The Journey of Perimenopause

You are not losing your mind. You are losing your hormones.

Dr. Leslie Peterson, N.D.

You suddenly realize you don’t feel like yourself. Something has changed in your body, and even though you know you’re “doing all the things” to try and be healthy it all seems to be getting worse. Your moods are unpredictable, your periods too. And you couldn’t care less about having sex anymore because you feel so fat and moody!

Those mysterious symptoms of mood changes, weight gain, fatigue, period fluctuations, PMS and the loss of your libido are due to the normal changes associated with the loss of your ovarian function, and consequently — your hormones. Known as Perimenopause, this transition from normal, monthly, predictable cycles to the complete cessation of bleeding (menopause) can span 10 years or more, and for some women may begin in their 30s.

Nature has a plan for women, and that plan to reproduce (whether you do or not), is only good for a few decades. You are born with all the eggs you will ever have, and those tiny little eggs, and the follicles that hold them, are responsible for the production of your essential hormones: estradiol, progesterone and most of your testosterone.

This predictable monthly rhythmic hormonal dance is responsible for controlling over 400 systems in your body, and thousands of your genes are signaled to work optimally in the presence of this miraculous symphony. But it doesn’t last for long, and once your eggs begin to run out, your hormonal production begins to wane and loses its rhythmic potential and signaling. This is what causes your symptoms. It isn’t anything you are doing wrong! Welcome to midlife.

How can you tell if what you’re experiencing is related to your hormonal changes, and is there anything else you can do about it? The underlying state of your health can have a huge influence on the trajectory of your perimenopausal transition. Underlying gut microbiome issues, chronic stress and cortisol dysregulation, environmental toxin exposures, poor nutrition, long term birth control use and certain chronic medical conditions can all contribute to making your perimenopausal transition more challenging. Evaluating the foundational state of your health may include testing for your thyroid, iron, blood sugar, lipids, micronutrients, cortisol and your hormones.

The unpredictable nature of perimenopausal hormones can make testing your hormones a challenge. I recommend that you begin to track your hormones with a Mira (opens in a new tab) device so you can begin to connect the dots of your symptoms and hormonal production and patterns. Using comprehensive urinary hormone testing, such as DUTCH, can also reveal patterns in your hormones that can be addressed with targeted nutrition and supplementation when appropriate.

Perimenopause is a great time to establish a baseline of your health, to gather information so that you know how best to focus your energy and efforts as you move toward and through menopause, and to support your decision-making around the use of hormone replacement (HRT), and support your living your best and healthiest life as you age!

I hear HRT is good for me! When can I start?

Depending on your symptoms as well as your general overall hormonal production patterns, hormone replacement can begin anytime. Many studies point to improved long term health when HRT is initiated before the complete decline at menopause.

Maintaining your normal monthly rhythmic cycling hormones can continue to support your health and longevity. Early in perimenopause, this might look more like supporting your ovaries with nutrition, herbs, addressing underlying chronic health conditions and managing stress. As you move through perimenopause and your hormones continue to decline, introducing hormone replacement therapy in a way that works for you and your body can transform your health, your moods, your life and your longevity goals!

My approach to perimenopause

  • Assess and address your foundational health so you know how to target your energy and efforts
  • Identify areas of your health that may be interfering with your normal ovarian function, and treat to restore normal, healthy function of your body’s systems
    • Cortisol and Thyroid dysfunction
    • Gut microbiome imbalance
    • Immune system dysregulation
    • Cardiometabolic diseases such as prediabetes, insulin resistance, hypertension, high cholesterol
  • Establish good lifestyle habits
    • Sleep!
    • Move your body regularly — Dance!
    • Don’t let stress run the show
    • Reduce exposures to toxins as much as possible
    • Get out in Nature
    • Seek support as you need, for emotional well-being
    • Manage your weight
  • Personalized supplementation. Enhanced nutrition as well as targeted nutraceutical stacks are intended to build and restore your best health, and support you in a powerful practice of self-love: the regular use of high-quality supplements.
  • Clean up your diet
  • Hormone Replacement and Restoration
    • Progesterone to balance estrogen fluctuations, help with sleep, calm the brain and moods
    • Testosterone to support well-being, improve muscle tone and building, help with weight loss, libido, moods and energy
    • Estradiol to support everything, when it is determined that your body is ready.

    What I call being “hormone ready” means your body is prepared to make good use of the hormones we add. Some women are ready to begin right away; others need to work on their gut health, their detox pathways or their cardiometabolic health first. Testing tells us which.

Questions women ask me

What is happening to my body?

Your ovaries are gradually winding down. The eggs you were born with are what produce your estradiol and progesterone, and as they run out, those hormones stop rising and falling in their old, predictable monthly rhythm. This is perimenopause: the years of change between regular cycles and your final period. It is normal, and it is not something you are doing wrong.

Why am I not feeling like myself?

Your hormones signal systems throughout your body — your mood, your sleep, your energy, your metabolism and your sex drive among them. When that signal becomes unpredictable, all of those systems feel it, sometimes at once. The underlying state of your health matters too: stress, gut health, nutrition and other conditions can make the transition harder. That is why I start by looking at the whole picture.

