By
Melbourne Functional Medicine
Rebecca Hughes
Medically reviewed by:
Are you noticing changes in your cycle, such as:
If so, you might be entering the perimenopausal window, and it’s often earlier than many expect. Many women start to notice these signs in their late 30s and early 40s, indicating that ovarian response may be waning.
Understanding hormonal changes
Your blood test may or may not reflect these changes you’re experiencing. Sometimes, Follicle Stimulating Hormone (FSH) rises on day two of your cycle to stimulate ovulation, while progesterone may begin to decline between days 19 to 21, which can contribute to shorter cycles. Declining progesterone might also explain premenstrual anxiety and poor sleep.
This is a perfect window for support, both for managing symptoms, and also to optimise your health for the perimenopausal transition, which can be challenging for some women.
Functional medicine can support your reproductive and hypothalamic-pituitary axis to strengthen ovulation, support mood before the period, and modulate the rise and fall of oestrogen.
Further consideration ought to be given to lifestyle choice and the health of the adrenal and nervous systems.
Listening to your body
Perimenopause can be unpredictable, leaving many women feeling confused and vulnerable. It’s a topic that often isn’t well understood or discussed within families and communities, which can lead to feelings of inadequacy rather than recognising these changes within a broader biological context.
In our 20s and 30s, our bodies can adapt to various situations - late nights, intense physical activity, and stress. However, the biology of perimenopause affects neurochemistry, connective tissues, body composition, sleep, hormonal systems, digestion, stress response, and libido. Essentially, it impacts nearly every aspect of your health.
As your biology changes, it’s essential to adapt and respond to your evolving needs for optimum results. What once worked may no longer be effective, so respecting what your body needs is vital. After all, arguing with biology rarely ends well - the body will always win.
Here are some key areas where you can develop habits to support yourself throughout the 5 to 10-year perimenopausal journey:
1. Nutrition
As we age, insulin sensitivity can decline. Now is the time to refine your diet by paying attention to the glycaemic load of your meals. Aim for adequate protein at each meal and replace grains with vegetables where possible. Incorporate legumes for slow-burning carbs that also benefit your microbiome. While it’s not necessary to cut grains out entirely - since they can support your mood - try not to rely on them as the foundation of your diet.
2. Movement
Building muscle mass directly improves insulin sensitivity. Women typically have less muscle mass than men and may not prioritise strength training as much. While we may lack the testosterone to build muscle rapidly, we do have oestrogen, which is also anabolic.
Make the most of this while you still have ample oestrogen!
Focus on complex movements that target the hamstrings, quads, and glutes with challenging weights. If you’re new to weight training, consider working with a trainer to gradually progress to challenging weights.
Fun fact: testosterone levels transiently increase in women during weight training!
3. Sleep
You may find that napping becomes necessary to cope with the demands of your busy social and work life. Now is the perfect time to re-evaluate what’s truly important and establish healthy sleep habits.
Quality sleep is essential for regulating hormones, especially during this time of hormonal flux. If you notice that warmth disrupts your deep sleep, consider adjusting your sleeping environment and pre-bedtime eating habits. Foods and drinks that raise your basal body temperature - like those requiring detoxification - can interfere with restful sleep.
Also, explore herbs like zizyphus and hops to help draw your body temperature down.
4. Mind
This is the most critical time of your life to treat your nervous system well.
Understanding when you’re in sympathetic overdrive (flight or fight) and how to actively move yourself to a parasympathetic (rest and digest) state is super important. Learn it, and practise it repeatedly during this hormonal transition. Mastering this is going to be your life vest some days.
Thankfully there’s a great deal of awareness around devices that track sleep, heart rate variability and stress; as well as techniques and tools to affect those.
Practising breath control is one strategy you can do anywhere - in your home, car, or even a toilet cubical. Overbreathing or hyperventilation sends a stress signal to our body, signalling threat or danger, the need to survive. Oftentimes we’re simply unaware or not tuned in to how our environment is affecting our breathing. The goal, which may seem counterintuitive, is to slow down breathing. You can learn simple techniques like 4-7-8, box breathing, diaphragmatic breathing, and different yogic breathing techniques. Attend a breathwork class for some inspiration.
Other habits to develop and learn are meditation, mindfulness and somatic techniques to help ground the body; hatha or iyengar yoga (not flow or ashtanga, as these are too dynamic for the desired effect), tai chi, walking in nature, and gratitude practice.
Therapeutic techniques such as massage, acupuncture, red light therapy, and float tanks are also worth exploring.
I recommend tracking your cycles to gain insight into where you’re at in the hormonal continuum. It also provides context for those days when you wish everyone would leave you alone so that you devote yourself to eating your body weight in chocolate! I recommend the app Flo, which offers useful features in its free version.
You may also want to experiment with tracking metrics like heart rate variability, sleep quality, and blood glucose. This data can motivate you to stick to new habits. For more detailed insights, Welltory offers a comprehensive interface for tracking these parameters. To monitor blood glucose, consider using a continuous glucose monitor, which we can provide access to in our clinic.
If all the gadgets and apps provoke anxiety or despondence at any time, simply listen to your body. It will tell you what it really needs.
Navigating perimenopause involves managing both physical and emotional changes. By recognising your body’s signals and adopting healthy habits in nutrition, movement, sleep, and stress management, you can better prepare for this transition. Respect your body’s needs and adapt to its changes.
Empower yourself with knowledge and seek support through functional medicine to alleviate symptoms and optimise your health. Listen to your body, track your progress, and be gentle with yourself as you embark on this journey toward a healthier, balanced life.
