Treatments for Perimenopause that Actually Work

Common Symptoms of Perimenopause and Menopause

I wanted to title this post "Female Bodies have All the Luck" or, as a client succinctly stated, "F* this Sh*t."

As you may have already discovered (weeeee!), perimenopause is a 2-8 year phase that occurs before menopause. Menopause is the cessation of menstruation, medically defined as 12 consecutive months with no periods. Perimenopause often starts during a woman’s late 40s to early 50s, but can start as early as mid-30s. In this article, I'm focusing mainly on perimenopause because this is the time when many symptoms mysteriously start arising and fluctuating - sometimes slowly, sometimes quickly. It's a blurry and confounding time for a lot of us and it'd be real nice to have meaningful supports in place so we don't navigate this alone or without answers. Thankfully, there are a number of treatment strategies from Eastern and Western medical traditions that can absolutely help us reclaim our health, bodies and our lives.

Due to vacillating hormones, perimenopause is characterized by numerous physical and emotional complaints, including irregular periods (shorter, alternating months, close or further apart), hot flashes, mood swings, headaches, weight-gain, forgetfulness, brain fog, musculoskeletal syndrome (physical pain), low libido, vaginal dryness, sleep disturbances, and more(!). While perimenopause and menopause are natural processes, treatments are sorely under-researched and it’s been largely not talked about, even though symptoms can be considerably uncomfortable and disruptive.

Different systems of medicine offer varying perspectives and approaches to perimenopause. Worth fleshing out since a more comprehensive, comparative list of treatments will give us a more robust toolkit for navigating this phase of life. 

If you’ve been suffering in silence, please know that there are a myriad of options available that can help alleviate or greatly reduce unwanted symptoms. The keys are finding knowledgable and compassionate healthcare providers and getting hormones tested regularly. This will help you figure out what you specifically need, as you need it, so that you can get ahead of symptoms early.

If you're seeking alternates to standardized allopathic Hormone Replacement Therapy (HRT), there are naturopathic, integrative and functional bioidentical options that can be just as effective, with potentially less side effects. If you are open to acupuncture, you can receive relaxing treatments that help reduce if not entirely alleviate symptoms altogether. I have a number of female clients who get weekly or biweekly or monthly treatments for perimenopause and they are doing great - just with acupuncture alone. If we then add-in herbs, homeopathic remedies and/or an bio-identical micronized estradiol cream, for example, you’ve got yourself a home run. The trick is finding and utilizing the approaches that best match your particular needs at different phases of the month and throughout this transition of ongoing change.

There are many treatment options to choose from. Since I'm not a medical doctor, I'm not an expert on allopathic approaches nor am I proposing one method over another - please don't let this substitute for professional medical advise and be sure to consult your physician/gynecologist before adding anything into the mix. I simply want to offer a brief overview of the different philosophies and treatment strategies available in the fields of Western Medicine, including Functional & Integrative, Chinese/Eastern Medicine, Yoga Therapy, and Homeopathy.

First, a few general Self-Care ideas:

• Stay active: some kind of movement/exercise daily.

• Stay hydrated, drink enough water, add electrolytes as needed.

• Prioritize sleep & get adequate rest.

• Take breaks throughout the day, especially when work is intensive.

• Talk to your friends and share resources.

• Enjoy a nutrient-dense, iron-rich, hight fiber whole foods diet and chew food mindfully.

• Avoid excess spicy foods, alcohol, caffeine - coffee is particularly tricky.

• Regularly test your estrogen, progesterone, testosterone, cortisol and DHEA levels.

• Vitamin D, Mag. Glycinate & Omega-3s are generally helpful when taken as instructed.

• Allow emotions to passage through, turn towards yourself with kindness, ask for support.

