Be Well: Preparing for Perimenopause: A How-To

by By Mpls.St.Paul Magazine 

We all have a general sense that menopause is a significant time of transition for women, whether our perceptions are shaped by watching movies, talking with friends and family, or from our own personal experiences. The focus tends to fall on the hormone estrogen, but this story is bigger than just hormones.

Equally important is that perimenopause and menopause typically coincide with years of major family and career shifts as well. The years between the ages of 40 and 55 just so happen to be when children transition away from home. And when careers achieve peak responsibility. And when aging parents start to face health challenges. And when planning for retirement kicks into high gear. These life events individually top lists of life’s biggest stressors. So when you stack them all up, one on top of the other, and add a life-changing biological transition to the mix too … well, it’s no mystery why menopause can be a time when depression strikes, perhaps for the first time in a woman’s life.

That’s a lot to absorb, but according to Tolu Oyelowo, DC, PhD, professor in the College of Chiropractic at Northwestern Health Sciences University, understanding the big picture gives you a chance to move through this transition more smoothly. She notes, “Ideally, the time to start thinking about how you’ll fare during perimenopause and menopause is in your 30s, because you can really cement the health practices that will carry you through these challenging years.

“Women in American society are very go go go, juggling careers and parenting and relationships, so by the time they enter perimenopause, their adrenal glands are zapped, and that’s a problem because you need healthy adrenal glands to make it smoothly through menopause.” The most uncomfortable symptoms of menopause––including depression––are influenced by the fall in sex hormones that occur as the ovaries close up shop. Oyelowo explains that as ovarian estrogen production dwindles, it becomes important to support adrenal health, for the adrenal glands produce the precursor hormones that provide the body with estrogen and other sex hormones after menopause. In effect, estrogen doesn’t completely disappear, but the process by which it’s created changes.

The Interplay Between Adrenal Health + Estrogen

So, if good adrenal health is imperative for a smooth hormonal transition through your 40s and 50s, how best to achieve it? It might surprise you that addressing that go go go lifestyle–– in your 30s (and beyond)––is the key. Chronic stress is persistent life stress without rest and recovery time. Our bodies handle periodic stress quite well, but when stress becomes chronic, it requires our adrenal glands to produce large amounts of cortisol, which in turn impedes the production of estrogen precursors. The result can be estrogen levels that dip uncomfortably low.

“Estrogen influences many functions in the body, including the neurotransmitter balance required for good mental health,” says Oyelowo. “If estrogen levels are too low as a woman enters and goes through menopause, addressing adrenal health becomes vital for bringing hormones back into balance. Some women will also need hormonal support to keep that balance and that’s completely OK.” If you’re currently in your 30s, protecting adrenal health looks like taking the time to build a foundation of good health habits, including not over-scheduling yourself, being active, getting good sleep, being connected to a social circle, and cooking plenty of nutrient-dense foods.

If you’re in perimenopause, menopause, or beyond, pay close attention to the stressors you can control, even “good” stressors like exercise. Oyelowo cautions, “This is not the time to go bonkers on high intensity exercise, especially if your schedule can’t allow adequate time for rest and recovery. You don’t want your body in a permanently stressed state, which impairs estrogen levels. Instead, focus on daily moderate exercise, stretching, and really good nutrition. This is a great time to take an inventory of all of the stressors in your life and dial back where you can.”

Being open to changing your routine is key. Oyelowo described her own experience, saying, “Women in menopause often discover that ‘what always used to work’ no longer does. For example, in my own journey, even given all that I know, it took me a while to listen to what my body was telling me about movement and routine. When I really tuned in, I realized I needed to dial back the intensity to feel really good again.”

Although Oyelowo is now retired from her chiropractic clinical practice, the process she used with patients applies to anyone experiencing menopausal symptoms and signs of depression. After addressing stressors, moderating exercise, adding stretching practices like yin yoga and/or fascia work, and working on good nutrition, the next step is to explore interventions like chiropractic adjustments, acupuncture, bioidentical hormone replacement, and/or supplements like ashwagandha, licorice root, DHEA, and sam-e. (Work with a practitioner before supplementing because all have pros and cons and can interfere with each other and/or other medications.)

Coaching patients to see hormonal balance and depression symptoms through the lens of stressors is a paradigm shift that helps women make clear decisions about where they put their energy. The sooner you can begin creating balanced habits and routines, the more smoothly the perimenopause-into-menopause transition will be.