106. Perimenopause - Thriving in the Transition

Perimenopause can bring heavy cycles, mood swings, weight gain, and brain fog — but it’s not “just part of getting older.” In this episode, Dr. Monica Minjeur unpacks what’s really happening with your hormones during this transition and why estrogen dominance plays such a big role. You’ll hear Stella’s story and learn how a restorative reproductive medicine approach can help you feel stable, supported, and empowered in this next chapter.

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Transcript

Monica: 0:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if the emotional, rollercoaster, heavy cycles, and unexpected weight gain weren't just a part of normal aging, but instead signs that your hormones were looking for help? In today's episode, I'll be exploring the often overlooked transition of perimenopause that's sometimes confusing and often frustrating season before menopause officially begins. When you feel like your body is falling apart, we'll talk about what's happening under the surface. Why estrogen dominance oftentimes plays a major role, and how a restorative reproductive medicine approach can help you to feel more strong, stable, and empowered without just getting a bandaid approach or feeling dismissed. So let's start off today with a story about a patient of mine who we'll call Stella. Now, Stella came to me as a 43-year-old mom of three, and she came to our clinic after months of just feeling off. Her once predictable cycles had become very erratic. Some months she had very heavy bleeding. Other months she had almost no periods, and sometimes she even was skipping periods. She was additionally starting to have occasional times of night sweats, breast tenderness, and a short fuse with irritability. Her primary care doctor told her that she was just getting older and handed her a prescription for birth control. But Stella didn't want to suppress her cycle. She wanted to understand it and what scared her most was feeling disconnected from her body and having no answers about what the next decade would look like before menopause finally hit. After hearing about Radiant Clinic from a friend, she reached out. So as always, we started with getting Stella charting her cycles and checking a full lab evaluation. We found out that she was ovulating irregularly, and her progesterone was consistently low while her estrogen levels were spiking early in her cycle. And this is a classic sign of estrogen dominance. We targeted progesterone therapy to help with Stella's cycles. We discussed nutrition strategies for clearing excess estrogen stress reduction tools, and discussed how we were going to help manage her other symptoms that she was navigating. After a few months of working together, Stella felt like herself again. Her cycles were more predictable and she understood how to see if they were going to go sideways. Again. Her mood swings had softened, and she felt like she had the tools to navigate this next season of life with confidence and clarity. So what is perimenopause? For many women, this can start as early as their mid thirties, but typically it begins in your forties and in general, it's a 10 ish year window before menopause starts, when ovarian function begins to decline. So again, menopause is defined not until after you have stopped having periods for a full year. Generally we see lab findings of menopause, that your estrogen levels go quite low and your FSH or follicle stimulating hormone goes quite high, meaning your body is trying to stimulate ovulation, but there's nothing left to happen. So before we hit this time of menopause, we have this whole timeframe leading up to it of perimenopause. Now, there's not one set definition of perimenopause when you're in the midst of it, but what many women experience from a symptom standpoint is a change in their cycle. Now, this can mean sometimes that your periods are happening closer together. Sometimes they're farther apart. Sometimes we just notice a change in either heavier or lighter bleeding. But most of the times when women are coming in with concerns, it's because of all of the other symptoms that can come along with perimenopause. Things like anxiety or mood changes, sleep disturbances. Some of my patients tell me, I used to sleep great and now I'm just having a hard time. Changes like brain fog or decreased libido, energy issues, weight gain, hair loss, worsening, PMS symptoms. All of these symptoms, which can sometimes seem a little bit nondescript, and especially for people who are mothers, they may feel like, well, it's just from busy life of being a mom, and sometimes it's hard to pull out what is actually hormonal changes, what is just normal life and what might be a sign of a bigger issue. So let's talk a little bit about estrogen dominance, because this is one of the common things we see, but I just wanna make sure that we're clear on what it is and isn't. So, estrogen dominance isn't always just having too much estrogen alone. It's about an imbalance between estrogen and progesterone, and I'd spent a lot of time discussing this. Back in episode number 49, so where we talk about estrogen dominance. And so if you wanna learn more specifically about that, you can go back to that episode. But as I discussed there briefly, it's either I've got too much estrogen, or in some cases it can be that my estrogen levels are actually normal, but my progesterone level. Too low, and that's most often what we find in perimenopause is that progesterone naturally starts to decline in our forties, and that can create irregular ovulation or even cycles where you don't ovulate at all. To top it off. During perimenopause, we can see some fluctuations in estrogen, sometimes being too high, sometimes being too low. And as we kind of sneak into this menopause phase, estrogen could really go up and down pretty significantly over the course even of a month. Now, there are lots of reasons why this happens. Some of it is just the normal physiologic process, but we also know that lifestyle changes, things like chronic stress. Poor sleep, poor exercise habits and environmental exposures, especially endocrine disruptors, can impact how our bodies are able to clear some of those excess hormones. Again, having too much estrogen specifically oftentimes will cause heavier periods or bigger clots. Breast tenderness, irritability, bloating can cause some mid-cycle spotting and sleep issues. We also know from a metabolic state that estrogen dominance sometimes can lead to troubles with losing weight because estrogen is stored in our fat cells. And so when we have excess estrogen around, it gets stored into the fat cells, which makes the fat cells enlarge. Over our lifetime. As adults, we typically don't gain much as far as the number of fat cells, but the size of those fat cells can change, and especially