Staying Balanced During Perimenopause: Five Steps for Success

The scientific explanation of perimenopause sounds so simple: a gradual slowing down of reproductive hormones until menopause. The reality, however, is that for many women the arrival of menopause isn’t a smooth, gliding descent but more of a turbulent landing complete with bumps, twists, and what can feel like the constant threat of a complete crash. That feeling is compounded by the timing, since perimenopause symptoms often begin at a particularly stressful time of life with mounting work and family demands. Add in the physical and emotional effects of hormonal fluctuations, and the entire process can easily start to feel like a cruel joke. 

Thankfully it doesn’t have to be that way. 

If you’re frustrated by symptoms like mood swings, weight gain, and anxiety, start by taking a deep breath. The first step to thriving not just surviving perimenopause is to acknowledge that it is a natural process. Don’t beat yourself up. Now is the time to give your body – and your mind – some love. 

How to Recognize Perimenopause

It is interesting to note that some studies show our attitudes towards menopause (and aging in general) can impact how we experience perimenopause symptoms. 

Know What to Expect

Knowing what to expect and what triggers perimenopause is important. Sometimes, women are baffled by the changes and blame themselves, telling themselves that they’re not working out hard enough or not coping well with stress. That’s why a good understanding of the changes you’re undergoing is important. 

This Phase Can Last Years

Perimenopause symptoms typically begin in the mid-forties and continue for a number of years until full menopause is reached, which is defined as having gone a full year without a menstrual period, marking the cessation of the release of eggs. Over this period, the ovaries’ hormonal production slows down in fits and starts, leading to fluctuating levels of estrogen, which creates shifting imbalances in the delicate seesaw of estrogen and progesterone. Earlier in life, estrogen levels are much more predictable with the menstrual cycle. 

Signs You May Be in Perimenopause

Symptoms can be subtle at first and easily mistaken for something else. They may increase gradually or you may find they come and go along with your fluctuating hormones, they can include:

• Changes in menstruation, which could include changes in timing (both more frequent or less frequent) and periods that are suddenly much heavier 

• Unexplained weight gain, particularly around the midsection

• Depression

• Brain fog

• Hot flashes

• Tender breasts

• Anxiety and panic attacks

• Restless legs

• Insomnia and difficulty staying asleep

• Irritability

• Changes in libido

• Vaginal dryness

• Acne (as if wrinkles weren’t enough to worry about)

5 Ways to Find Balance During Perimenopause

The good news is that several lifestyle changes can help maintain hormonal balance and make it easier to cope with the changes that do occur. 

1 - Aim for a Good Night's Sleep

Ironically, getting restful sleep can become more challenging just when we need it most, and a majority of perimenopausal women report sleep difficulties. Waking up frequently is the most common complaint, often due to hot flashes. As always, a holistic approach helps, as a hormone-supporting diet can help regulate hot flashes. 

In addition, it’s important to practice good sleep hygiene: 

• Avoid using electronic devices at least one hour before bedtime.

• Avoid caffeine, large meals, and vigorous exercise in the evening.

• Build a predictable wind-down routine into your evenings. 

• Keep your bedroom temperature on the cooler side for better sleep.

• Avoid synthetic materials in bedding and sleepwear in favour of natural fabrics like cotton or linen.

Since melatonin production slows with age, melatonin supplements may be necessary. A healthcare practitioner can help assess the need for supplements. 

2 - Address Your Stress

The stress hormone cortisol rises with age, which is partly to blame for the increase in belly fat many women experience during perimenopause. Taking proactive steps to reduce stress will help get a handle on cortisol levels. 

Find Out What Works Best for You

Adequate sleep helps to lower cortisol, as does gentle, mindful activity such as yoga or tai chi. In fact, studies have found that mindful activities can reduce hot flashes, which will favorably impact sleep, which in turn helps to reduce belly fat – it’s all connected!

3 - Get Moving

Regular exercise helps with stress, reduces body fat, and improves your overall quality of life. It’s important to acknowledge, however, that what worked in your 20s and 30s may not be as effective at this stage of life. 

