It’s a conundrum. You, or someone you love (like your mom), is suffering with the symptoms of menopause or perimenopause, and you’ve been offered hormone replacement therapy, or anti-depressants, or maybe even a hysterectomy. Understandably, you may be unsure how to proceed, because there are mixed messages out there and they are loud! Some people say you should grin and bear it. Others say you should take invasive action. What’s a night-sweating, mood-swinging, irritable-weepy, menstrually unpredictable woman to do?

First of all, let’s get one thing straight: The transition into menopause is natural, not pathological. Just like the transition into puberty is not a disease, and pregnancy is not a disease, perimenopause is not a disease, or a “syndrome” or even an “issue,” necessarily. Conventional medicine likes to make anything uncomfortable into a problem, then give you some kind of pharmaceutical or surgery to “cure” it, but menopause is merely one more in a series of inevitable hormonal transitions. Every woman goes through menopause eventually, sooner or later. It’s like death and taxes, as they say.

It’s interesting to know that, in some places around the world and throughout history, menopause isn’t considered that big of a deal. In some cases, that may be because women’s health issues are not prioritized, and I’m sure many women have suffered uncomfortable side effects of this transition in silence, but I also know firsthand that many women don’t really notice the change that much. Why is that? I believe the reason is obvious and often overlooked by conventional medicine: How you live largely determines how you will weather that hormonal transition.  

There is probably a genetic component to menopausal “symptoms” (which I wouldn’t really call symptoms—I would call them signs). Some women are more inclined to have more uncomfortable signs that menopause is coming. If your mother had hot flashes and night sweats, you may be more likely to have them, too. Hormones govern millions of biochemical processes in your body, so when they change, you are likely to notice. Whether it’s temporary fluctuations in your body’s ability to thermoregulate (hot flashes), skipped or more frequent and heavy periods (amenorrhea or dysmenorrhea), mood swings, or weight gain, you may be particularly prone to certain bodily responses to hormonal changes, but your lifestyle might very well be making things worse than they have to be.

So my answer to, “Should I do something about perimenopause” is “Yes!” But my answer to “Should I take drugs or get surgery” is, “Maybe try a few other things first.” You might find that hormone replacement therapy, anti-depressants, or a hysterectomy really do rescue you from a lot of pain and discomfort, but what if some simple lifestyle changes could make things easy enough to deal with until it’s over? Because ladies, perimenopause, by definition, does not last forever.

The Effect of Diet on Menopause

Let’s start with the most basic thing you can do, without any doctor’s visits, medications, or even cost, that could significant impact how comfortably you transition into menopause: What you eat. Research has demonstrated that a diet rich in vegetables and fruits results in fewer general, physical, and mental menopausal symptoms, while diets rich in saturated and trans fats, sugars, and processed foods result in more uncomfortable symptoms.

Food may also delay the onset of menopause. A 2017 study of women 40 to 65 showed that women who had a high intake of fatty fish (like salmon and mackerel) and fresh legumes (beans, peas, lentils) experienced natural (non-surgical) menopause 3.3 years later than those who ate more refined carbohydrates like refined pasta and rice. More vitamin B6 and zinc were also associated with delayed menopause.

For those of you who suffer from hot flashes and night sweats—one of the most common complaints of the menopausal transition—know that there are natural remedies for this particular phenomenon. One of them is simple: Weight loss. In a study of 17,473 women between the ages of 50 and 69 who were not taking hormone therapy, women who lost more than 10 pounds, or more than 10% of their body weight, significantly reduced or eliminated hot flashes and night sweats. Easier said than done, I know. See the next section for why this might feel more challenging now, and what you can do about it.

There are also some very effective natural herbal remedies for hot flashes and night sweats. In my book, Vibrant, I pass along some recommendations from my acupuncturist and herbalist, Dr. Liu. She says that Tu Si Zi (Chinese dodder seeds), black cohosh, red clover, licorice root, and vitex (chase tree berry) are all effective herbal remedies for helping balance hormones during the menopausal transition.

To summarize, reduce menopausal symptoms like hot flashes and mood swings by:

  • Eating more vegetables and fruit.
  • Eating less saturated and trans fat, sugar, and refined carbohydrates.
  • Eating more fatty fish
  • Eating more legumes
  • Taking vitamin B6 and zinc
  • Losing some weight.
  • Trying hormone-balancing herbs.

