Active Aging, emotional, environmental, Integrative Health Coaching, Integrative wellness, Life Beyond Menopause, movement, nutrition, Perimenopausal, rest, social

What The Hell Is Perimenopause, And How Did It Happen To Me?

Like birth, death and taxes, menopause is one of those guarantees in life. And like birth and death, the surprise is only in the when, not the if. Menopause is technically defined as that point in time when you have not had a period for twelve consecutive months. So what do we call all that time leading up to menopause? That is perimenopause.

The average woman experiences menopause at age 51, with anywhere from 45-58 considered normal. Indications of perimenopause can start occurring up to ten years before actual menopause, meaning even as early as 35 a woman can start having associated symptoms.

Those years of a woman’s life between 35 and 50 are hectic enough. Between raising kids, managing a career, working on marriage/partner relationships, caring for elderly parents, keeping a house and yard, or any of the many other things that take up space and time in our life, we barely have the capacity to do it all. But we do. We keep our heads above water for the most part. We make it work. But the symptoms of perimenopause can cause us to come crashing down.

Not every woman will have every symptom, some may have very few, or to a very mild degree. In some women, the symptoms are subtle, in others they are severe. They are caused by the changes in levels of hormones in our bodies, particularly estrogens, progesterone, and testosterone. Our ovaries are responsible for 90% of estrogen production in premenopause, so as the ovaries begin decrease in function, estrogen naturally decreases. Lifestyle choices can dramatically impact the symptoms though. Poor nutrition, sedentary activity level, smoking, chronic illnesses such as diabetes and autoimmune disorders, environmental toxicity, and nutrient deficiencies all contribute to our hormonal imbalances.

So, what are the symptoms of menopause anyway?

Hot flashes and night sweats – 75% of all women will experience hot flashes at some point in time during the perimenopause years. In 20% of women they will be severe. They may last for as little as a few weeks to as long a 10 years or more. They can disrupt sleep and daily life. They can destroy one’s confidence in themselves. You may feel that your temperature is never regulated, being too hot one minute and too cold the next. A simple outing to the grocery store in the winter is complicated by what to wear. If you put on a sweater to keep you warm while traveling there, you may find yourself ready to rip it off in the middle of the produce aisle when the mister comes on. Bedroom ceiling fans become a must no matter how cold it is outside, or how wrong your Feng Shui master says it is. Your partner and the cat (or dog) may have to find another place to sleep. Your relationship will surely not be affected by “I want a snuggle,” one moment, followed quickly by “do not let any part of your body touch me,” the next. Sweaty, sticky sex may have been a thing in the backseat of a car in the middle of a hot summer night when you were in college, but now you realize it was not all it was cracked up to be. You may also revel in the joy of talking to your boss with sweat dripping off your forehead, hoping she doesn’t notice. (Oh, no. I’m not having a hot flash, I just ran a mile during my coffee break.) You may also collect an assortment of handheld fans, distributed in every purse and bag you carry.



Period changes – Periods may become longer, shorter, heavier, or lighter. You may experience more irregular periods or episodes of skipped periods. All this uncertainty to look forward to before they finally fall off the cliff completely. It’s like living through those early teen years of not knowing when and where you will start all over again. Only this time, you may bleed so heavily that you soak through your clothes in a matter of minutes. That old fear of walking into a room of your peers with a huge blood spot on your ass comes crashing back. If you are one of the lucky ones whose periods actually change for the better, or whose periods simply go along as always and just stop one day, thank your lucky stars. Just remember,  even if you skip for eleven months and then have one, the clock starts again.
Sleep problems – 30% of women who never had trouble sleeping before, now do. Some of this may be attributed to the hot flashes and night sweats. It is hard to sleep when you are throwing the covers off, then trying to find them again in the dark to get them back on. But some women who don’t report problems with either of those still have trouble sleeping. Either they can’t fall asleep in the first place, or they fall asleep quickly, but wake up in the middle of the night and can’t get back to sleep. Then they fall into the practice of watching the clock tick the minutes away until the alarm goes off. On the plus side, it is a good way to practice math problems, (if I fall asleep right now, I will get in this many hours and minutes. Okay, now subtract 15 from that last calculation.) Seriously though, as the days go on and sleep deprivation becomes more and more pronounced, nothing else in your life is going to get better. Weight gain, low energy, brain fog all are enhanced with poor sleep.


