Understanding perimenopause and its impact on metabolic health

Perimenopause is a natural phase in a woman's life that marks the transition to menopause. This period can last two to ten years and is characterized by alternating low estrogen and high estrogen cycles with progressively lowering progesterone levels until periods stop for a full year. These hormonal changes can significantly affect metabolic health, leading to challenges such as weight gain, altered cholesterol levels, and difficulties in blood sugar regulation. 

However, there are ways you can optimize your metabolic health during this transition.

Weight gain during perimenopause

One of the most common complaints during perimenopause is weight gain. Many women notice that they are gaining weight, especially around the abdomen, despite not changing their diet or exercise habits. 

This weight gain is often attributed to hormonal shifts that affect how the body stores fat. As estrogen levels decline, fat distribution tends to shift from the hips and thighs to the abdomen. This leads to an increase in visceral fat, which is linked to higher risk of heart problems, high blood pressure, high blood sugar, and unhealthy cholesterol levels. The increase in abdominal fat can be exacerbated by an increase in cortisol due to high stress. 

Additionally, the loss of muscle mass accelerates during this time. Muscle tissue is metabolically active, meaning it burns more calories than fat. As muscle mass decreases, so does the resting metabolic rate, making it easier to gain weight.

Cholesterol changes

Perimenopause also brings about changes in cholesterol levels. Estrogen plays a protective role in maintaining healthy cholesterol levels by increasing HDL (the "good" cholesterol) and regulating LDL (the "bad" cholesterol). As estrogen levels drop, total cholesterol, LDL cholesterol and triglycerides often rise, which can increase the risk of cardiovascular issues.

Women may experience a significant increase in total cholesterol and LDL cholesterol during this transition, which underscores the importance of monitoring these levels regularly. 

A diet rich in fiber and healthy fats, such as those found in whole grains, fruits, vegetables, legumes, nuts and seeds, fish, and olive oil, can be a good starting point.

The rise of insulin resistance 

The hormonal fluctuations during perimenopause can also lead to insulin resistance, a condition where the body's cells do not respond effectively to insulin. Insulin resistance is a key factor in the onset of metabolic syndrome which promotes weight gain, especially around the waistline. 

As estrogen declines, women may find it more challenging to maintain stable blood sugar levels, leading to symptoms such as increased hunger, sugar cravings, and fatigue.

The connection between your gut and metabolism

However, estrogen is not all to blame. The gut microbiome is central to metabolism and is altered during perimenopause. Dysbiosis, an imbalance in gut bacteria, is linked to increased visceral fat, decreased metabolic rate, and insulin resistance. These changes can lead to energy crashes, cravings, and weight gain. Declining estrogen and progesterone levels during perimenopause can also weaken your gut barrier, increasing its permeability (also known as leaky gut) which plays a role in chronic bloating, sensitive skin, mood changes and low bone mineral density.

Other factors like poor sleep from hot flashes, night sweats, or racing thoughts can cause increased hunger, sugar cravings and fatigue which can worsen weight gain. Thyroid problems can also slow down metabolism and lead to symptoms like weight gain, fatigue, brain fog, mood swings, dry skin, hair loss, cold intolerance and constipation. It is important to review your health history with a qualified health practitioner to discover what’s driving your symptoms and find the right solution for you.

Perimenopause Diet and Lifestyle

To combat metabolic changes during perimenopause, it's crucial to adopt a balanced diet that focuses on complex carbohydrates, fiber, and protein. Regular physical activity, particularly strength training, can help build muscle mass and improve insulin sensitivity, making it easier to manage blood sugar levels.

Many women do not consume an adequate amount of protein. Some lack the digestive capacity to digest them properly. Meeting your daily protein requirement helps maintain steady energy and prevent muscle and bone loss. 

Cholesterol does not mean all fats are bad for you. In fact, you need healthy fats from olive oil, avocados, and nuts and seeds to make healthy hormones. Consider reducing sugar and refined grains to improve blood sugar regulation and limit alcohol intake to calm your hot flashes.

Stress management is vital, as chronic stress can disrupt hormonal balance. Mindfulness practices, better sleep hygiene, and regular exercise tailored to individual needs (such as yoga or strength training) can significantly improve overall well-being.

Naturopathic approach to optimal metabolic health

If you’re already eating healthy and exercising but still struggling to lose weight or achieve healthy cholesterol or blood sugar levels, you may need further assessment and personalized treatment.

Holistic assessment and understanding the real reason WHY you’re having difficulty losing weight may require testing of: 

•           Metabolic markers (insulin, glucose, lipids)

•           Inflammatory markers

•           Nutrient status

•           Gut microbiome health

•           Complete hormone panels (including sex hormones, thyroid and cortisol)

•           Genetic factors that affect hormone metabolism, insulin regulation and cardiovascular risks

•           Toxin load assessment

A thorough history taking will guide proper investigation. Curated testing will reveal specific imbalances contributing to your symptoms which assists in designing personalized protocols.

Personalized treatment: Personalized medicine means investigating and reviewing your unique needs to create strategies that deliver results. This includes layering of dietary, lifestyle and natural medicine to achieve your health goals. The ultimate goal is to get you to a place of sustainable health and pro-active prevention where you are thriving, not just surviving.

Perimenopause isn't something to endure, it's a transition to navigate with curiosity and compassion. It’s not “just stress”, or “just aging”. It’s about understanding and healing your relationship with your body. With the right support, perimenopause can be a time of empowerment, self-discovery, and renewed health and wellbeing.

References
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