Women’s hormones have been largely overlooked in healthcare, with misinformation and societal shaming skewing the perception of one of the most important implications of long-term health. The transition into perimenopause and eventually, menopause, is one area where women have been under-resourced in conventional medicine, although it is perhaps the most significant health occurrence in a woman’s life. While the conversation is changing, there is still an opportunity to clarify women’s biological experience and normalize safe and effective support throughout these crucial hormonal transitions.
Women experience three major shifts in hormones throughout their lifespan: the onset of menstruation, pregnancy and postpartum, and the transition into menopause. The perimenopausal phase, or the timeframe before many women have fully shifted into menopause, can be a multi-year transition where estrogen and progesterone start to fluctuate unpredictably. This often occurs years before the final menstrual period and can start as early as the mid-30s. Perimenopause can include symptoms like irregular cycles, hot flashes, night sweats, sleep disruptions, and mood changes – all of which can vary wildly from month to month. Studies suggest upwards of 75% of women experience perimenopause symptoms, but a majority of women do not seek treatment due to lack of education or resources and a cultural consensus that living with debilitating symptoms is a “normal” part of being a woman. While hormone decline occurs naturally in both women and men as they age, less is understood or accepted around the early years of a woman’s transition into menopause.
To continue shifting the conversation away from stigma and towards support, it is important to educate women and normalize care around the natural, biological process of perimenopause.
- Perimenopause is not a sudden “switch”
A woman does not simply wake up one morning with perimenopause. It is a gradual process defined by the transition between a woman’s reproductive years and menopause. Over time, the ovaries begin to produce less estrogen and progesterone gradually and inconsistently. This shift lasts on average four years and can be influenced by genetics, lifestyle, or certain preexisting endocrine-related health conditions. The most common symptom that can indicate the transition into perimenopause is irregular menstrual cycles including skipped periods and/or changes in flow. Other signs can include brain fog, weight gain, insomnia, hot flashes, vaginal dryness, and mood changes. These symptoms start small and slowly intensify as hormones continue to shift, though women can go through a range of experiences with differing timelines. It is important to be aware of any changes, even the most gradual, and track symptoms over time instead of waiting for a severe issue before seeking support.
- Mental health AND brain health matter
It is important for all women to know: your symptoms are not in your head. Especially mental health symptoms. Hormone fluctuations during perimenopause can affect serotonin, dopamine, and other brain chemicals, making this a high-risk period for anxiety and depression. Research shows a measurable increase in depressive symptoms and mood disorders compared to premenopause, especially in women with a history of mental health challenges. Routine screening for mood changes, early access to counseling or cognitive behavioral therapy, and addressing sleep problems can make a significant difference in how women experience the mental health impact of hormone changes.
The gradual and eventual decline of estrogen throughout a woman’s life also greatly impacts brain health itself. Estrogen plays a large role in the structure and function of important areas of the brain linked to memory, cognition, and mood. In fact, reduced estrogen levels over time have been linked to an increased risk of Alzheimer’s disease. In addition to supporting women’s mental health in perimenopause, supporting brain health throughout a woman’s lifespan through targeted hormone-supporting therapies or other lifestyle behaviors is essential to help prevent disease and enhance longevity.
- Hormone interventions are not only beneficial; they are necessary
Many women believe their symptoms of hormone decline are their destiny. That is simply not true. There are many ways to support hormone levels safely and naturally to not only help ease symptoms, but also prevent long-term health effects associated with the absence of these crucial signaling molecules. Estrogen is a protective hormone for heart health, and when levels decrease in perimenopause and more dramatically in menopause, this puts women at risk for cardiovascular events. Women who enter menopause at an early age are at an even higher risk. Hormone changes also affect metabolism which can lead to fat accumulation and lean muscle mass degradation, further elevating the risk of developing heart disease and osteoporosis. While hormone interventions starting in perimenopause can help ease initial symptoms of hormone decline, they can also begin to protect a woman’s future health.
Luckily, there are options for women hoping to find relief for perimenopausal symptoms and continue to support their hormone health for years to come with targeted, personalized care. Bioidentical hormone replacement therapy (BHRT) uses hormones that are chemically identical to those produced by the body (unlike conventional HRT, which uses synthetic hormones). BHRT allows for precise supplementation of hormones that can rebalance the body and restore it to optimal functioning. BHRT should only be delivered by an expert in hormone health and be closely dosed and monitored, with hormones sourced responsibly from trusted compound pharmacies. This personalized approach can help restore hormone levels to their optimal levels naturally and alleviate symptoms such as hot flashes, vaginal dryness, and mood changes. Over time, hormone support can help maintain bone density and protect the heart and brain. Recent studies suggest benefits are greatest when started in healthy women under 60 or within 10 years of menopause onset. Functional medicine providers trained in hormone balance may also suggest support through nutrition, exercise, and lifestyle adjustments as a part of a comprehensive, whole-body approach to care.
- Access & advocacy are essential
Many women enter perimenopause without adequate information or access to care. Women should be empowered with knowledge about their own bodies and be provided with healthcare options that support their lifestyles and safeguard their future health. Unfortunately, stigma and lack of resources limit many women from receiving the resources they need to make informed decisions. Surveys reveal that many conventional healthcare providers receive little training in perimenopause and menopause management, and only offer short appointment times that limit in-depth conversations. Inconsistencies in safe access to hormone replacement therapy, lab testing, or integrative services can also make it impossible for widespread care for most women. Improving care means advocating for better provider training and patient support, and ensuring that women receive unbiased, accessible information about hormone health and what it means for them.
Functional medicine can help fill gaps by offering longer consultations, comprehensive care plans, safe access to hormone balancing therapies, and better patient education, but further system-wide changes are needed to make quality care accessible to all women.
The future of perimenopause care
The first step towards better care for women entering perimenopause is understanding the personal and unique nature of hormone health. Perimenopause is a distinct clinical phase that requires personalized care rather than a one-size-fits-all approach. Perimenopause care through the lens of functional medicine allows for in-depth, targeted care tailored designed to support a woman’s unique biology, symptoms, desires, and goals.
When providers and patients have access to the right tools, treatments, and support, perimenopause care can be normalized and benefit the livelihoods and health of millions of women. It is important for women to recognize symptoms early, do not dismiss them, seek medical providers who will listen and collaborate, and advocate for their right to informed, safe care.
When we integrate evidence with personalized strategies and fight for equitable access, we not only improve women’s health during perimenopause, but we can transform the conversation for the next generation.
To learn more about your options for perimenopause care, speak to our team of functional medicine and hormone health experts today.