Vaginal dryness – As estrogen decreases, the vaginal walls thin and have less lubrication and elasticity. This can lead to painful sex. There is often a tearing or burning sensation with intercourse. Just when it should be more fun, it becomes less fun.


Urinary problems – Low estrogen can also cause a loss of tone in the muscles of the pelvic floor. This can lead to leaking of urine when doing anything that puts pressure on this area. Coughing, sneezing, laughing, running, walking, jumping, picking up something off the floor, yelling at the kids, or getting out of bed can cause anything from a little squirt to a mighty flood. Urinary tract infections also can increase due to the lack of lubrication that used to move the bacteria away. The honeymoon cystitis without the honeymoon.


Weight gain and fat redistribution – Because of the way all the hormones of our body work together, when one or two get out of whack, the others tend to follow. Cortisol and insulin get thrown off-balance as the sex hormones give way, causing more fat to be distributed around the belly. The lack of sleep and low energy doesn’t help matters any. Neither does the fact that we seem to have more and more on our plates, both the dinner plate and the life plate. Cholesterol levels seem to change as well, with increasing bad and decreasing good.


Mood changes – Is it any wonder we are in bad moods sometimes with all of the above changes going on? But, there is an increased risk of depression during perimenopause. And a feeling of always being tired doesn’t do much for your overall happiness.


Mild cognitive impairment and poor concentration – Some just refer to it as brain fog. Not remembering where you left the keys to the car more often than you used to. Forgetting to pick up the kids. Not being able to finish a cohesive thought. Jumping from one task to the next, without remembering to go back to the first one. Research shows that those who have some mild impairment during the perimenopause years are more likely to suffer from Alzheimer’s later in life.


Less hair on your head, more hair on your face, and dry skin – These are just thrown in for kicks and giggles. Could anything be more fun than a bald, flaking, bearded woman?


Conventional treatments are mostly targeted to treat specific symptoms. Synthetic and bioidentical hormone replacement therapies and progesterone creams are available but are not without risks. You can use lubricants for better, less painful sex. Sleep aids may provide more sleep, but not necessarily better sleep. Antidepressants may alleviate the mood disorder symptoms, but again, side effects are many. Weight loss aids are not usually very helpful in the long-term.

Using a balanced, whole foods diet, the right kind and amount of exercise, and getting proper sleep can keep your body and hormones in check to minimize the effects of perimenopause. Stress reducing practices such as meditation or yoga will also help. Having good support and community around you is imperative. Herbal treatments may relieve or reduce the severity of some symptoms.

The Japanese have no word for menopause. For centuries they have mostly not had the symptoms that bother us in the west. We can take some clues from their diets and lifestyles. The women who practice a mostly Mediterrainean lifestyle are similarly blessed. Both of these cultures tend to eat mostly plant based foods, supplemented with fish and grass-fed meats. They move every day, mostly walking, and enjoy strong communities and support, especially with other women with whom they develop lifelong friendships.


The fact is that the sooner earlier you delvelop lifestyle strategies to combat these symptoms, the easier your perimenopause years will be. But it is also true that it is never too late to start. Adapting your lifestyle to address better nutrition, movement, and sleep will set you on the path to feeling better every day.


Integrative wellness, Menopause and Beyond, Perimenopausal

The Story Of The Inukshuk

On our wedding day my new husband and I opened a gift from his Canadian friends. Inside was a beautiful human figure made of stacked pieces of amethyst. The card indicated that the figure was called an Inukshuk. Having never encountered one before, I looked it up to see what it represented.


My research led me to understand that Inukshuks are from the Inuits. They were erected as guideposts to give direction to the nomadic tribes of the harsh Arctic region. The stone markers were massive, created with the cooperation of the entire group. Their presence made the way easier and safer for those who followed.

Each stone of the Inukshuk is separate. But each stone cannot work on its own. Each needs the support of the one above and below to function in entirety. This support is achieved through balance. Perfect balance makes the structure secure. Removing one stone will topple the entire structure. Shaving an edge off one stone, or choosing one that does not fit well with the others, being too big or too small, will create instability. This instability will cause failure of the structure, even if the fault is not immediate. Eventually, it will fall, destroyed by the slightest wind or the weakest vibration.  But, when everything is in balance, the whole of it works wonderfully.

