What the Heck is Perimenopause???

Well, I will just come out and say it…I have started the process towards menopause.  I had thought menopause was a thing for women in their fifties, then I learned about perimenopause. Rage? Check. Change in menstration? Check. Exhaustion? Check. Crying out of the blue for seemingly no reason? Check. Trouble sleeping? Check. ?It all seemed to come out of no where. I know this is all very natural but it still took me by surprise. In an effort to embrace this process as another natural stage in life I wanted to learn more and empower myself with some knowledge about how to best take care of myself during this time of change. I connected with Stefanie Miska, a Dr. of Traditional Chinese Medicine, registered acupuncturist and herbalist. Her practice is focused on women’s reproductive health from menarche to menopause and navigating all the transition in between. She took the time to write up some information for us on perimenopause and treatment options. Thank you Stefanie!

Stefanie Miska

Peri-menopause is synonymous with ‘around- menopause’, this can be a big surprise for many women in their 40’s and the years leading up to menopause, that these symptoms can come on much sooner, which can feel like wreaking physical, mental and emotional havoc on their lives.
Women start peri-menopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.
It is virtually impossible to know when the transition from peri-menopause to menopause actually occurs and menopause itself can only be diagnosed a full 12 months after your last period.

In our ageist culture, many women, instead of believing in their capacity to remain strong, attractive and vital throughout their lives, instead come to expect their minds to deteriorate with age. – Christiane Northrup

For what might be five to 10 years before you actually stop menstruating, your ovaries begin to produce fewer of the sex hormones estrogenprogesterone and testosterone
While estrogen decline usually comes closer to menopause itself, estrogen fluctuations are thought to cause peri-menopausal plights such as hot flashes, vaginal dryness, urinary incontinence, even impacting motivation and ambition.
Symptoms of estrogen decline
Estrogen is often the last hormone to decline, but is the hormone that is traditionally associated with menopausal symptoms. As you approach menopause your ovaries slow their production of estrogen. While your ovaries continue to make some estrogen for the rest of your life and your body is still producing it from other sources, the overall effect is a dramatic drop in the level of estrogen circulating in your body—about 30–60 percent for most women. Symptoms of estrogen decline include:
    Hot flashes
   Night sweats
   Vaginal dryness
   Decreased energy and ambition
   Depression or mood swings
   Mental confusion
   Urinary incontinence
   Recurrent urinary tract infections
 Symptoms of progesterone decline
Declining progesterone may be a factor in irregular or heavy bleeding—one of the primary complaints of peri-menopausal women—and can also contribute to problems with sleep, memory and concentration, not to mention tender breasts and bloat.
This state of a low progesterone-to-estrogen ratio is also referred to as “estrogen dominance.” Some of the symptoms that women suffer when progesterone declines include:
   Breast swelling and tenderness
   Mood swings
   “Fuzzy thinking”
   Trouble sleeping
   Water retention
   Weight gain
 Symptoms of testosterone decline
Testosterone, commonly associated with male reproductive and lifelong health, is in fact a key factor in women’s sexual health and general well-being throughout life. Low T or low testosterone can affect bone production and lean muscle mass, is a common culprit in lost libido (sex drive), and may be the missing ingredient when you’ve lost your mojo.
Testosterone levels may also start to decline well before the last menstrual cycle. While the symptoms of low testosterone are often more subtle that those of low progesterone, for some women they can be significant. Symptoms of low testosterone include:
    Loss of sex drive
   Decreased sexual response
   Decreased sensitivity in your erogenous zones
   Decreased sense of well-being, energy, and ambition
    Loss of or thinning pubic hair

Perhaps with education and proper perspective, we can look forward to the day when people will stop viewing menopause as a crisis, or even as ‘the change,’ and see it more appropriately as ‘yet another change.’ For living is constant change. That is the essence and its promise –Dr. Kathryn McGoldrick 

Menopause from a Chinese Medicine perspective 
In Chinese medicine, as both men and women age, our vitality, constitutional strength, or what we call, Kidney Qi, begins to decline. The kidneys are responsible for our reproductive health and play an essential role in egg development and sperm quality. 
The Kidneys govern growth and the ability to reproduce. (This is a “natural process” of ageing and does not imply kidney failure.)
As we age and our ‘essence’ declines, this is when (peri)menopausal symptoms begin to occur. 
If there is a decline in Yin energy, there are more signs of heat, like hot flashes, night sweats, dizziness, vertigo, spontaneous sweating.
If there is a decline in Yang energy, there are more symptoms like digestive weakness, lethargy, fatigue, cold extremities, and loss of appetite.
It is possible to have a combination of both of these patterns.
Rather than trying to restore your hormones to the levels they were in your 20s or 30s, Chinese medicine works to smooth your transition by nourishing the kidney system and bringing your body into balance.
Conventional treatment for (peri)menopause
HRT-The most common treatment for symptoms of menopause is Hormone Replacement Therapy (HRT) – low dose estrogen, sometimes on its own or with progesterone. Long term use of hormone therapy may have some cardiovascular and breast cancer risks, your doctor will discuss benefits and risks with you.
Vaginal estrogen –To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring.
Low-dose antidepressants – Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes.
Alternative treatment for (peri)menopause
Acupuncture and TCM herbal medicine:
Symptoms of menopause can be successfully treated with acupuncture and herbal medicine. 
Acupuncture brings your hormones into balance and reduces anxiety through a process called homeostatic regulation. It has been shown to improve the function of the hypothalamic-pituitary-ovarian axis, which is the mechanism responsible for balancing reproductive hormones.
Herbal therapy is used to tone and replenish deficiencies and stimulate your own hormonal production.

In my clinic, I have seen weekly acupuncture treatments completely abolish hot flashes and night sweats. I use a combination of acupuncture and Traditional Chinese Medicine herbal formulas, specifically tailored to and individuals symptoms, to alleviate dryness, lessen irritation, moderate emotions, regulate bleeding and reduce anxiety-Stefanie Miska

What you eat may aggravate these hot flashes.  Eating inflammatory foods can make a mild warm sensation into a severe sweaty experience.  Some of the most common foods which aggravate hot flashes are: alcohol, coffee (caffeine), spicy foods, fatty foods and sugar.
Naturopathic Medicine: 
A naturopathic doctor prescribes a wide range of natural therapies including bio-identical hormones, herbs, homeopathic remedies and lifestyle modification suggestions.
Mindfulness :

A mindfulness practice like meditation, yoga, and walking in nature can help calm the nervous system and alleviate menopause symptoms.

Thank you so much for the great info Stefanie! Stefanie treats in person, in beautiful Victoria, BC and works with women remotely via the wonders of the web.
You can also find her in these places

Here’s to embracing the changes that come our way,


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