Consider Reducing the Intensity

Somewhat ironically, overly intense exercise can overtax your body and result in an increase in cortisol. Remember those stress tips above? That’s why it’s important to find a form of exercise that works for you. Don’t feel pressure to do high-intensity workouts if your body responds better to lower-intensity programs like Pilates or walking. Because everybody is different, it may take a bit of trial and error to find what works for you. The best exercise is always the one that you will stick to, and the one that gives you joy instead of adding to your stress levels. 

4 - Eat a Hormone-Supportive Diet

The concept of being gentle with your body during perimenopause extends to your diet. At this stage in life, you should focus on foods that support hormonal balance and provide nourishment. The four pillars of a healthy perimenopause diet are:

Protein

You start to lose muscle with age, so it’s important to counteract that with adequate protein to retain muscle mass. Choose lean proteins, including some plant-based sources like chickpeas and lentils. 

Fiber

A slowed metabolism may also slow down digestion. This may lead to constipation and foods hanging around longer causing fermentation leading to gas and bloating. Fibre helps food move smoothly through the bowels and also helps us feel fuller for longer, limiting cravings. Fibre can be found in loads of foods from flaxseed, chia seed, beans and legumes to spinach, broccoli, apples and pears.

Fat

Healthy fats, like Omega-3 fatty acids, can help reduce hot flashes and may boost mood, according to some studies. Good sources of Omega-3 include salmon, hemp seeds, and flax seeds.

5 - Manage your Blood Sugar and Insulin Levels

High blood sugar can exacerbate hot flashes and other perimenopausal symptoms. This can be a bit of a vicious cycle, since changing hormonal levels can actually raise the production of the hormone insulin, which regulates blood sugar. It’s crucial to limit consumption of processed carbohydrates and sweet drinks during perimenopause, as insulin resistance becomes more commonplace. Fiber and protein can help preserve insulin sensitivity, so instead of a quick hit of something sweet for a snack, look for more satiating foods like nuts, seeds, or whole grains. 

A lot is happening during perimenopause for many women – career, family, decisions about the future - but taking some time to focus on your own health will help you feel empowered with the changes in your body.

If you are looking for extra support or experiencing hormonal issues and would like to dive deeper into what's going on and the best natural course of action give me a call. As a Naturopathic Doctor, I can help guide you in this transition in a healthy and holistic way.

Sources

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Nat Sci Sleep. 2018 - Fiona C Baker,corresponding author1,2 Massimiliano de Zambotti,1 Ian M Colrain,1,3 and Bei Bei

Melatonin, human aging, and age-related diseases

Exp Gerontol. Nov-Dec 2004 - M Karasek 

Mindfulness Training for Coping with Hot Flashes: Results of a Randomized Trial

Menopause. 2011 - James Carmody, Ph.D., Associate Professor of Medicine,corresponding author Sybil Crawford, Ph.D., Professor of Medicine, Elena Salmoirago-Blotcher, M.D., Doctoral Fellow, et al

Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study

Menopause 2009 - Nancy Fugate Woods, PhD, RN, FAAN, Ellen Sullivan Mitchell, PhD, and Kathleen Smith-DiJulio, PhD, RN

The role of calcium in peri-and postmenopausal women: consensus opinion of The North American Menopause Society - Menopause 2001 - The North American Menopause Society

DEPRESSION AND EMOTIONAL ASPECTS OF THE MENOPAUSE - BCMJ, October 2001 By: Diana Carter, MBBS

Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial -  PMC 2011 - Marlene P. Freeman, MD,1 Joseph R. Hibbeln, MD,2 Michael Silver, MS et al

Vasomotor symptoms and insulin resistance in the study of women's health across the nation, J Clin Endocrinol Metab. 2012 - Rebecca C Thurston 1, Samar R El Khoudary et al

Natural Support for Seasonal Allergies

You’ve been careful for over a year now. Social distancing is so ingrained in your consciousness that you do a double-take when you see old concert footage on TV. You’ve grown to appreciate the benefits of face masks (no need to worry if there’s a bit of spinach in your teeth, protection from the wind or that random pimple on your chin). Your bubble is airtight, and you’ve finally figured out the most flattering Zoom camera angle. 

