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Perimenopause 101: WTF is Going On and How to Stay Fit & Healthy

Menopause. “Ugh, the CHANGE.”

How many times have you heard menopause referred to that way?

And always with a scary, negative dun dun dunnn tone, right?

The negative messaging and portrayal around menopause is one issue that leads women to fear it.

In my lifetime (until very recently), I’ve only seen menopause portrayed as something to fear. Our popular culture typically shows menopause as the end of life as we know it, complete with lots of unpleasant changes, and the dreaded drying up of our youth, our athletic potential, and our sexuality and attractiveness.

The other issue is that many women have no clue about what the f*ck is actually happening to them when they experience symptoms of perimenopause.

At some point in middle age, they start to feel strange, new things happening in their bodies and their doctors and friends are telling them “you’re getting older” or “you just need to manage your stress better, exercise more, and get more sleep”.

No one is telling them that what they are experiencing is actually signs of perimenopause.

Sure, we’re told “just you wait” for the obvious perimenopausal symptoms like hot flashes, night sweats, vaginal dryness, wild and unpredictable mood changes (going “menopostal”), weight gain, and no more periods.

All of which we’re told will happen, oh you know, sometime around age 50 … ish.

We are so not prepared for what actually occurs.

And because we’re not prepared for what and when things actually happen, it all feels completely out of control and we have no clue how to manage these perimenopausal symptoms and what to do to handle the widespread, life-changing shifts that occur.

So, it’s time for a reeducation and a reframe around menopause and the menopause transition.

Because understanding these changes can be empowering — as we lose the fear and confusion around them. And when we understand what’s going on and know more about what to expect, we can look for simple lifestyle changes that can help manage the severity and duration of our symptoms.

Having your perimenopause symptoms dismissed by doctors and friends isn’t helping.

Being told that your menopausal symptoms are “natural” and “normal”, so “suck it up” isn’t helping.

And the less we talk about it openly, the more fear and shame women will continue to carry with them and perpetuate for future generations.

So let’s take a factual look at perimenopause and menopause and talk about what these stages are, how the two key hormones, estradiol and progesterone, fluctuate, the common symptoms they trigger, and how you can help manage them through some simple lifestyle changes.

What are perimenopause and menopause?

Menopause is technically one point in time. It’s the date marking 12 consecutive months of no periods. So you are post-menopausal when you’ve gone 12 consecutive months without menstruation.

Pre-menopause is the period before menopause.

Perimenopause is the period between pre-menopause and post-menopause, beginning with the onset of the symptoms of the transition to menopause, which generally start 4-6 years before menopause.

Typically, perimenopause begins between the ages of 36-45 and can last for up to 10 years.

Betcha didn’t know that 👆🏼 little detail, did ya?

What do our hormones actually do?

Pre-menopause, the two hormones – estrogen (primarily estradiol) and progesterone – work together to keep your menstrual cycle running smoothly. That’s the part most of us know.

What you might not know is that, together, these two hormones regulate many different responses within our bodies. Let’s talk about a few key things.

Regulate body composition

Estradiol is our anabolic hormone — like testosterone is for men — meaning that it promotes muscle protein synthesis to stimulate tissue growth and promotes bone remodeling to keep our bones strong. It also helps stimulate muscle strength and function. On the other hand, progesterone acts to suppress muscle protein synthesis to minimize tissue overgrowth and decrease the rate of bone resorption to promote bone density.

Estradiol also plays a role in where our bodies store excess energy and how our fat tissue is distributed.

Regulate immune function and inflammation

Estradiol promotes immune activation, fluid retention, and inflammation. On the other hand, progesterone counters those responses to try to keep things in equilibrium — it decreases immune activation and fluid retention and suppresses inflammatory responses.

Regulate gut bacteria

When estradiol and progesterone are produced by your ovaries, they then pass through the liver and go into the gut to be unbound and biologically activated by the good bacteria in your gut, so they can attach to their respective receptors and be used by your body. As long as these hormones are still being produced and sent into your gut for unbinding and activation, your body will keep a large population and wide diversity of good gut bacteria around to help.

