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I think I am in the Perimenopause….

Giselle Cooke, Holistic Health Consultant at Next Practice GenBiome

Being a woman can be so challenging; managing the constant parade of hormonal fluctuations that we experience throughout our lives that can threaten to destabilise our relationships, our peace at home and our career paths. Some women endure many years of torturous PMS (premenstrual syndrome) with its mood disturbances, weight fluctuations, headaches, cravings and skin breakouts.

I think the most confusing time hormonally for women is the perimenopause, which can occur any time from age 30 to 50, with the eventual end of menstruation and fertility with the actual menopause.

How do I know I am perimenopausal?

Experiencing altered menstrual cycles: either heavier, more frequent periods with passing clots, or scanty occasional bleeds that peter out to amenorrhoea (absence of periods). For most women the end of menstruating is a blessing – no more heavy bleeding, iron deficiency and the inevitable social embarrassment of periods appearing without warning. Hormone cycling finishes, so PMS ends, but equilibrium is still a few years away…

There are no rules at the perimenopause: it is a bit like white water rafting down the hormonal river of life before the waterfall. Perimenopause may last either a few months or a few years, depending upon your genetics, your stress levels, your nutrition, your body composition and your level of activity. Actually, add attitude to the list!

What is going on with my hormones?

Contrary to conventional medical wisdom, oestrogen does not disappear altogether at the perimenopause, and neither after the menopause for most women. In fact, oestrogen levels rise for the first couple of years after periods cease, which is the reason why bleeding stops, as it is falling oestrogen levels that bring on our periods. When I check the salivary hormones of my patients, I usually see a rise in their oestrone (E1), the most potent oestrogen which causes most symptoms, such as fluid retention, weight gain and hot flushing. At this time the more benign oestrogens, oestradiol (E2) and oestriol (E3) either stay level or deplete, throwing out the balance of your oestrogen subtypes (E1: E2 + E3).

To make matters more challenging, there is a relative drop in progesterone levels, the key hormone for navigating transition to the menopause with ease. When progesterone drops and exposes a rising estrone, this leads to a tendency of more anxiety and depression. Weight starts to increase due to fluid accumulation and fat deposition, compounded by a reduction in thyroid efficiency. For women who are chronically stressed at the perimenopause the experience is hugely more challenging, as cortisol production rises to handle the daily stress, robbing the sex hormone bank of pregnenolone and thus progesterone.

Along with progesterone deficiency comes increased tendency to inflammation – world-renowned Italian menopause expert and sexologist, Dr Alessandra Graziottin, refers to it in her presentation “Menopause and inflamm-aging: facts and therapeutic options” (1). Ultimately the more inflamed our tissues become, the faster we age. According to Dr Graziottin, fluctuations in oestrogens, such as those occurring at the perimenopause, cause histamine release, as well as the release of inflammatory cytokines, “leading to progressive degenerative processes and loss of functional competence”, i.e. ageing. One of the keys to delaying ageing at this time of life is to reduce oestrogen and cortisol dominance and to balance these pro-inflammatory hormones with adequate progesterone, along with the lean tissue-building hormone testosterone.

So, what can I do to get some relief?

Rapid relief of perimenopausal hot flushing and mood changes can be delivered with an integrative treatment protocol of herbal medicines, dietary adjustment, stress reduction techniques and exercise prescription. Herbs such as wild yam, passiflora and chaste tree are key to this treatment approach, as they regulate oestrogen, correct cortisol and boost progesterone. Exercise reduces body fat stores where oestrogens are supplied by precursor hormones. Exercise also improves sleep and stabilises mood. Environmental solutions, such as wearing natural fibres that breathe and sleeping in a well-ventilated bedroom along with cooling Ayurvedic diets reduce internal heat to reduce hot flushing.

If your perimenopause experience is more challenging, further investigation into your particular hormone balance can be done with salivary and urinary hormone profiling. These functional medicine tests allow our doctors to accurately diagnose your hormonal status by checking up to ten hormones and their subtypes and to safely prescribe tailored, bio-identical replacement hormones if yours are quite depleted. This prescribing is co-ordinated with your gynaecological checks (breast and pelvic examinations and Pap smears).

Because each woman experiences the perimenopause uniquely, we offer an individualised, integrative approach at GenBiome to managing this stage of life to manage your symptoms and boost your level of wellness. Therapeutic acupuncture treatments support your herbal or hormonal prescription, as well as breath- and mindfulness training, to balance your nervous system and assist hormone correction for complete care.

Life will go on much more smoothly with integrative perimenopause management.

Giselle Cook is a Holistic Health Consultant with a focus on wellness medicine, optimal ageing and epigenetic interventions. Giselle works with patients to address health fundamentals such as achieving optimal nutrition and hydration, essential daily movement and exercise, enjoyment of social and creative activities, living in a clean and harmonious environment and getting enough restorative sleep. Giselle is available on Tuesdays and Thursdays at GenBiome – Edgecliff and also offers free explorer 15 min sessions over the phone. Book your appointment online or please phone 02 8311 2800 for more information.


Graziottin A. “Menopause and inflamm-aging: facts and therapeutic options”, lecture presented to 2012 Congress of the Sri Lanka College of Obstetricians & Gynecologists (SLCOG), Sri Lanka, July 27-29, 2012