So why do you feel like you’re sick, when you’ve done everything right? Watering eyes, runny nose, sneeze attacks? Is it time to self-isolate? What if you sneeze in the grocery store line-up? After all, there is no bigger social faux pas right now than an unexpected public sneeze. Should you have a COVID-19 test?

An Unusual Year for Allergies

Even at the best of times, seasonal allergy symptoms are inconvenient and annoying. Add in the very understandable fear of COVID-19, and allergy sufferers experience extra stress, which is never a good thing when trying to stay healthy. It’s more important than ever to practice a seasonal allergy reducing lifestyle this spring, to alleviate stress and keep yourself healthy and strong. Plus, many of the lifestyle measures that reduce allergies improve your overall health and wellness. 

The sneakiness of seasonal allergies

It’s not surprising that allergy sufferers worry about COVID, since some of the symptoms are very similar. Seasonal allergies can cause:

A runny nose

Watery eyes

Coughing

Wheezing

Headaches

Post-nasal drip

Shortness of breath

Reduced sense of taste or smell

These symptoms often appear in the spring, when trees begin pollinating. Pollen in the air can trigger our bodies to release the powerful chemical histamine, which leads to allergy symptoms. 

Invisible Spring Pollen

Contrary to popular belief, allergy triggers at this time of the year are usually tree pollen, not pollen from flowers, and they’re often not visible to the naked eye. To further complicate matters, the start of spring allergy season can vary by year, so allergy sufferers often don’t realize it has begun until symptoms appear. It’s also important to note that allergies of any kind can develop later in life, so if you’ve sailed through spring in the past, but suddenly notice you’re sniffling, seasonal allergies could be the cause.

Regional Variations

The types of pollen in the air vary by region, with different types of trees contributing. Birch, oak, and ragweed are common culprits, each producing its own distinct pollen. As a result, there’s no single catch-all solution, or even one simple diagnostic procedure, for pollen allergies. 

Changing Times

Interestingly, seasonal allergies seem to be on the rise. Climate change may be to blame, as higher temperatures can increase pollen production. A 2019 study in the Lancet showed significant increases in the pollen count and a longer pollen season across the northern hemisphere, and although the average in North America hovers between 10 and 25 percent of the population, pollen seasons vary between locations and from year to year. In fact, a 2017 Statistics Canada study found that 40 percent of Canadians reported pollen or grass allergies – that’s a lot of congested people.

5 Steps to Help Reduce Seasonal Allergy Symptoms

Fortunately, science is providing more information about preventing and reducing seasonal allergy symptoms. Check out some easily adapted lifestyle tips below. 

1 - Reduce Stress

I get it: Life is stressful right now. However, the irony is that stress can exacerbate allergy symptoms, which in turn creates more stress. To end this cycle, take proactive steps to bring down the pressure. 

Studies have found that meditation and yoga have a positive impact on allergy symptoms. Getting enough sleep is also important. Of course, allergies can also interfere with sleep, since it’s hard to fall asleep with a stuffy nose. Sleeping with the windows closed can help keep pollen out to preserve your indoor air quality. 

2 - Keep Indoor Pollen Under Control

In addition to keeping your windows closed, small changes in your daily routine can help reduce the amount of pollen in your home. Consider this: When you’re outside, you’re often surrounded by tree pollen which can rest on your clothes, hair, and skin, so you need to take special measures to get rid of it. 

Have a quick shower when you first come home at the end of the day, and launder your clothes frequently after spending time outside. Investing in a portable high-efficiency particulate air (HEPA) air filter and vacuuming with a HEPA filter will also help keep the air cleaner. 

Although we want to avoid pollen, getting outside is still important for mental and physical health, particularly while we’re still avoiding indoor gatherings. Try to schedule walks following a rainfall, when the air will be clearer. 

3 - Reduce Other Airborne Irritants 

Perfumes, air fresheners, scented candles, aerosol sprays, conventional cleaning products, dust and cigarette smoke are all irritants commonly found in the home that can make your nasal passages and eyes more vulnerable to reactions to pollen. Keeping your home with natural, non-toxic cleaners or even steam-cleaning will help reduce the overall load on your mucus membranes.