In addition to helping to maintain a good balance of gut bacteria, estradiol also helps limit the permeability of your gut barrier by creating tight junctions between your intestinal cells and keeping the mucosa together. This gut barrier protection also keeps gut bacteria from going through your intestinal wall and getting into circulation, which helps keep inflammation down.

Regulate brain function and mood

Estradiol up-regulates serotonin activity by making more serotonin available in the brain and prevents its reuptake. Additionally, estradiol suppresses serotonin breakdown and increases the density of serotonin receptors.

Sounds an awful like what selective serotonin reuptake inhibitors (aka anti-depressant meds) do, right??

Serotonin isn’t just a mood regulator though — it also has input into the hypothalamus which controls body temperature regulation. So estradiol is an important part of how women’s bodies thermoregulate.

Regulate metabolism, insulin sensitivity, and cholesterol levels

Estradiol regulates glucose metabolism and helps maintain insulin sensitivity, because when estradiol is present, less insulin is needed to get glucose out of your blood stream and into the cells of our tissues where it’s needed.

Estradiol also moderates the release of stored fatty acids into the bloodstream to be used as fuel. Too many free fatty acids circulating in your blood can lead to increases in cholesterol and triglyceride levels. So estradiol also plays a role in cardiovascular health.

Key hormonal changes in perimenopause

So, pre-menopause, estradiol and progesterone work together in many ways to counter balance each other. And the ratios of hormones fluctuate daily based on where you are in your cycle, but they behave in a relatively predictable manner.

In perimenopause, women begin to have fewer anovulatory cycles — which is when a cycle occurs where no egg is produced. Since progesterone is released after ovulation, without ovulation, the ratio of progesterone to estradiol is off. In those cycles, there is what’s called estrogen dominance because, relative to its partner in crime, progesterone, there is more estradiol driving the body’s key responses.

As we discussed briefly above, the balance of these hormones is key for so much of what goes on in our bodies. So to have the ratio be way off suddenly is quite a shock to the system.

As you have more and more anovulatory cycles, your body begins to dial down the estradiol to find balance. There are also increases in follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels in an attempt to jumpstart your ovaries to produce a viable egg for the next cycle.

So, now the levels of hormones are all out of whack and are showing up in wildly different ratios from one month to the next.

Eventually, we end up in menopause with high FSH, high LH, and our progesterone and estradiol flatline at their lowest ever levels and these changes are then permanent.

And it’s not just the levels of these hormones that are constantly shifting through perimenopause — the number and sensitivity of the hormone receptors in our bodies also changes.

So the menopausal symptoms we experience are actually the result of hormone withdrawal.

Symptoms of perimenopause

So, after all of the technical explanation, you’re probably now getting a clearer picture of why this throws just about everything off and just how widespread the effects can be,

As these hormones fluctuate wildly from day to day and month to month, the way our bodies respond to any stressor or change is completely thrown off.

And every system in our bodies that’s affected by estradiol and/or progesterone has to figure out on the fly how to drive the bus without the main bus drivers — and (at first anyway) they aren’t very good at it so there are lots of miscalculations and missteps.

These are what lead to various symptoms common in perimenopause, like hot flashes, night sweats, brain fog, mood swings, restlessness (“tired and wired”), insomnia, inflammation, joint pain, vaginal dryness, low sex drive, increasing blood sugar, cholesterol, and trigylceride levels, and weight gain.

And to make it even more fun, each woman will have different hormone ratios and patterns, so every single woman on earth will have a different perimenopausal experience.

Managing your perimenopause symptoms through diet, exercise, and lifestyle changes

But the good news is that there are ways to manage these perimenopausal symptoms through simple changes to your diet, exercise, and lifestyle.

