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Natural Awakenings Milwaukee Magazine

PERIMENOPAUSE: Hormones During the 40s and Late 30s

Apr 30, 2021 08:30AM ● By Joanne Aponte


For women in their 40s or even late 30s, there can be a lot of disruption in their hormonal cycling. This can lead to significant symptoms that decrease the quality of life, such as:

  • Very heavy periods;
  • Shorter menstrual cycles (periods come closer together);
  • Irregular periods (long cycles or missing a period);
  • Sore and tender breasts;
  • More frequent migraines (especially ones that come before, during or after a period);
  • Night sweats (typically right before, 
during or after a period);
  • Mood issues (such as mood swings, low stress threshold, anxiety, depression, irritability and sometimes even rage);
  • Heart palpitations;
  • Trouble sleeping.
Women experiencing some of these symptoms may be in the phase of life called perimenopause. Perimenopause is the process of hormonal and brain changes leading up to menopause when periods finally stop and fertility ends. The process typically starts when women are in their forties, though for some women it begins as early as their late 30s, and it can last up to ten years before the final period, or menopause. While it’s a completely normal transition, it can be a tumultuous time for many women.

Perimenopause involves a sequence of events. First there is a decline in progesterone levels, as well as high and fluctuating estrogen levels, as though the estrogen is on a roller coaster. As one progresses through the process, eventually estrogen levels will drop and remain consistently low. Towards the end of this process, there are changes in insulin metabolism—which partly explains why it’s so much harder to lose weight in one’s 40s.

Most of the symptoms of perimenopause are due to the declining levels of progesterone, combined with the elevating levels of estrogen. Estrogen can spike up to three times higher than when you were younger. This big gap between high levels of estrogen and low progesterone is what causes problems.

To stay feeling healthy and happy during this process, try the following tips.

Manage one’s stress and aim to keep one’s body in parasympathetic mode (aka “relaxed mode”) by exercising regularly; spending time outdoors everyday; having meaningful relationships and good social connections; practicing breathing techniques, yoga and/or acupuncture; and using adaptogenic herbs such as ashwaganda and rhodiola.

Get adequate sleep and maintain a consistent sleep schedule. If one is unable to sleep on one’s own, magnesium, adrenal support and progesterone could help.

Decrease caffeine to a maximum of one cup per day. Try green or matcha tea instead as these are also great for hormone balance.

Keep alcohol consumption low. Drinking alcohol interferes with the body’s ability to metabolize and clear estrogens.

Eat a healthy whole-foods diet that is low in sugar, low in white refined and packaged foods, and low in dairy. Think of dairy as a condiment, such as a sprinkle of cheese on a salad.

Eat two to three cups of cruciferous vegetables each day, such as cauliflower, kale, broccoli, cabbage, collard greens and Brussel sprouts.

Ensure good blood sugar balance and address pre-diabetes or insulin resistance—high levels of blood glucose and insulin are very inflammatory and can lead to more hormonal imbalance and fluctuation.

Try magnesium. This mineral helps with sleep, reduces migraine frequency and is great for irritability and anxiousness. It is also involved in the metabolism of estrogen and can help maintain better estrogen balance.

Those with very heavy periods may need to lower their estrogen. Progesterone or nutrients may help. Iron deficiency can make heavy periods worse, so it’s a good idea to have iron levels checked.

Mood issues might signal the need to improve production of neurotransmitters in the brain. Magnesium, B-complex and the amino acid 5-HTP are helpful for this.

Support better estrogen and progesterone balance. A phytonutrient from broccoli called DIM (diindolylmethane) can help balance the estrogens when they are high. To boost low progesterone, the herb chastetree berry helps the brain increase natural progesterone production. For some women, using a progesterone cream or prescription pill might be needed. Progesterone is particularly helpful when there are heavy periods, sleep problems and high feelings of stress and anxiety.

Dr. Joanne Aponte is a naturopathic doctor at Lakeside Natural Medicine. Her passion is to help address the underlying causes of health issues with the use of nutrition and natural medicine to promote healing. Her practice focus is on digestive disorders, women’s hormone imbalances and infertility. Visit for more information.