4 - Eat Antihistamine Superfoods

Certain foods can help bring down systemic inflammation and slow the production of histamine. Eating a well-balanced, whole foods diet with plenty of vegetables, healthy fats and low in sugar is a great starting point - and including some of these antihistamine superfoods can be effective too:

Omega 3 Essential Fatty Acids

Foods high in omega-3, such as fresh salmon, chia seeds, and flax seeds. 

Pineapple and Papaya

Vitamin C found in many fruits can inhibit histamine and support the immune system, but some fruit contains enzymes that actively reduce antihistamines in the bloodstream. Pineapple contains the enzyme bromelain, and papaya contains papain.

Spices

Certain spices can act as decongestants. Ginger, in particular, is effective in reducing nasal symptoms. Early research suggests that curcumin, which is found in turmeric, can also ease the symptoms of seasonal allergies. 

5 - Consider Nutritional Supplements (under the guidance and support of your ND)

Research is uncovering new beneficial treatments for seasonal allergies and rediscovering the benefits of traditional remedies. 

Vitamin D

Vitamin D deficiency is prevalent worldwide, and with its roles in anything from inflammation to immune support and bone health, supplementing with vitamin D is widely recommended. Recent studies looking at the effect vitamin D supplementation has on seasonal allergies found that participants who took vitamin D reported a reduction in symptoms compared to those who took a placebo.

Herbal Remedies

Stinging nettle is a herb that is often used in natural medicine for its anti-inflammatory properties. In a 2000 study, half of the participants who took a stinging nettle supplement reported a reduction in seasonal allergy symptoms, and almost 2/3rds felt better.

Antioxidants

Quercetin, an antioxidant flavonoid found in brightly coloured produce like berries and kale, also helps reduce the body’s production of histamine.

If you’re struggling to get seasonal allergies under control, give our office a call or CLICK HERE to book an alignment call to see if we are a good fit to work together. As a Naturopathic Doctor I can run lab tests to gain specific information on your allergies. Together, we can create a customized plan that will give you peace of mind as we move into spring and summer. 

Research 

Perceived stress predicts allergy flares - Annals of Allergy, Asthma & Immunology - Amber M. Patterson, MD, Vedat O. Yildiz, MS, Maryanna D. Klatt, PhD, William B., Malarkey, MD Published:August 08, 2013

Sleep and allergic disease: A summary of the literature and future directions for research - Daphne Koinis-Mitchell, PhD,a Timothy Craig, DO,b Cynthia A. Esteban, MSN, MPH,a and Robert B. Klein, MDa, J Allergy Clin Immunol. Dec 2012 

Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis, Journal of the American College of Nutrition, April 1992

Immunomodulatory effects of curcumin in allergy, Sep 2008, Food Res. Molecular Nutrition & Food ResearchViswanath P Kurup 1, Christy S Barrios

Inhibitory effect of honeybee-collected pollen on mast cell degranulation in vivo and in vitro, Journal of Medicinal Food, Mar 2008, Yasuko Ishikawa 1, Tomoko Tokura, Nobuhiro Nakano, Mutsuko Hara, François Niyonsaba, Hiroko Ushio, Yuji Yamamoto, Tadahiro Tadokoro, Ko Okumura, Hideoki Ogawa

Temperature-related changes in airborne allergenic pollen abundance and seasonality across the northern hemisphere: a retrospective data analysis - The Lancet Planetary Health, March 2019 - Lewis H Ziska, PhD , Prof László Makra, PhD, Susan K Harry, AAS, Nicolas Bruffaerts, PhD, Marijke Hendrickx, PhD, Frances Coates, MS, et al.

Vitamin D in allergic disease: Shedding light on a complex problem, The Journal of Allergy and Clinical Immunology - Feb 2013 - Beda Muehleisen, MD, Richard L. Gallo, MD, PhD 

Quercetin with the potential effect on allergic diseases, Allergy, Asthma & Clinical Immunology May 2020 Morteza Jafarinia, Mahnaz Sadat Hosseini, Neda kasiri, Niloofar Fazel, Farshid Fathi, Mazdak Ganjalikhani Hakemi & Nahid Eskandari 

Vitamin D and the development of allergic disease: how important is it?