First, let’s look at some dietary changes:

  • Adequate protein intake stimulates lean muscle development and repair, helps minimize the decline in the functional capacity and strength of your muscles, boosts blood vessel control which helps with regulating blood pressure and body temperature, and modulates serotonin levels for better mood control. Aim for at least 1.8g of protein per kilogram of body weight per day, distributed throughout the day. 

  • Getting enough fiber important for managing cholesterol levels, reducing blood sugar spikes, optimizing nutrient absorption during digestion, keeping your guts healthy, reducing inflammation, and helping you feel fuller on less food volume, which is important if your goal is to avoid weight gain or maintain your current body weight. Aim for at least 30 grams per day, ideally from whole grains, fruits, and vegetables.

Wanna learn more about how nutrition could positively impact your symptoms and dog deeper into why it’s so important to eat well to support your body thru the changes?

Check out our 5-week online course 👇🏻

Second, here are some ways that your exercise can also have a profound effect on your perimenopause symptoms:

  • The training stresses applied to your body during strength training exercises and conditioning improves vascular compliance, which improves dilation and construction of blood vessels, which not only improves vascular health and muscle function, but can also help reduce hot flashes and night sweats in perimenopause.

  • Plyometrics, power training, and high intensity interval training can also improve metabolic health, blood glucose control, and insulin sensitivity to prevent heart disease and diabetes.

  • High intensity or sprint interval training when combined with strength training help to decrease abdominal fat, increase lean muscle mass, as well as improve bone health, blood sugar levels, and glucose metabolism.

  • A solid, moderate volume of exercise with appropriate levels of recovery helps to regulate gut microbiome diversity — which improves your ability to maintain a healthy body composition, so that’s reducing body fat, decreased deep belly fat accumulation, and increasing muscle mass. It also stimulates your gut bacteria to improve the integrity of your gut barrier.

  • High intensity and vigorous physical activity helps manage anxiety symptoms better than lower or moderate intensity exercise.

  • Regular exercise helps you manage stress better and improves sleep quality and quantity.

And finally, changes to your lifestyle can also be hugely beneficial for managing symptoms of perimenopause:

  • Having a solid stress management plan can help reduce anxiety levels, down regulate your nervous system, and help you sleep better.

  • Good sleep hygiene makes it easier to make good dietary choices and get your workouts in regularly and it improves your ability to recover from training and life.

Simple changes can help your body adjust to this transition 

So heck yeah, things are changing at the molecular level during perimenopause.

And no, you’re not going crazy and it’s definitely not all in your head.

By understanding the significant and widespread changes that occur in perimenopause and being proactive through simple lifestyle changes, we can manage the symptoms better and move through midlife with more confidence.

But just because these changes are “simple”, doesn’t make them easy to make. Odds are, this will require you to make significant changes to the way you’ve been doing things in your life at a time when your plate is already pretty damn full.

And that can feel overwhelming.

Luckily though, you don’t have to make these changes all at once or figure it out on your own.

Our experienced coaches can work with you one-on-one to create a roadmap from where you are to where you want to be in a way that aligns with your personal values and keeps space for what’s most important for you.

We’ve helped many women take control of their health and fitness and get their life back without needing to overhaul their whole lives all at once. 

Read more about our coaching and package options here.

Curious about coaching and how it could benefit you? Schedule a no-obligation, no-pushy-sales-tactics discovery call with our CEO and Head Coach below.

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Hi, I'm Alison

I’m the Founder + CEO of Miles To Go Athletics.

My own journey has taken me from always-injured-and-in-pain-farthest-thing-from-an-athlete in my 30s to ultramarathoner + competitive weightlifter in my 40s and beyond. So I firmly believe that athleticism is accessible to EVERYONE and is actually the key to better quality of life.

My team + I are here to help you stop putting your life on hold due to pain, injuries, and “getting old” and instead get back to the things you really want to be doing – like being active with friends & family, chasing bucket list goals, and feeling badass at any age.

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