Why did no one prepare me for this change?

I hear this question more than almost any other. The early signs of perimenopause — a change in your cycle, your sleep or your mood — are easy to put down to stress or a busy life, and they can begin earlier than many women expect. Part of my work is giving you the explanation you didn’t get, so the changes stop feeling mysterious and start making sense.

What can I expect in the future?

Your cycles will gradually become less predictable, and in time they will stop altogether; menopause is that complete end of bleeding. How the years in between go varies a great deal from woman to woman, and the underlying state of your health has a big influence on it. Perimenopause is a good time to establish a baseline, so that you know where to focus your energy as you move toward and through menopause.

What is the best way to test my hormones?

Because perimenopausal hormones are so unpredictable, a single test only shows one moment. I recommend tracking your hormones at home with a Mira device, so we can connect your symptoms to your actual hormone patterns over time. Comprehensive urinary hormone testing, such as DUTCH, shows more about how your body produces and processes your hormones. Alongside these, I look at your foundations: thyroid, iron, blood sugar, lipids, micronutrients and cortisol.

Can I take hormone replacement, and if so, when can I start?

Possibly — and the answer is personal. Whether hormone replacement is right for you, and when to begin, depends on your symptoms, your hormone patterns and your health history, which is exactly what we look at together. Early in perimenopause, support often starts with nutrition, herbs, addressing underlying health conditions and managing stress. As your hormones continue to decline, hormone replacement can be introduced in a way that works for you and your body, when your body is ready for it.

Are there alternatives to hormone replacement? I just want to do this “naturally”.

Yes, there is a lot we can do. It starts with your foundations: sleep, movement, stress, and an anti-inflammatory way of eating. Then we look at what may be getting in the way — your gut, thyroid, cortisol or blood sugar — and use targeted nutrition, herbs and supplements where they fit. Whether that is enough for you, or whether hormone support becomes part of your plan later, is something we work out together as things change.

How can I prevent the diseases of aging that are common after menopause?

Prevention is the reason naturopathic medicine exists. Conventional medicine tends to wait for symptoms, or for something to fail, before it treats disease. Naturopathic and functional medicine offers a proactive, personalized strategy that may predict and prevent chronic decline decades early.

In practice, that means we look now at the markers that matter most for your long-term health — your hormones, blood sugar, cholesterol, blood pressure, thyroid and micronutrients — and act on what they show, long before a problem would otherwise surface. Perimenopause is a great time to start.

What happened to my sex drive?

You are not imagining it, and you are far from alone. Falling and fluctuating hormones, including testosterone, play a part. So do sleep, stress, mood and how you feel in your own body. It is a common reason women come to see me, and it deserves to be taken seriously as part of the whole picture, not brushed aside.

Why am I so tired, anxious, or depressed all of a sudden?

Perimenopause is primarily a physical process, not a psychological one — even though it may feel like it! Your hormones help regulate your energy, your sleep and your mood, so as they fluctuate and decline, you feel it in all three — and poor sleep makes the other two harder. Feeling tired, anxious or down during these times is common, and it’s important to understand the underlying causes of your changing moods.

Thyroid, iron, blood sugar and cortisol can play a part too, which is why I check them alongside your hormones. If your low moods last or deepen, tell me, so we can look at them properly.

My body doesn’t respond to exercise the way it used to. How can I feel stronger and build muscle?

Many women notice this in perimenopause, and it is not a lack of effort. Your hormones, including testosterone, help your body build and keep muscle, recover and sleep. So I start there: we address the physical changes of perimenopause first, including restoring your hormones when your body is ready for them.

Without that foundation, efforts to build strength, sleep better or manage your weight tend to have limited success. With it, strength-building movement and good nutrition have something to work with.

Why am I hearing such different things from my friends about what they’re doing?

Most of what your friends have been offered comes from conventional medicine or social media influencers. It is not individualized but more about a one-size-fits-all approach built around a limited menu of products, labs and services. The general lack of consensus in how HRT is prescribed or recommended creates a lot of confusion for women as they try to find what works best for them.

I am not a conventional medical practitioner, and that is an important part of what makes my care different. My approach is personal and individualized, informed by specialized testing of your own hormones and health, and built around your body, your history and your goals. Bring what you’ve heard; I’m always happy to talk it through.

I don’t want to stop having periods. Is there any way to keep this natural process going?

Yes, there is. That is the whole point of the approach I practice, Physiologic Hormone Restoration Therapy® (PHRT®). Instead of giving the same dose every day, it restores your hormones in the rising and falling pattern of a monthly cycle. For women with a uterus, that rhythm brings back a monthly shedding of the uterine lining.

Some women welcome that; for others it is a real consideration, and we talk it through before you decide. I explain the difference in my article on rhythmic vs. static hormone dosing.

If this sounds like you, the simplest first step is a free, 15-minute Fit Call by phone with our practice manager. Your first visit with me can be in person at our Murray office or by telemedicine anywhere in Utah.

Have questions about your own picture?

A 15-minute Fit Call is the right next step.

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