I think this is the perfect metaphor for our health and our lives. No one element alone will ensure we are well. The many aspects that must work together are in constant flux, and we need to remember to balance them so we can keep ourselves upright and stable. Our physical, environmental, financial, emotional, spiritual, social, and intellectual beings all need attention. Our bodies need proper nutrition, movement, and rest. Our minds need stillness and stimulation. Our souls need nature, and light, and imagery, and faith.

Putting all of these aspects together would be manageable in a perfect world, without any influence from outside sources. If we each had all the resources we needed at our disposal at all times, we would all live happy, carefree lives. We would also all be pretty dull beings. No one wants to live that way, even if we could. We love the forces around us. The subtle winds, the babbling creeks, the steady vibrations of life’s ebb and flow. So, we need to learn to live with the resources we have and learn to put them to their best uses. We must become versed in how to give and take, how we can support one element with another when one becomes depleted. If the winds are like hurricanes, or the rivers swell to flood stage, or the vibrations become earthquakes how do we steady and steel ourselves against the forces? How do we, like the Inukshuk, use every stone to balance and form integrity. How do we remain upright and robust?

We must remember what each stone represents, but also how they all work together. If we want to lose weight, we cannot focus only on what we eat. How we move, and how and when we rest, where and with whom we spend our time, how we feed our brain, our soul, how comfortable we are with our finances, what we worry about how often we are kind to ourselves all play significant roles in how our bodies use and store our food. If we feel our memory and brain functions are decreasing, it will do us no good to use brain-teasing exercises exclusively. If our bodies are weakening, just lifting weights won’t do the trick. These things may help short term, but to create lasting improvements, we must examine all the stones. We have to find our strength in the whole.

This is what integrative medicine is all about. We use our strengths to bolster our weaknesses. We look at the whole of our beings. We find where we need to focus our attention to become the whole person we want to be. It might not be where we first thought. The process is slow, as the building of an Inukshuk surly is as well. The process is just as much about our perspective and attitude as about our action. The engineers of the massive structures didn’t just gather a bunch of stones as quickly as they could. They gave much thought and energy to finding the right stones. They examined them in detail to see which one would fit best in each position. They did all this before moving a single stone. If one didn’t work as expected, they might have had to reassess, move things around, or discard and find another. The conceptual phase guided the action phase of the building. They used their knowledge, gained through evidence-based study, what had worked in the past, and what had not. This is also how we must address our health. We can’t leave success to chance. We must research, study, and find actual evidence-based solutions. Then we can take the actions necessary to get the results we want and need.

The guiding symbol of the Inukshuk also serves to remind us that we are not alone in our journey. Others have passed this way before. There is no shame in leaning on another’s knowledge. Those researchers have left their monuments along our paths to help us navigate our health. Their interest is in improving our lives. Finding that path and staying on it can sometimes be difficult. Those outside forces sometimes cause us to lose our way. Life can cause us to lose our way. Finding support can help us see with clarity. Learning how to use that support can keep us moving forward. That is the role of an integrative medicine health coach; helping you to find the tools, resources, knowledge, strength, guidance, and passion for feeling right. To possess the knowledge to head off or manage the chronic, debilitating diseases that have so overwhelmed our society. You can conquer. You can find community. You can find the support that you need. The path is in front of you, and there have been monuments erected to navigate it easily.

As I began my health journey, I thought of how I would build an Inukshuk to represent it. What stones I would use, and how I would place them. I set the stones serving the physical and environmental elements as the feet, the base of all my needs. These two aspects hold the weight of the rest of the structure. The domains that relate to those, nutrition, movement, and rest on the physical side; stillness, me time, and nature on the environmental, became the legs. Financial and emotional elements felt right in the belly region. In the gut. The spiritual stone landed naturally in the heart. And stress in the chest, because that is where I mostly feel my stress. The arms reaching out to friends, family, support, community, to hold and be held was where the social stone worked best. And the head became the intellectual stone, where knowledge and education and curiosity exist. I now use this image as my talisman. It reminds me to stay healthy. It encourages me to return to the basics when I find myself straying off my path. It points the way forward.