Holistic Perimenopause
The stigma around women’s hormonal health in mid-life is staggering. Even the most intelligent, educated women I know quickly stop the conversation when HRT (hormone replacement therapy) is mentioned. We have a lot of work to do around educating women that perimenopause is different for everyone and there is no wrong way of navigating it.
Some Do Nothing
Symptoms may emerge and risk factors may show up on blood work. This could include cardiovascular or cardiometabolic concerns including an increase in cholesterol or a decrease in blood sugar regulation. Cognitive or neurological symptoms like forgetfulness, mood changes or muscle weakness may occur. Osteopenia or muscular-skeletal syndrome also are common and can be significant factors that affect quality of life. Doing nothing is absolutely an option. Nothing has been available for a long time and women learned to tough it out. I wonder if this is now expected as a morally superior approach.
Unfortunately the rate of suicide increases significantly for women in their late 40’s and many emerge after menopause with significant health risks that can be disabling. This can look like injuries that don’t heal, cardiometabolic changes that are difficult to recover from and sleep issues that are debilitating. I like to imagine a medical system that supports women through perimenopause so that we are set-up to thrive in the second half of life.
The Foundation
Some women apply herbal medicine, nutraceuticals, diet therapy and lifestyle changes. Keep in mind that all of these can be effective and this is the foundation that all other treatment relies on. However, there are limitations. For example phytoestrogens in food binds to an estrogen receptor and can mildly stimulates that receptor. Phytoestrogens do not add estrogen and may not help with any of the risk factors. Nutrients are very supportive especially protein, creatine, Vit D, magnesium, B6, omega 3’s and zinc. Supplementation can be great especially if your diet is limited. In terms of lifestyle medicine reducing environmental toxins, adding in strength training and focusing on stress management are all key.
HRT isn’t a Dirty Word
Some women add in bioidentical hormones. Much of the stigma regarding HRT was that there wasn’t a clear distinction between synthetic progestins which are not safe and microionized progesterone which is safe. Synthetic estrogens found in birth control are also very different than bioidentical estrogen that is administered topically. DHEA and testosterone are also incredibly important for women’s long-term health although the medical system still makes it difficult to access these.
Other Considerations
Finally, some women also need medication to help with some of the risk factors and symptoms that perimenopause brings forward. HRT is a prescription but some consider it ‘natural’. Pain medications can be indicated especially for migraines and musculoskeletal syndrome (herbs and CBD can also help). Anti-depressant/anti-anxiety medication is also commonly prescribed alongside hormonal birth control. More comprehensive lab work and diagnostic can reveal why these aren’t always effective.
Women are being diagnosed with ADHD during perimenopause because of growing awareness of neurodiversity and the fact that girls were often overlooked in childhood diagnosis. Sleep support can be herbal or prescription although oral progesterone is often effective. Non-hormonal medication for hot flashes and other vasomotor symptoms can be used if hormones are not a good choice for example post breast cancer. Some medications and nutraceuticals can be pulsed meaning used for a time or cycled. In my practice I offer a range of adaptogens to support the stress response.
It’s your choice. Being informed is the way forward. Holistic medicine means including everything. Nothing is wrong or bad. It’s about knowing what’s right at the right time and adapting when it’s time. Lab work can help tremendously in terms of knowing what’s needed when.
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