this crazy dance:

Cortisol (from the adrenals) gets into action to keep you safe and able to cope during occasional times of strife. It keeps you alert to potential danger and ready to make a hasty retreat if necessary.

Unfortunately, we’ve set up our lifestyles in such a way as to keep that state of emergency going constantly. (To read more about this concept, click here.)

When stress gets the best of you, or you can’t get out of bed in the morning, that’s cortisol out of whack.

On the other hand, you know that elated mood you’re in about a week after your period, like someone lifted a veil? You know the peaceful, blissful state, like you’ve never looked or felt better than in your 2nd trimester of pregnancy? That’s progesterone at work.

Progesterone calms the brain as part of its job to keep you zen & happy while pregnant.

Given the way that cortisol can dominate progesterone (see #3 in the green box), it’s not hard to see why so many women of this age suffer from anxiety.

Estrogen is like the Enjoli of the body. You remember the ad?

“I can bring home the bacon, fry it up in a pan, and never, ever let you forget you’re a man, ‘cause I’m a wo-o-oman.”

Ah yes, the epitome of the 70s women’s movement – elbowing in to take our place in the boardroom without giving up power in the bedroom, all while keeping up the housework.

The main peril of this life stage is estrogen dominance, the state in which estrogen is too high relative to progesterone.

It happens because of progesterone decline, progesterone resistance (see the green box), or because diet & lifestyle increase your exposure to xeno-estrogens & estrogen mimics from chemicals.

In terms of attitudes and ideals, it’s easy to see how this state has energetically become so prominent these days. Modern women focus most of the our energies into being sexy, successful, multi-tasking CEOs and push aside the instinct to make babies until much later, if at all.

Part of estrogen’s job is to enhance our female wiles to snag a mate, then give us the wherewithal to raise/maintain/hold together a family. One part of this particular super-power means that estrogen (along with her sister progesterone) makes us more, umm, let’s call it open to compromise.

I heard it best described in a conversation between Marc David and Dr. Sara Gottfried (during the Psychology of Eating Conference in July). One of them said something like, we spend childhood just being ourselves, go through the 1st change to become accommodating for about 35 years and then go through the 2nd change to be our (true) selves again.

Estrogen dominance also disrupts thyroid function (through iodine displacement as described in the green box).

Thyroxin modulates metabolism, that is, your energy levels and your ability to lose weight. The thyroid gland sits in your throat, the middle of the 5th chakra, the emotional centre of expression and judgment. Your Voice.

It’s interesting to note that the hormone, which defines the first half of womanhood, also keeps the ability to speak your truth in check.

One thing for sure, once you get to the end of the fertile leg of the journey, once the estrogen levels off to a minimum, you no longer give a shit what others think. I see women in perimenopause all around me compelled to say what they have to say, do what they have to do, wear what they want to wear. It’s no wonder job and husband dissatisfaction are high on the perimenopausal complaint list.

(This by no means insinuates you have to change them – unless you do – but it means you need to reassess priorities and relationships. You may need to learn a few new dance steps with your sweetie, your colleagues, even your girlfriends.)

I could go on about all of this. In fact, as I wrote this, I realized that I could develop each sentence into a paragraph, each paragraph into a chapter…hmm, now there’s an idea… For now, I’ll keep it “simple”.

Is there a “simple” way to address the complexity?

You bet: reduce estrogen dominance.


1. Reduce exposure to xeno-estrogens.

Opt for household cleaners with natural ingredients (never anything chlorine based).
Pull out your grandmother’s old cleaning tricks.

2. Clear out/displace the excess.

Eat 7-10 servings of vegetables each day. Vary the types and colours; always include leafy greens, sea vegetables and (cooked) cruciferous.
Eat legumes (pulses) at least 3 times a week.
Eat good quality protein and fats (building blocks for all your hormones) at each meal.

Make it simple: vegetarian chili with sliced avocado

3. Reduce mental-emotional stress

Hang out with your girlfriends
Hang out in Nature (sunshine!).
Move in a way that you love, be it Zumba or running, surfing or dancing,…

Even simpler: Take a walk in the park with your BFF.

(For more detailed information about reducing estrogen dominance, click here.)

As I said, this is really just the tip of the iceberg, but let’s get this conversation happening. I’d love to hear about your experiences. Let’s support each other through this transition, to land softly grounded on the other side.