The Effect of Exercise on Menopausal

You can probably guess that I’m going to say exercise can help to alleviate many of the signs of perimenopause and you are right! Research shows that women going through the menopausal transition are less likely to gain weight, develop depression, lose muscle mass and bone density, get heart disease, and have hot flashes and night sweats if they do 20 to 60 minutes of aerobic exercise 3 to 5 days a week, and strength training 2 to 3 day per week. If you’re already doing that, great! You will be less likely to gain weight and feel uncomfortable during menopause. If you aren’t, however, then this is the time to start.

Weight gain becomes easier during menopause, as metabolism slows and hormones change, and a loss of estrogen alters how the body processes fat. We also know that excess body weight can exaggerate hormone levels that are linked to symptoms, since body fat can act like an endocrine gland and produce its own hormones. Without adjusting your lifestyle as your hormone balance shifts, your body will be more prone to storing visceral fat around your organs, and that’s dangerous. Excess weight is associated with insulin resistance, type 2 diabetes, high blood pressure, high cholesterol, liver disease, reflux, sleep apnea, gout, and many other chronic conditions, not to mention heart disease and some forms of cancer, and exercise may be the best complement to a vegetable-and-fatty-fish-rich diet for effective and permanent weight loss.

It may even be a necessary complement. One study of 79 healthy postmenopausal women determined that only those women with the highest level of exercise (in the study, that meant taking more than 12,500 steps per day) had normal BMIs! This demonstrates how absolutely essential exercise is during the menopausal transition (although I would argue it is absolutely essential at every stage of life).

To summarize, reduce menopausal symptoms and menopause-associated weight gain by:

  • Doing 20 to 60 minutes of aerobic exercise 3 to 5 days per week.
  • Doing some strength training (like weightlifting) 2 to 3 days per week.
  • Getting more than 12,500 steps per day.

The Effect of Relationships on Menopausal Signs

If you are familiar with my Vibrant Triad (the three necessary foundations for vibrant health), you know what’s coming next: Connection! If you think your menopausal symptoms, especially mood swings, irritability, and feeling especially emotional, are only to do with your hormones, think again. These volatile feelings are also related to stress, body image, life satisfaction, and yes, the quality of your personal relationships.

It’s true that women often experience more mood swings during all hormonal transitions (puberty, postpartum, and menopause), but the intensity of these changes are also related to general health, stress level, financial stress, education, body weight, and a lack of social support. You can’t influence all of these things, but you can reach out to foster relationships with family and friends, and you can work with your primary life partner to improve your relationship by increasing open communication and mutual respect and empathy. Research shows that people with more family and social support have fewer menopausal symptoms, and one study showed that when a marital (or equivalent) partner understands more about what happens during the menopausal transition, marital satisfaction rating rose significantly.

Finally, remember, the best way to get social support is to give it, so be the friend, family member, and partner you wish others to be for you. It’s not always easy, but it can go a long way towards making difficult times easier on everyone.

To summarize, you can improve your relationships to improve your menopause experience by:

  • Reaching out to family and friends when you need support.
  • Helping educate your partner about what happens during menopause.
  • Offering support, kindness, and understanding to others. The good ones will reciprocate!

What About HRT?

A final word about hormone replacement therapy: I would never say that HRT is never a good idea. I have seen it do wonders for many people. I can’t advise someone personally if they are not my patient, but my general advice is not to discount HRT. I only suggest that you get your lifestyle in order first, to see if that takes care of the problem. HRT is great if you need it, and maybe you do, but with a more vibrant lifestyle, you might not need it after all. It’s always worth improving health habits before deciding on pharmaceutical or surgical options.

Most important is to take care of yourself, whatever that turns out to entail. Give yourself what you need. Choose foods, exercises, and friends who make you feel better, not worse. Thing big-picture, not instant gratification. And love yourself the way you would love your best friend, your partner, your child. You are just as valuable, just as worthy, and only you can really feel, by listening to your body, what you need. So listen up, and provide. There is no better time to commit to self-care than during the major hormonal transitional event that is menopause.

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