Hooman Mirzakhani, MD,1,2 Amal Al-Garawi, PhD, MMSc,1,2 Scott T. Weiss, MD, MS,1,2,4 and Augusto A. Litonjua, MD, MPH

Statistics Canada Health Fact Sheets - Chronic Conditions, 2017

The Connection Between Gluten and Thyroid Issues

By now, you’ve likely heard about gluten intolerance. The buzz word  “gluten-free” is everywhere in the health world. But how impactful is gluten? For those with thyroid issues, it may be affecting you more than you realize.

Thyroid Conditions Are Fairly Common

About 20 million Americans are currently suffering from a form of thyroid disease. And roughly 60% don’t know it. Thyroid disorders are particularly common in women with one in eight females going on to develop a thyroid condition within her lifespan, and women are five to eight times more likely to have thyroid issues than men.

Your Thyroid Can Be Under or Over Performing

A malfunctioning thyroid can lead to either over or under-production of thyroid hormones. These hormones — called T3 and T4 — affect every organ system in your body. 

Your heart, central nervous system, autonomic nervous system, bone, gastro-intestinal tract and metabolism all obey the orders of your thyroid hormones.

A Holistic Approach

Whether the issue is hyperthyroidism, hypothyroidism, Grave’s disease, or Hashimoto’s thyroiditis, the symptoms of thyroid issues can vary in severity from moderate to life-changing. That’s why naturopathic practitioners take a holistic approach to tackle thyroid issues from all angles - and that always includes nutrition.

The Gluten Intolerance Link

Recent research links gluten intolerance and auto-immune issues, meaning if an auto-immune condition is the underlying cause of your thyroid disorder, your relationship with gluten may be an exacerbating factor. This connection happens so often that some studies suggest gluten intolerance screening for anyone with auto-immune thyroid issues.

Auto-Immune Thyroid Issues

If you have an auto-immune thyroid issue, eliminating gluten entirely is typically critical to fully understanding your condition. Even eating small amounts can cause immune reactions lasting up to six months, so complete elimination is needed in order to notice any difference in your symptoms and lab findings.  

Gluten-free diets can be tricky to maintain, but the results are worth the trouble. Your gluten intake may be the critical factor affecting the function (or auto-destruction) of your thyroid.

How Does Gluten Lead to Autoimmunity?

When you ignore food sensitivities, your gut often pays the price in inflammation. Over time, inflammatory foods (like gluten) can degrade the delicate lining of your small intestine, leading to permeability or “leaky gut”. When this happens, food particles are able to slip past the protective mucosal layer, between the cells lining the intestinal wall, and reach your bloodstream. The protein portion of gluten — called gliadin — is a common culprit.

Mistaken Identity

The immune system targets these proteins as foreign particles and begins to attack them. Unfortunately, gliadin protein molecules are strikingly similar to the molecules that make up the thyroid gland. Once antibodies to gliadin are created, they can mistakenly attack thyroid tissue. From that point on, you have an auto-immune response to gluten.

A Gluten Intolerance Can Be Hidden

Many people misinterpret gluten intolerance as a “digestive” issue only. But it can affect far more than just the digestive system. Antibodies triggered by this kind of gluten intolerance travel throughout the whole body: the joints, skin, respiratory tract and brain can all  be affected. In fact, for some people affected, no digestive symptoms are seen at all. With a wide variety of possible symptoms, gluten sensitivity may take a lot of effort to uncover.

Other Grains Can Mimic Gluten

As if the situation wasn’t complex enough, once the antibodies for gluten have been created, they can mistakenly attack other proteins too. Certain grains, such as corn, oats and rice, are naturally gluten-free yet their proteins are so similar to gluten that they occasionally still elicit an immune response. A naturopathic doctor can help you identify which foods may trigger your gluten sensitivity. 

Casein Sensitivity May Also be an Issue

Lactose intolerance is much more common than gluten intolerance. However, the two often overlap. In one study in Italy, roughly 25% of people with lactose intolerance also had celiac disease, a digestive condition that is linked to gluten-related autoimmunity. 