Allopathic (Western) Medicine: Approaches to Perimenopause

In the world of Western medicine, we understand that the symptoms associated with perimenopause are due to progressively declining levels of estrogen, progesterone and testosterone. As women age and our egg stores dwindle, our ovaries produce less estrogen, which can cause the hypothalamus (the brain’s temperature regulation center) to become more sensitive to small changes in body temperature. The brain then misinterprets normal body temperature as too high, triggering cooling responses, such as dilating blood vessels (leading to hot flashes) and activating sweat glands (causing night sweats). It’s all the body’s attempt to regulate temperature in response to hormonal shifts. These faulty attempts can also cause frequent waking and poor sleep quality. Decreasing progesterone levels are often linked with sleep disturbances, and low estrogen and progesterone can lead to perimenopause induced sleep apnea - where the body’s ability to maintain open airways is compromised, causing sudden and frequent waking. Low testosterone is commonly associated with low energy, brain fog and a reduced libido.

The primary allopathic treatment for perimenopausal and menopausal symptoms is Hormone Replacement Therapy (HRT). Estrogen, progesterone and/or testosterone are often prescribed to reduce the above-mentioned symptoms. It's pretty wild how much hormones play a role in women's health and the field of HRT is finally getting the attention it deserves. At long last, modern treatment strategies are more precise and tailored to individual women’s needs. With careful testing, administration and monitoring, HRT offers impressive benefits and poses much less longterm risk.

Western physicians also prescribe non-Hormonal medications, such as SSRIs and gabapentin, which have been shown to be effective in treating perimenopausal symptoms. These options are especially helpful for people who can’t take HRT due to hormone related cancer risk, etc.

Functional & Integrative Medicine: Common Recommendations for Perimenopause

Functional, Naturopathic and Integrative traditions follow a similar paradigm of understanding regarding perimenopause, though the approach to treatment is somewhat different. The emphasis here is on a nutrient-dense, whole-foods, protein and fiber rich diets, and consistent exercise. Carefully tailored bioidentical and non-bioidentical hormone treatments are commonly prescribed. General wellbeing supplements like Vitamin D, Magnesium, and Omega-3s are often recommended. Single herbs as well as combination herbal formulas can be very helpful.

Listed below are a few herbs that help manage symptoms of perimenopause. As always, consult a physician.

Black Cohosh - can reduce hot flashes, night sweats, and mood swings.

Chaste Tree Berry - supports hormonal balance by influencing the pituitary gland. Can help with hot flashes, irregular cycles, breast tenderness, and mood changes.

Maca Root - an adaptogen that helps with hormonal balance, energy, and mood. Can reduce stress and support overall vitality.

Dong Quai - helps balance estrogen levels and reduces hot flashes and menstrual irregularities.

Evening Primrose Oil - Can relieve the severity, frequency, and duration of hot flashes. During pre-menopause, it helped me with breast distention. Every body is different.

Functional and Integrative approaches tend to highlight gut health (diet, pre & probiotics) and stress reduction via meditation, yoga, vagal toning, etc. As is generally the case, a healthy, balanced diet and stress reduction can go a long way in reducing inflammation and perimenopausal symptoms.

Chinese Medicine and the Treatment of Perimenopause

From a Chinese Medical perspective, perimenopause involves a gradual decline in Qi, Yin and blood. Common TCM Diagnoses Related to Perimenopause include but are not limited to:

• Kidney Yin Deficiency: characterized by symptoms of hot flashes, night sweats, dryness, insomnia, and irritability.

• Kidney Yang Deficiency: associated with cold sensations, fatigue, water retention, and low libido.

• Kidney Qi Deficiency: can involve urinary issues, back pain, and feelings of exhaustion.

• Liver Qi Stagnation: can manifest as mood swings, irritability, breast tenderness, and digestive issues.

• Heart and Kidney Disharmony: often linked to anxiety, palpitations, insomnia, and emotional instability.

• Phlegm and Blood Stasis: shows up as weight gain, bloating, and irregular menstruation.

Understanding the specific pattern of imbalance is essential in determining the most appropriate treatment strategy. Treatment strategies include balancing Yin and Yang, tonifying Yin, nourishing the Kidney Yin and/or Yang, resolving Liver Qi stagnation and so on. Along these lines, Chinese Medical herbalists select ingredients based on an individual’s patterns, and prescribe both single herbs like Black Cohosh and personalized formulas based on a person’s specific needs.

