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March 1, 2009
Understanding perimenopause for ourselves and our patients
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Understanding perimenopause for ourselves and our patients

by Kelli Swanson Jaecks, RDH, MA

Sweat soaked sheets. Sweat beading on my brow and breasts. Sweat running in rivers through the valleys of my flesh. I woke, drenched in sweat and hotter than hell. It had started, the unwanted signs and symptoms of the female body aging. The night sweats came with the smallest touch from my husband, as small as his toe brushing my leg. They came unbidden, while I lay there blissfully sleeping, touching nothing but my pillow and sheets. This was the most prevalent sign that I was entering the land of perimenopause, the sweats screamed that change was coming, change was upon me.

Our culture today is rife with negative connotations of menopausal women. Women often use this time of life as an excuse to be a witch and leave burned corpses in their wake as they lose all emotional control. Or some women shut themselves off from others, becoming depressed over their various symptoms. Those around them often walk on eggshells for fear of a hormonal explosion. Not only do women feel like “hormone hostages,” their loved ones do too! While we cannot stop the changes, we can learn to effectively manage them and celebrate the new era we are entering!


In order to cope positively with hormonal changes, it helps to understand what's happening with your body. Perimenopause is that time all women pass through on their way to full menopause and life after periods. It usually begins somewhere in the mid–40s, with symptoms occurring in various ways and degrees. Each body passes through a little differently, depending on many factors, including genetics and lifestyle. We often hear women say, “I'm going through menopause”; however, menopause itself is only one day. Menopause is the day you haven't had a period for 12 months in a row.1 One is not in menopause, but is either perimenopausal or postmenopausal. The average age of menopause is 51.2

Perimenopause and menopause are normal states of natural aging, and are caused by the decline of ovarian function. The androgen hormones estrogen, progesterone, and testosterone fluctuate and decrease as we age.3

Signs and symptoms of perimenopause

These hormonal fluctuations can affect a female's vasomotor, cognitive, vulva–vaginal, skeletal, and dental systems. It's no wonder that many women become overwhelmed by their bodily changes and are at a loss as to how to manage them. During perimenopause and up until menopause, the ovaries gradually shut down, making less of the hormones estrogen and progesterone. Hormonal levels can be highly erratic, exhibiting differing fluctuation patterns from month to month. The changing levels of these hormones trigger perimenopausal symptoms, which include, but are not limited to, changes in the pattern of one's periods, either longer or shorter time span between periods, lighter or heavier flow, hot flashes, night sweats, mood swings, mental fog, change in sexual desire, loss of bone, and changes in cholesterol levels.

When my symptoms progressed to the point of disrupting my sleep and making my home life miserable, I sought relief. I wanted a natural solution, and after some research, I discovered alternative therapies to traditional hormones to help me cope positively with the changes I was experiencing.

My journey

My journey began with a visit to a nurse practitioner (NP) who specializes in women's health. I reported my symptoms and their severity and participated in an in–depth interview about my life, including stressors, relationships, lifestyle, diet, exercise, and self–awareness. I then took a saliva and blood spot test in the convenience of my home. The tests were sent to a lab that specializes in compounding hormones, and I was given a detailed medical list of hormone levels from all three major glandular systems — reproductive, thyroid, and adrenal. (See for the testing I used.)

Once the lab results were in, I met with the NP for her diagnosis and treatment plan. My results indicated a need for thyroid support (energy and metabolism), adrenal support (stress, energy support, decrease fatigue), and progesterone (mood swings).

My treatment plan includes an over–the–counter progesterone cream, vitamin B complex, and zinc and selenium each day for thyroid support. I also take vitamins C, D, and E for adrenal support and general health. I was told to get eight to nine hours of sleep each night. I've been following this regimen for nearly a year and I've seen a marked decrease in my most annoying symptoms, such as mental fog, night sweats, and low energy. I will have my hormone levels tested again in two months.

Alternative therapies

There are many alternative therapies that can provide relief for perimenopausal symptoms. The basics are the same as living an active, healthy lifestyle.

  • Eat organic fresh foods, focusing on whole grains, fruits, and vegetables
  • Get regular heart–pumping, weight–bearing exercise five times a week
  • Sleep at least seven to eight hours per night
  • Use alcohol moderately
  • Stop smoking
  • Maintain a healthy body mass index (height/weight/lean body mass)
  • Engage in a regular, satisfying sex life1,2,4

Besides these basics, many women choose to visit chiropractors, massage therapists, naturopaths, herbal specialists, and acupuncturists for relief of certain perimenopause symptoms. Each of these healing modalities can provide relief and relaxation, thereby increasing quality of life. While symptoms will not always go away, they can be managed.

Perimenopause is a journey of discovery: discovery of your bodily changes, and discovery of what works for you. While there is no single answer for every woman, we do know that making positive lifestyle choices can go a long way in helping women feel better about perimenopausal changes.

Successful management of these hormonal changes is empowering! As we seek to understand ourselves more fully and take steps to alleviate the negative symptoms of perimenopause, we will be happier and so will those around us. No more hormone hostage, but rather a freedom–loving perimenopause princess!


  2. North American Menopause Society. Menopause Practice: A Clinician's Guide 3rd edition. Cleveland, Ohio 2007

    Signs and Symptoms of Perimenopause1,2,3

    • Shorter, longer, heavier, or lighter periods
    • Longer or shorter intervals between periods
    • Hot flashes, extreme sweating
    • Night sweats and sleep problems
    • Mood changes
    • Vaginal dryness
    • Changes in sexual function–thinning of vaginal walls
    • Changes in sexual desire
    • Loss of bone
    • Change in cholesterol levels
    • Trouble focusing, feeling mixed up or confused
    • Headaches
    • Hair loss or thinning on your head
    • Hair growth on the face
    • Joint and muscle aches
    • Frequent urination
    • Similar symptoms as experienced with premen–strual syndrome (PMS)1,2,3

    Processes the body goes through during perimenopause3

    • Ovaries release eggs less regularly
    • Fertility decreases
    • Testosterone decreases
    • Ovaries gradually produce less estrogen and other hormones
    • Menstrual cycles shorten, there are fewer ovulations, there is more cycle irregularity
    • Circulating levels of estrogens and progesterone are markedly reduced