Last week when discussing how sometimes what looks healthy on paper can become unhelpful in practice, I mentioned that the high point on the inputs-vs-results bell curve moves due to a variety of factors—and that inputs will likely need to change as the context in which they’re applied changes.
Today I’ll briefly discuss a prime example of a physiological shift that prompts adjustments—along with some high-level suggestions on where those adjustments might matter most.
That example is perimenopause.
As I heard during a recent conversation on the topic, “Personal experience is showing me that what used to work doesn’t anymore…”
Understandably, that can be really frustrating.
(While this may not apply to you personally, it likely applies to someone you care about. And understanding it can make you a better partner, coach, or friend!)
What’s actually happening
In The New Menopause, Mary Claire Haver, MD explains:
A woman’s menopausal journey is made up of three discrete medical stages: perimenopause, menopause, and postmenopause. By definition, these are different stages, but in terms of experience they can feel very much the same.
The reason symptoms can be similar throughout the stages of menopause is that they are all caused by deprivation of sex hormones (estrogen, testosterone, progesterone) that results from the decline and eventual end of ovarian function.
She goes on to say that research shows the average duration of symptoms during the transition lasts about seven and a half years, increases to roughly twelve years for women who reported earlier experiences with hot flashes, and includes far more symptoms than the commonly known hot flashes and night sweats.
Some of those symptoms include:
- Headaches or backaches
- Joint or muscle pain
- Irritability, depression, or anxiety
- Unusual tiredness or sleep disturbances
- Brain fog or memory issues
- Body composition changes and prediabetes
- Decreased muscle mass and bone density
While each woman’s experience will vary, Haver points out that the list of symptoms often remains the same throughout the entire transition, but their severity can fluctuate dramatically.
What to do about it
In both Haver’s personal and medical experience, many people think that not much can be done about menopause symptoms. But that seems to be the case more so because of the minimal research that has been done on the topic (in relation to other medical categories) than on the validity of the belief.
As a consequence of the minimal research, most medical practitioners receive very little training on it. Haver—who is currently in her late 50s—claims that her generation of medical students received “maybe a one-hour lecture in medical school and another six hours in residency”.
Fortunately, a variety of adjustments can be made to improve symptoms.
Again, from Haver:
One point that became clear after reviewing hundreds of studies is that there are universal truths about how we create good health after menopause.
The first truth: Good menopausal health is not an accident.
And the second: It is never, ever going to be achieved as a result of a single pill or supplement or treatment. It is instead the result of adopting a collection of daily behaviors and habits that many of us may have previously neglected (or that we just “got away with” being inconsistent about in our younger years).
Different symptoms of course require different solutions—and not quite half of the book is dedicated to the details of her Menopause Tool Kit recommendations.
Obviously, I can’t cover everything here, but here’s the overview of her recommended Best Practices:
Movement
Changes to body composition are often met with the view that “more cardio” is the solution. In reality, it’s only a small part; building and retaining muscle mass is the often overlooked component.
(This claim is backed by others as well, specifically exercise physiologist Stacy Sims and Dr. Gabrielle Lyon—whose book, Forever Strong, is directly recommended by Haver.)
Ultimately, prioritize:
- Starting or continuing resistance training—gradually increase weights and take longer breaks (this isn’t “cardio with weights”)
- Cardio training that varies between “long, slow distance” and “power repeats”
- Daily stretching
Nutrition
Consistency and an anti-inflammation focus matter here. While Haver suggests considering intermittent fasting for anti-inflammatory benefits, I’ve heard opposing views from others. In any case, you can’t go wrong by eating real food.
A few other high-leverage adjustments include:
- Increasing protein intake—Haver recommends 1.3-1.6 grams of protein (daily) per kilogram of ideal body weight, although higher intakes could potentially be helpful in some cases
- Reduce added sugars—fruit, for example, shouldn’t be an issue in moderation
- Increase fiber to a minimum of 25 grams per day
Supplementation (when appropriate)
As I mentioned above, eating real food is optimal—including as the foundation for obtaining necessary nutrients.
But in certain cases, supplementing can be a simple addition that promotes consistency.
The first options to consider potentially include:
- Fiber (especially if grains are an issue for your digestive system)
- Omega-3 fatty acids (if you don’t eat much fatty fish)
- Vitamin D (Eggland’s Best eggs are great whole-food options for this—and they’re reasonably high in Omega-3s)
- Creatine (especially if you don’t eat much red meat)
Recovery & stress reduction
Coffee, alcohol, and blue lights from screens (e.g. TV, smartphone) are ubiquitous. But small daily inputs compound, both positively and negatively. Since these can all mess with sleep quality, strongly consider their use.
Additional options include:
- Getting sunlight—for vitamin D and the brain’s production of serotonin, which is linked to mood and well-being
- Spending time in nature—for its stress-reducing benefits
- Personal preference strategies like yoga, meditation, journaling, setting healthy boundaries, spending time with friends…
Pharmacology
Hormone Replacement Therapy (HRT or MHT—Menopausal Hormone Therapy) has been controversial for years. Early research from the late 1990s and early 2000s shaped much of the public perception around risk—but many discussions emphasized relative risk numbers without always putting absolute risk into context.
More recent analyses have refined our understanding.
HRT isn’t appropriate for everyone—but it also isn’t the blanket danger many were once led to believe.
If symptoms are significantly affecting quality of life, discussing options with a knowledgeable, up-to-date practitioner may be worthwhile. Not all practitioners approach this option the same way, and finding one who stays current and collaborative matters.
If you live in the Milwaukee area, consider a consultation with Alyson at Midlife Midwife MKE. A couple women I know have had great experiences.
Putting it into practice
If you’re navigating perimenopause, no single change will magically fix every symptom. But slow, steady, and consistent change can make a big difference in the long run.
The most potentially impactful strategies—because they seem to be the most uncommon in regular everyday practice—include:
- Prioritizing resistance training
- Increasing protein and fiber intake
- Protecting sleep and recovery
- Discussing persistent symptoms with a knowledgeable provider
This phase doesn’t require resignation.
It requires strategy.