This means that for many people, going gluten-free won’t be enough to get to the root of their auto-immune symptoms. If an intolerance to casein (the main protein in dairy) may be at play, patients are often advised to adopt both a dairy-free and gluten-free diet during the elimination phase, with dairy being added back separately to assess casein sensitivity.

How We Test for Gluten Intolerance

There are multiple ways to test for food sensitivities and ascertain whether gluten intolerance may be playing a part in your thyroid issues.

Testing for Antibodies in the Blood

Running a food sensitivity panel is one way to start learning what is going on. Although they are expensive to run, and do not always lead to a clear path of action other than the complete avoidance of the foods in question, these blood tests can be vital guideposts in the dark for tricky cases.

IgA and IgG

Both IgA and IgG antibodies are tested. These antibodies are created in response to gluten particles in the bloodstream. IgA and IgG are delayed-response antibodies — they aren’t created immediately, making them a good indicator of a long term sensitivity to gluten. However, a milder case of gluten sensitivity (when antibodies haven’t been created) may be missed, and false negatives can occur if a patient is currently avoiding gluten.

Creating a Benchmark

Your naturopathic doctor may advise running a food sensitivity panel before you begin an elimination diet so that you have a benchmark to work with. While eliminating gluten and dairy are the most common requests, you may be asked to remove one or more other foods based on the results of your food sensitivity panel so that other potential problem foods don’t interfere with the success of your elimination phase.

The Gluten Challenge 

Hypo-allergenic diets may be one of the most powerful tools a naturopathic doctor can prescribe, but no bones about it: these diets can be very difficult and can take a long time. The hidden benefit is that the diet you are on during the investigation eliminates your possible triggers, so you should start to feel better right away, even as you uncover the details of your sensitivity.

Luckily, when it comes to auto-immune conditions, removing dairy and gluten are often the main dietary requirements and there are many alternative foods available.

The Elimination Phase

For anywhere from two to six weeks, depending on your individual situation, you’ll remove all dairy and gluten from your diet. During this time, you’ll keep a close eye on your symptoms to see if they resolve or reduce dramatically. If symptoms don’t resolve, you may be asked to remove additional foods: like eggs or soy.

The Challenge Phase

Once your symptoms resolve, you’ll reintroduce each food one at a time. Let’s say dairy first. You’ll have dairy in every meal for two days while keeping note of any symptoms or sensitivity reactions. Then you’ll be instructed to stop eating dairy for three days. 

If there are no reactions during elimination or in the final phase, a dairy sensitivity can be ruled out. At that point, you can safely add dairy back into your diet. 

A Positive Result

Next, you will begin the challenge phase for gluten. Let’s say you did have a symptom response to gluten. At that point, you would be instructed to eliminate gluten from your diet for another three to six months before attempting the challenge again. After a longer break, and various gut healing protocols, some food sensitivities are no longer as offensive.

If - on the other hand - your symptoms did return when you reintroduced gluten, your naturopathic doctor may diagnose you with gluten sensitivity &/or intolerance.

Weekly in my practice, I am helping patients regain their thyroid health. The health of your thyroid affects every cell in your body. If you suspect an autoimmune condition may be affecting how well you feel, please reach out or call my office. As your naturopathic doctor I have access to a wide array of investigative tools and lab tests to help you uncover what’s really going on - and come up with a tailored plan to help you feel like yourself again.

Resources:

Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clinic proceedings. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664572/. Published 2009. 

General Information/Press Room. Published 2014. American Thyroid Association. https://www.thyroid.org/media-main/press-room/

Ojetti V; Nucera G;Migneco A; Gabrielli M; Lauritano C; Danese S; Zocco MA; Nista EC;Cammarota G;De Lorenzo A;Gasbarrini G;Gasbarrini A; High prevalence of celiac disease in patients with lactose intolerance. Digestion. https://pubmed.ncbi.nlm.nih.gov/15775678/. Published 2005. 

Shahid MA. Physiology, Thyroid Hormone. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK500006/. Published May 18, 2020.