To Prepare for a "Change of Life", Start with a Change of Lifestyle

By whatever name, pre-menopause, perimenopause, or early menopause, there is a phase in a woman’s life that predates menopause. This article focuses on these years, which I refer to as perimenopause, and gives you information you need to understand what is happening to your body, to know when you are in perimenopause, and to know what to do once you are.


A Menopause Chronology

Menopause is the loss of the sex hormone system, of a woman’s ability to produce any meaningful levels of the hormones estradiol and progesterone. So, let’s begin by spending a moment on what happens to a woman’s sex hormone system throughout her lifetime.

A woman is born with all the eggs she is ever going to have.

At birth, she has about 1 to 2 million eggs. Then, throughout her life, she loses eggs through a natural, destructive process called atresia. At puberty, only about 400,000 of her eggs remain. Throughout the reproductive life span, from puberty until menopause, women lose about 1,000 eggs each month. Of these thousand eggs, only one matures and is released.

So, for so long as she has any eggs, a woman’s eggs are always exactly the same age as she is — chronologically. A 10-year old girl has 10-year old eggs, a 30-year old woman has 30-year old eggs, and a 45-year old woman has 45-year old eggs. And a 70-year old woman has, you guessed it, no eggs at all!

Eggs remain dormant until a girl reaches puberty. At that time, her eggs begin to mature and start to produce the sex hormones estradiol and progesterone. Estradiol is the form of estrogen made by eggs as they grow in the ovaries. Generally, a woman’s eggs produce peak hormone levels from age 18 to only about age 34. Of course, it varies from woman to woman; some women produce their sex hormones at higher or lower levels and for longer or shorter periods than others. As a woman gets older and her eggs continue to age, they produce decreasing amounts of sex hormones.

Perimenopause is the point at which the level and the consistency of sex hormone production begins to diminish and/or become irregular.

One result of this reduced and more erratic hormone production is that her menstrual pattern becomes more erratic as well. She will typically have either more or less frequent periods and may even begin “skipping” periods. This change in menstrual pattern occurs because the levels and consistency of sex hormone production are what determine the timing and duration of a woman’s menstrual periods. Ultimately, when sex hormone production levels drop low enough, a woman completely stops having menstrual periods. At that point, she is fully “in menopause.”


How do I know if I am in Perimenopause?

What makes confirming perimenopause a bit tricky is that women do not necessarily have any symptoms, at least initially. Also, perimenopause manifests differently for every woman and begins at different times depending on a variety of individual factors. In many cases, it is not until the latter part of perimenopause that women begin to encounter some of the classic signs and symptoms of menopause such as hot flashes, night sweats, weight gain around the middle, sleep disruption, irritability, and changes in skin, hair and nails.


Don’t be fooled. Whether or not you have symptoms isn’t what determines if you are in perimenopause.

What does? Well, as simplistic as this may sound, your age is the best way to determine if you are in perimenopause. By the time you reach your early to mid thirties it is highly likely that you are in perimenopause – even if you have no apparent symptoms. In fact, even if you are still able to get pregnant, you may still be in perimenopause! This may sound extreme, but it’s not. Remember the definition of perimenopause: “the point at which the level and the consistency of your sex hormone production begin to diminish and/or become irregular.

So, age is the primary determinant, but not just your chronologic age, how old you are in years. Rather, it is your metabolic age that determines when perimenopause begins. By metabolic age, I mean the extent to which you are and have been in metabolic balance or imbalance during your life. If you have experienced significant metabolic imbalance due to poor nutrition, high stress, poor sleep habits, exposure to toxins such as nicotine and alcohol, over exercising, etc., then your eggs are older metabolically than they are chronologically. Therefore, you are more likely to begin perimenopause and, thus, menopause, at an earlier age.


What Do I Do Now That I Am In Perimenopause?

The best thing you can do in perimenopause is to “get in shape” for menopause by maintaining or restoring your metabolic balance. As I wrote over a decade ago in my first book, The Schwarzbein Principle, the degenerative diseases of aging such as cancer, heart disease, type 2 diabetes, Alzheimer’s dementia, osteoporosis, and strokes are not genetic; they are caused by metabolic imbalance. To understand the concept of metabolic imbalance, please read my latest book The Program.

There are two primary causes of metabolic imbalance:

  • Poor nutrition and lifestyle habits
  • The loss or compromise of any hormone system.

As explained in The Program, if you are not eating, sleeping, or exercising properly, if you are constantly stressed, are ingesting toxins such as sugar, preservatives, alcohol, or nicotine, then you are undermining and will ultimately damage your metabolism, which is the central element of your overall health. The metabolic imbalances that result from poor nutrition and lifestyle habits drag down your other hormone systems causing further metabolic imbalance, and magnifying the impact of continued poor nutrition and lifestyle habits – a classic downward spiral.

The loss of any hormone system also causes metabolic imbalance. Menopause is the permanent loss of the sex hormone system. Therefore, in preparation for menopause, which will tax your metabolism, it is extremely important that you correct any current metabolic imbalance by paying careful attention to your nutrition and lifestyle habits and changing anything that is undermining your metabolic health. By doing so, you will eliminate or at least minimize symptoms during both perimenopause and menopause, and you will lessen the metabolic impact of the loss of your sex hormone system.

What about hormone therapy during perimenopause? Provided you are still ovulating, it is not likely you will need to do so. If you are having irregular periods or symptoms such as hot flashes, night sweats, or sleep disturbance, your first line of therapy is always attention to your nutrition and lifestyle habits. That said, if you are no longer regularly ovulating, then, in all likelihood, you will need supplemental progesterone. Of course, once you are fully “in menopause” you should absolutely consider Hormone Balancing Therapy (HBTx™). See: Treat the Problem Not Just the Symptoms With Bioidentical Hormones


A Final Note

As the title of this article says, the best way to prepare for the “change of life” is to start with a change of lifestyle. Most women come into menopause with some degree of metabolic imbalance due to poor nutrition and lifestyle habits. The greater the degree of metabolic imbalance at the onset of menopause, typically, the greater the impact of menopause, both in terms of classic symptoms, the worsening of preexisting conditions, and the acceleration of metabolic imbalance.

The beginning of perimenopause – whether you have symptoms or not – is a wake-up call that tells you to take care of your metabolic health by paying special attention to your nutrition and lifestyle habits. The end of perimenopause signals the time when you should strongly consider beginning HBTx. By doing so, you will do a great deal to minimize and even eliminate the classic symptoms of menopause and, more important, lessen the extent to which menopause accelerates your aging process and promotes the degenerative diseases of aging.


To your health and happiness,

Diana Schwarzbein, MD