When you share in the comments, you open possibilities for others.

Get your friends in on the conversation with the social media buttons too!


16 thoughts on “Navigating the Perils of Perimenopause

  1. Pingback: Inner Peace as Part of Health | Whole Health

  2. Where were you when I was in peri-menopause! Now, that i am post-menopausal, I still experience all of the above if I don’t eat right. Three smoothies a day keeps my hot flashes away!

  3. Great post Cathy. This topic so needs to be discussed and demystified to support those that are going through this beautiful and empowering evolutionary process. Thank you for sharing your wisdom xx

  4. Pingback: The Anatomy of Anxiety + 5 Ways to Help | Whole Health

  5. “perimenopause is a transition. perimenopause is a transition. perimenopause is a transition.” i WILL get through this. i have been actively reducing estrogen dominance (but my fibroids are confusing matters). could you explain the link between chlorine and etrogen, cathy?

    • Chlorine disrupts endocrine function in general, in that it displaces iodine in the body. Chlorine-based products, as well as certain chemicals in plastics (BPA), pesticides are known as xenoestrogens: substances that mimic estrogen in the body. Meaning they stimulate estrogen receptors as if they were the real deal, and increase the effects in the body. Fibroids definitely thrive under their influence. And yes, April, you WILL get through this!

  6. Cortisol! That’s me!

    7-10 servings of vegetables per day and legumes… I know I don’t do this and maybe that’s what I’m missing – plus I love sugar so I’m sure that’s not helping. Also, what do you think are good proteins and fat?

    Love this article, my husband and I were just talking about my hormones today… lol!

    • Sounds like you’ve got yourself a challenge, Kathleen! Focus on increasing the veg, and your need for sugar could start to wane. Good fats: you’ll find a bit of info by following the link under #3 above (a more detailed article is in the works). More protein details here.

  7. I have never thought about peri menopause as puberty in reverse. Nice!

    Just turned 49 and haven’t had too many symptoms, some night sweats here & there but I love all of the great info. I bookmarked this! TY

  8. Great article! I have been through this time , and i am so glad i am on the other side!

    Thank god it does not last. I feel great now and yes i speak and be my truth.

  9. Cathy, I have a question that I forgot to ask earlier.

    My friend Brittany (38) and I always joke that we have anywhere from a good week to ten days of bliss after our periods. She has horrendous PMS like yours truly.

    My question is…

    What happens after menopause? Are we going to get four good weeks? No good weeks? I would go back and reread the science above, but my brain is exceptionally fuzzy today due to… you guessed it!… so it’s just easier for me to ask. 😀

    Thank you! xo

    • From an emotional standpoint, PMS brings forth the little things that need to be addressed (on a monthly basis) in the same way that perimenopause highlights them (as a life cycle). Time to look at the particular moods & symptoms you experience and dig into what’s behind them (sometimes it’s food-related, or it could be a dream you’ve left unfulfilled… I’d say bring Brittany on that walk with you – stop joking about it and start looking for patterns.

  10. This is so interesting and informative.

    I turn 45 next month. Last year at this time, I could have sworn that I was perimenopausal. I was about to do the craziest thing of my life and quit my lucrative career to become a writer. I was feeling restless and anxious, but I was also ready to finally follow my dream.

    My naturopath tested my blood, and she told me my hormones were in great shape. Hormonally, I was a healthy 34 year old woman! She even had to double check the chart to make sure that a mistake wasn’t made at the lab! 🙂

    I still ovulate every 14 days like clockwork. I still have “normal” periods. I still have my usual PMS from hell. 😮

    I do feel a bit more overwhelmed than usual, and sometimes I don’t feel that my motivation and willpower are where they used to be. And the memory… Wow. Please tell me that comes back!

    I’m wondering if my psyche might be ahead of my hormones. It didn’t want to wait a few years to be my true self again. I want it now. 🙂

    I love the simple advice here. I’m heading to my Vitamix right this minute to prepare that green smoothie I didn’t make yesterday or today.

    Bookmarking this for future reference. Thank you!

    • I’m curious, Michelle, when your naturopath tested your hormones, was it just the estr & prog? Those mental symptoms you describe are part of the cortisol effect. Enjoy that green smoothie, and be sure to get out for a walk.

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