During an acupuncture treatment, tailored points are selected to harmonize your specific imbalance and hormonal fluctuations. Moxibustion (the heat emanating from burnt mugwort) can stimulate certain points to provide warmth, break up stagnation and increase circulation. Acupuncture and it's accompanying healing modalities help alleviate the intensity, frequency and duration of hot flashes, night sweats and other symptoms. Consistent acupuncture treatments often enhance sleep quality, energy levels, weight regulation and overall emotional and physical wellbeing.

In Classical and Traditional Chinese Medicine, diet is pretty much always a huge determinant of health. Consider “food as medicine.” To harmonize imbalances during perimenopause, it's recommended that women include more Yin-nourishing foods like black beans, adzuki beans, kidney beans, black sesame seeds (a few), seaweed, dark leafy greens, walnuts, pears, and barley. Cooling foods clear heat. They include, but aren't limited to: lettuces, cucumbers, watermelon, jicama, mung beans, and tofu. Tofu and soybeans can be particularly helpful for estrogen-deficiency because of their the high concentration of phytoestrogens.

Foods that aggravate perimenopausal symptoms and are best avoided include spicy, fried, and overly stimulating foods like caffeine and alcohol, both of which exacerbate heat symptoms like hot flashes. Coffee is thought to deplete Kidney Yin (a root cause of perimenopausal imbalances). As always, lifestyle plays an important role in symptom progression, so practices that reduce stress and increase circulation like walking, meditation, Tai Chi and Qigong are often suggested. 

Yoga Therapy for Perimenopause & Menopause

Yoga calms the nervous system and dissolves stress by slowing thoughts through the mindfulness of breath and movement/sensation. Yin-nourishing poses like Child's pose, Cat-Cow, Supported Bridge, Bound-ankle, gentle twists, forward bends, and Legs Up the Wall all resource the parasympathetic aspect of the nervous system, improve circulation, and up-level mood. Through regular practice, yoga lowers stress hormones and hyper-arousal, helping practitioners manage anxiety, mood swings, and sleep disturbances no matter what their cause. 

For perimenopause, and menopause, it's recommended to practice a yin-nourishing sequence of poses twice per day. Typically, a set would take 10-15 minutes, so not a lot of time invested for an impressive ROI.

Reduce or eliminate perimenopausal symptoms with these Yoga Poses. Thank you Tummee :)

Homeopathic Remedies to treat Perimenopausal Symptoms

Homeopathy offers various remedies that help ease and sometimes even alleviate the symptoms of perimenopause and menopause. To find the best-match remedy, homeopaths focus on an individual's specific symptoms as well as their overall constitution. While it's always best to refer to a specialist, test-driving a 30x, 6c or 12c potency 1-2x/day for a few days can clue you into whether it's a right or wrong match. A well-matched remedy can provide acute as well as lasting relief. The most frequently prescribed homeopathic remedies for perimenopause are:

1. Lachesis - Useful for women who experience intense hot flashes, especially with sweating, palpitations, and irritability. Symptoms may worsen during sleep or on waking. It is also recommended for women who feel worse from tight clothing around the neck or waist and may have a tendency towards passion/jealousy and/or emotional eruptions.

Key Symptoms: Hot flashes, mood swings, left-sided symptoms, feeling of constriction.

2. Sepia - Often recommended for women who feel emotionally flat, indifferent, or overwhelmed by their responsibilities. It’s also useful for those experiencing low libido, vaginal dryness, and a general sense of lethargy. Key Symptoms: Indifference, fatigue, irritability, prolapse or weakness in pelvic organs, vaginal dryness.

3. Sulphur - Indicated when a woman experiences frequent hot flashes that rise to the head, accompanied by a burning sensation and redness in the face and chest. It’s helpful for those who feel hot in general, especially at night, leading to restless sleep. Key Symptoms: Hot flashes with redness, heat intolerance, restlessness, itching, and irritability.

4. Pulsatilla - great for women who are highly sensitive, weepy, and/or seek comfort and reassurance. It’s often used when symptoms are changeable and there is a tendency to feel better in fresh air and worse in a stuffy/warm room. Key Symptoms: Mood swings, tearfulness, changeable symptoms, hot flashes that improve with cool air, need for reassurance.