when they're storing estrogen as well as insulin, which we'll talk a little bit more about next week. Those fat cells can increase in size, which oftentimes is linked to weight gain. So what do we do in restorative reproductive medicine to help with this perimenopause transition that's different than conventional medicine? As we noted in Stella's case, oftentimes women are just put on birth control or said, Hey, go put in an IUD, and that'll help to regulate your cycles. Now, many women in their forties are not trying to get pregnant, and so for some of them they think that if I use some sort of contraception that's kind of killing two birds with one stone. The reality is though, if we're just trying to suppress those symptoms, either with birth control or an IUD, we oftentimes are masking the other underlying hormone changes that are crying out for help. So again, in restorative reproductive medicine, we want to give you the tools in order to be able to understand what's going on with your cycle and really fix that underlying cause. So we always will start with cycle charting, and this is one of the big things we find is that many women think that charting your cycles or tracking ovulation is just for trying to get pregnant. And really, for us, we use it as a way to understand your hormone patterns rather than just guessing. So cycle charting becomes this really empowering tool to let you know every day, where am I at in my cycle? Am I ovulating this month, which is a good sign of hormone health. And what's going on with my cycle as I look back, cycle over cycle again, we would focus on targeted lab testing, specifically looking for estrogen and progesterone levels at a couple different times in your cycle. We also pay attention to testosterone, which oftentimes will start to decrease in perimenopause, which can lead to decreased libido, energy problems, and exercise intolerance. And then we always will still continue to do our deep dive when it comes to thyroid function, cortisol levels, vitamin deficiencies, and looking for ovulation dysfunction. When we support that ovulation with progesterone when needed, it oftentimes helps to support an ovulatory event, which then can help to regulate the length of your cycles. So again, we may not be doing ovulation stimulation medications with the intention of trying to get pregnant, but helping to balance your cycle. Good progesterone, adequate testosterone, and a normalization of the estrogen detoxification pathway can really help to get a good ovulatory event, which then helps to regulate the cycles. Again, always utilizing bioidentical hormones, especially progesterone, because during this timeframe, we also know that we can start to see increased cancer risks, and we don't want to be doing any type of synthetic hormones, which may be linked to increased cancer risks in the long term. We also are always addressing what's going on from a standpoint of insulin resistance and blood sugars. I oftentimes am finding troubles with insulin resistance in perimenopause because many women are concerned about weight gain, and so they're severely restricting their carbohydrate intake. Now, while this can be beneficial in some cases, if you are already dealing with insulin resistance. And not getting enough carbs, it can actually perpetuate this cycle and create even higher spikes of insulin, which over time can lead to pre-diabetes. So we talk a lot about how we would help to create a balanced diet, rich in protein that has a good amount of carbohydrates that are healthy. And oftentimes we actually see that women will lose weight when we can adjust the mindset on this. We also are always talking about improving sleep, stress reduction, and what is appropriate exercise again, typically focusing on well balanced exercise. As we discussed a couple weeks ago, strength training and weight bearing become especially important in our forties because we wanna make sure that we are continuing to have good bone health. Going into menopause. So very different approach as opposed to here. Just go on birth control and hopefully this will last you through until you hit menopause. We really wanna focus on optimizing hormone levels. Most women in perimenopause do end up needing some progesterone support, but really focusing on what are those lifestyle changes that we can make in order to help you get through this transition. So just a few practical tips for thriving in the transition. Again, always want you to be tracking your cycle, even if it's irregular, because that helps us to spot any patterns that may be going on. We also always want to address gut health and making sure that you are having a regular bowel movement every day. This helps eliminate not only excess estrogen that's in your system, but other toxins that may be building up. Try to avoid exposure to estrogen mimicking substances. So there's been a lot out recently talking about how these endocrine disruptors are in many of the common household items. We have plastics, fragrances, and personal care products. So trying to avoid those endocrine disruptors when possible can help to avoid that excess estrogen-like substances that get into our bloodstream. Again, supporting our ovulation with sleep, blood sugar, balance, and adequate calories because our bodies do still need good calories, good cholesterol, and good carbs in order to function appropriately. And most importantly, please, please, please know this is not just in your head. This does not have to be just something that you suffer through. Your hormones are real and you deserve care that listens. I would love the opportunity to tell you more and to get your questions answered in real time. So we have an upcoming event that's going to be a Facebook Live held on Tuesday, September 9th at 8:00 PM Central Standard time. Go to our website, radiant clinic.com to register for our event perimenopause. Thriving in the transition, and then join us on our Facebook page live at the time of the event to tune in. If you can't make it, we will post the video to our YouTube page after the event so you can view it there. Make sure to share this with a friend, because if you are going through perimenopause, I know that you have had these conversations with your friends who are probably going through it as well. Imagine if this season of life wasn't something to dread, but an opportunity to finally listen to your body. Imagine having a clear plan, supportive care, and real understanding of your changing hormones. Imagine not just surviving perimenopause, but feeling empowered, supported, and thriving in this transition. This way forward is possible, and I can't wait to partner together with you to help you to thrive in the transition of perimenopause. Okay. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach, please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.