Embrace Perimenopause

Make perimenopause your opportunity to embrace healthier habits.

Written by: Victoria Biddick, NZ Associate Registered Nutritionist

Introduction: As we enter perimenopause, our bodies undergo various changes.

These changes can begin anywhere from 2 to 10 years before the final menstrual period (1). Some are noticeable and can be easily acknowledged as they happen, while others may go unnoticed, gradually emerging until we notice a shift in how we feel or physical changes in our body. Navigating these transitions can be challenging, especially if our lifestyle remains unchanged, often leading to a loss of confidence and uncertainty about how to adapt.

At Everee Women™, we want to reframe perimenopause as the perfect opportunity to make positive changes that support your health and wellbeing, so you can live your best midlife.

Why is my body changing?

Your body is changing due to fluctuating and declining levels of the sex hormones oestrogen, progesterone, and testosterone (1). Oestrogen plays a significant role in these changes, as it has a protective effect on our overall health during childbearing years. It influences many processes in the body, not just in the reproductive organs, which is why we experience a range of symptoms and bodily changes.

Natural ageing is another contributing factor. Over time, our cells experience wear and tear, our immune system slows down, and we may begin to experience chronic low-grade inflammation, known as inflammaging (2). Our metabolic hormones, such as thyroxine and insulin, which are responsible for converting nutrients into energy and regulating energy levels, also decline (1).

Impact on Health and Wellbeing

Body changes during perimenopause can significantly impact our health and wellbeing. By understanding these changes, we can take proactive steps to manage them, ensuring better overall health.

Some of the changes occurring during perimenopause include:

Decrease in:

• Bone Density:
  Our bones serve as a calcium reserve for the body. If our diet lacks sufficient calcium, some bone tissue breaks down. When our diet is rich in calcium the bone tissue rebuilds itself. This remodelling process continues in women until around the age of 30. In our early 30’s, any bone that breaks down will not rebuild, leading to decreased bone density(2). Oestrogen helps prevent bone loss, and as its levels decline, women become more susceptible to falls, fractures, and osteoporosis (1).
• Muscle Mass:
  Natural ageing results in the loss of muscle mass as the body becomes slower at building muscle and physical activity declines (2). Lower oestrogen levels accelerate muscle loss in perimenopause. Maintaining muscle mass and strength is crucial for balance and movement, and is linked to healthy ageing (2).
• Metabolism:
  Metabolism slows during perimenopause due to reduced levels of metabolic hormones and changes in body composition (2). A decrease in insulin makes it harder to break down and absorb carbohydrates, increasing the risk of type 2 diabetes. The thyroid hormone thyroxine, which governs overall metabolism, may also decrease, leading to tiredness and weight gain. Since muscle mass burns energy at a faster rate, declining muscle mass also contributes to a reduced metabolic rate (2).

Increase in:

• Belly (Visceral) Fat:
  During childbearing years, oestrogen signals fat to deposit on the hips and buttocks. This fat serves as an energy reserve. As oestrogen levels decrease, fat redistributes to the belly area, increasing the risk of type 2 diabetes and heart disease (1).
• Blood Pressure:
  Oestrogen helps keep blood vessels healthy and dilated, allowing blood to travel freely throughout the body. As oestrogen levels decrease, there is an increased risk of high blood pressure, which can damage blood vessels and increase the risk of heart disease - the leading cause of death in New Zealand women (3).
• LDL Cholesterol:
  LDL cholesterol, often referred to as "bad" cholesterol, is associated with a higher risk of heart disease (3). As oestrogen declines, the liver’s cholesterol production is affected, leading to higher levels of LDL cholesterol. Excess LDL cholesterol can build up in arteries, increasing the risk of heart attack or stroke (3).

Making Positive Changes to Support Your Health and Wellbeing

The combined effects of perimenopause and natural ageing can make this stage of life feel particularly challenging. While it might seem like you're "falling apart," many symptoms will ease once menopause is complete (1). Oestrogen continues to offer some protective effects for up to 10 years after menopause, but after that, we are on our own.

We can't change what is happening to our bodies, but we can change how we respond. Instead of thinking, "I'm miserable and falling apart," we can choose to view it as, "I'm strong, and this is an opportunity to make positive changes for my health and wellbeing."

The symptoms of perimenopause is a call to action, a chance to do things differently and live an awesome midlife and beyond.

What Action Can I Take to Improve My Health and Wellbeing?

It’s never too early or too late to make positive lifestyle changes, no matter where you are on your menopause journey. If you're unsure of your current stage, check out our “Where are you at on your Menopause Journey?” blog or download the Everee Women™ symptom tracker.

The advice below is general advice - for any specific tailored advice relevant to any health conditions please talk to your health professional.

Steps to Improve Health and Wellbeing During Menopause:

1. Midlife WOF at the GP:
   We recommend a visit to your GP for a midlife check-up. This is a great opportunity to discuss symptoms, body changes, and whether HRT or other treatments might be right for you. It’s also important to rule out any other underlying conditions. Dr. Sarah Marr, a Christchurch-based GP, suggests booking a double appointment to allow ample time for a check-up and discussion of available options to manage your symptoms.
2. Eating a Wholefood Diet:
   Focus on a diet rich in vegetables, fruits, quality proteins, whole grains, low-fat dairy, and healthy fats. As metabolism slows, it’s essential to make every meal nourishing. The Heart Foundation offers great guidance on healthy eating. Stay tuned for more on eating for health during perimenopause in our Women’s Wisdom blog.
3. Regular Exercise:
   Any exercise is better than none. As Kate Ivey shared in our Embrace the Change webinar, specific exercise routines support midlife changes. Prioritise lifting heavy weights, and include SIIT (Short Intensity Interval Training) and HIT (High Intensity Training) in your routine.
4. Reducing Alcohol Intake:
   Your body’s ability to process alcohol diminishes during perimenopause, and you may feel the effects more strongly. While no alcohol is ideal, aim to limit your intake to a “safe level” of 10 standard drinks per week (4).
5. Sleep Hygiene:
   Disrupted sleep is a common challenge in perimenopause. Nikki Bezzant recommends prioritising sleep with a regular bedtime, a pre-bedtime routine, and avoiding alcohol (most of the time!). She also advises not stressing about sleep, as that can make things worse.
6. Stress Management:
   Be kind to yourself. Perimenopause brings many changes, and it’s important to take time for yourself. Set boundaries, push back on unnecessary activities, and give yourself permission to adjust to your new normal.

If you're uncertain about where to start, seek support. This can come from your GP, friends, family, or lifestyle health professionals like personal trainers or nutritionists.

At Everee Women™, we want to create a supportive community for you during perimenopause. Remember, you're not alone, there are many resources and strategies to help you navigate these changes.

References

1. Australasian Menopause Society (2020). What is Menopause? Australasian Menopause Society.
   https://www.menopause.org.au/images/infosheets/AMS_What_is_menopause.pdf
2. Whitney, E., Rolfes, S., Crowe, T., Walsh, A. (2019). Understanding Nutrition (4th Australia and New Zealand ed.). Cengage Learning.
3. Heart Foundation NZ (2023). Why Does Menopause Increase the Risk of Heart Disease? Heart Foundation NZ.
   https://www.heartfoundation.org.nz/about-us/news/blogs/why-does-menopause-increase-the-risk-of-heart-disease
4. Ministry of Health (2020). Eating and Activity Guidelines for New Zealand Adults: Wellington: Ministry of Health.
   https://www.health.govt.nz/system/files/documents/publications/eating-activity-guidelines-new-zealand-adults-updated-2020-oct22.pdf