5. Graphites - indicated for weight gain, constipation, and skin issues like eczema or dryness during perimenopause. It’s also helpful for those who feel cold and sluggish, with a tendency toward depression. Key Symptoms: Weight gain, constipation, skin issues, coldness, sluggishness, low mood.

6. Belladonna - for sudden and intense hot flashes, especially when accompanied by a flushed face, throbbing headaches, and sensitivity to light. It’s ideal for women who experience sudden overheating and sweats, often with a pounding pulse. Key Symptoms: Sudden, intense, throbbing hot flashes, flushed face, headaches, sensitivity to light.

7. Ignatia - indicated when strong features of perimenopause include grief, emotional distress, or depression. Helpful for mood swings, with alternating periods of sadness and anger, and a sensation of a lump in the throat. Key Symptoms: Grief, emotional distress, mood swings, sensation of a lump in the throat, sighing.

8. Cimicifuga (Black Cohosh) - recommended for women experiencing emotional symptoms like depression, anxiety, and/or gloominess. Helps relieve back pain, headaches, cramping pain that extends down the legs, and a heavy feeling in the lower abdomen.Key Symptoms: Depression, anxiety, heavy menstrual flow, physical pain, headaches.

9. Calcarea Carbonica - suited for women who feel overwhelmed, anxious, and easily fatigued. They tend to be organized and responsible - though not always. It’s also helpful for those experiencing hot flashes, night sweats, and weight gain, especially around the abdomen. Key Symptoms: Fatigue, anxiety, hot flashes, night sweats, weight gain, excessive sweating that is often cool or clammy to the touch.

10. Natrum Muriaticum - helpful for women who are emotionally reserved, prone to depression, and experience dryness of the mucous membranes or post nasal drip. It’s especially helpful for women who have a history of grief and emotional trauma. Key Symptoms: Emotional reserve, dryness, headaches, depression, grief.

It's important to keep in mind that Homeopathic remedies are highly individualized, meaning that the remedy should match the specific symptoms and overall constitution. It's best to consult with a qualified homeopath to determine the most appropriate remedy and potency for you.

Please note: I do not recommend that people take homeopathic remedies based on the instructions on the "littlle blue tubes." Start with a low potency, like 6c, 1 pellet under the tongue 1-2x/day when symptoms are present. If you get some traction, you can increase to 12c and see how that goes. Once symptoms abate, pause the remedy, only start up again if symptoms stop improving (plateau) or return. Remember: Less is more - no need to kick a ball already rolling down the hill.

Conclusion - you made it!

As you can see, all of these approaches differ in some ways and also overlap. While the understandings and treatments might vary, we can borrow from some or all of them (and other traditions) to create a comprehensive support plan that best matches our particular needs. A well-rounded care plan with a team of supportive and knowledgable providers can make perimenopause and menopause absolutely manageable, if not an illuminating venture!

If you'd like to schedule an acupuncture, intuitive or combination healing appointment, please don't hesitate to reach out. You can book directly via the site or text/call 917 519 2432 or email britta@intuitivehealthhealing.com.

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Bonus! While perimenopause is often associated with challenges, this developmental phase is also laden with profound opportunities for personal growth - as most adversities are. Perimenopause and Menopause can invoke more:

Self-Awareness and Clarity: Perimenopause can foster deeper introspection, prompting us to re-evaluate our lives, priorities, and relationships. The clarity helps us come into our authentic selves and home in on what truly matters.

Empowerment and Independence: Hormonal shifts can also bring a sense of empowerment. This may be a potent time of setting boundaries, expressing needs, and making decisions that prioritize our own well-being.

Creativity and Transformation: With all that mojo shifting away from reproduction, we may notice surges in creativity. Now's a great time to explore new interests, careers and relationships.

Inner Wisdom: As we transition through perimenopause, we can tap a deeper reservoir of wisdom. Emotional maturity and trusting our own intuition/power are hallmarks of this time. We shift from outwardly nurturing to inner expansion and higher expression.

Freedom from Reproductive Cycles: With the tapering of menstruation, many female bodies experience relief, greater stability and ease.

I wish you the resolution of any and all physiological and emotional symptoms and I also pray that perimenopause will serve as a powerful journey toward self-realization.