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By: Dr. Sushma Shah - Naturopathic Doctor


Perimenopause is the time of change leading up to actual menopause-the normal biological event that marks the end of a woman's reproductive years. It usually occurs between the ages of 45 and 55, lasts about 4 to 5 years, and is commonly associated with a shift from regular to irregular menstrual cycles prior to stopping completely. Symptoms associated with menopause may also occur during this transitional period. Menopause is one of the major turning points in a woman's life. Approaching menopause involves a process of change - and every woman experiences this transition in unique and individual ways.

Many women discover that menopause gives them a new lease on life - physically, emotionally, sexually, and spiritually. They are enthusiastic about becoming free of their concerns about pregnancy and menstruation.


Menopause is the time at "mid-life" when a woman has her last period. It happens when the ovaries stop releasing eggs — usually a gradual process. Sometimes it happens all at once. It can be a stop-start process that may take months or years. "Climacteric" is another word for the time when a woman passes from the reproductive to the non-reproductive years of her life.

The ovaries' production of estrogen slows down during perimenopause. Hormone levels fluctuate, causing changes just as they did during adolescence. The changes leading to menopause may seem much more intense than those during puberty. The intensity may be affected by a woman's feelings about aging, including her reactions to social judgments about aging. Induced menopause occurs if the ovaries are removed or damaged as in hysterectomy, chemotherapy, or radiation therapy. In this case, menopause begins immediately, with no perimenopause. The time after menopause is called postmenopause.


  • Irregular menstrual cycles—menstrual bleeding slows, becomes erratic, and then stops permanently (the process takes about 4 years)

  • Hot flashes—flushing of face and chest (may be accompanied by heart palpitations, dizziness, headaches)

  • Night sweats

  • Cold hands and feet

  • Vaginal changes—dryness, itching, bleeding after intercourse

  • Urinary changes—frequent urination, burning during urination, urinating at night, incontinence

  • Insomnia

  • Mood changes—depression, irritability, tension (usually occurs with sleep disturbances)

  • Loss of skin tone leading to wrinkles

  • Weight gain and change in weight distribution with increased fat in the central, abdominal area

Over time, depleted estrogen levels can contribute to the development of more serious medical conditions, including the following:

  • Osteoporosis

  • Cardiovascular disease

  • Alzheimer's disease

  • Macular degeneration (a serious eye disorder and the leading cause of blindness in the Western world)

  • Glaucoma

  • Colon cancer

  • Menopause and Hormone Balance Issues


In the years leading up to menopause (perimenopause) menstrual cycles that may once have been like clockwork start to become erratic. Bleeding may be heavier or lighter than usual—although women are not officially in menopause until they have had 12 consecutive months without a period. Erratic cycles are a sign of erratic ovulation leading to highs and lows in estrogen and progesterone, an effect many women describe as an emotional roller coaster.

Forgetfulness and foggy thinking, mental confusion and mood swings are hallmark symptoms for many women; as are hot flashes and night sweats, tearfulness, unwanted weight gain, thyroid problems and declining interest in sex, no matter how much we love our partner. Of course not all women experience all these symptoms—as individuals we each have our very own biochemistry—but it is common to experience some degree of discomfort during the menopausal years. And the degree to which we experience discomfort is likely to be associated with the degree to which our hormones are out of balance.

Perimenopause may begin as early as 35. It usually starts about two years earlier for women who smoke than for women who don't. Women reach menopause at different times. The timing is not related to race, class, pregnancy, breastfeeding, fertility patterns, the birth control pill, height, age of menarche (first period), or age at last pregnancy.

The average age for menopause is 51. If menopause is reached naturally or surgically before the age of 40, it is called early or premature menopause.

Estrogen levels drop very abruptly after induced menopause — when both ovaries are removed surgically or through radiation or chemotherapy. This often intensifies the conditions associated with menopause and may lead to major physical and emotional changes, including depression. Most women who have "natural" menopause experience a more gradual decrease in hormone levels.

It is somewhat reassuring to remember that perimenopause is a temporary phase. And most symptoms are temporary, such as mood changes and hot flashes. For most women perimenopause will last two or three years, though for some it lasts as long as 10 or 12 years.

A few symptoms — vaginal dryness and changes in sexual desire -may persist or worsen after menopause unless they are treated.

Women in perimenopause have reduced fertility but they are not infertile. Although menstruation may be sporadic, pregnancy can happen. That's why women need to consider birth control during perimenopause. All women should discuss their contraceptive options with a clinician — whether or not they are menstruating.


50 to 75% of women in the U.S. experience hot flashes and/or night sweats during menopause. Hot flashes can be very mild, or quite severe. Hot flashes are sudden or mild waves of upper body heat that last from 30 seconds to five minutes. Hot flashes can start with a tingling sensation in the fingers or rapid heart beats. Skin temperatures rapidly rise from the chest to the face and may cause facial redness and sweating.

Perspiration is also common to the phenomena and in some women the hot flash takes the form of a night sweat, followed by a chill that has one groping for the covers kicked to the floor just minutes earlier. Night sweats are on a continuum with hot flashes, occurring most often in the wee hours between 3 to 4 a.m., a common cause of sleep disturbance in menopausal women, many of whom say they wake drenched in perspiration. Usually triggered by falling estrogen and rising levels of follicle stimulating hormone, hot flashes arrive unannounced, and usually at a most inconvenient time. Besides hormonal changes, anxiety and tension magnify hot flashes and many women find that hot drinks and wine do the same. In most cases, hot flashes usually go away a year or two after actual menopause and the cessation of menses.


Many people experience high levels of mental and emotional stress on a regular basis, which puts a significant strain on adrenal function. The adrenal glands are two triangle-shaped glands that sit over the kidneys, and are primarily responsible for governing the body’s adaptations to stress of any kind. When stress becomes excessive or is not well-managed, the ability of the adrenal glands to do their job becomes compromised. The adrenals normally secrete cortisol in response to stress, exercise and excitement, and in reaction to low blood sugar.

The body normally secretes the highest amount of cortisol in the morning to get us going, with levels decreasing throughout the day. People with adrenal imbalance will often have abnormally high or low cortisol levels throughout the day. If stress remains too high, the adrenals are forced to overproduce cortisol continuously. After a prolonged period of time, the adrenals can no longer keep up with demand and total cortisol output plummets leading to adrenal exhaustion.

The hallmark symptoms of adrenal dysfunction are stress and fatigue that is not alleviated with sleep—that tired all the time feeling. Other common symptoms include sleep disturbances and/or insomnia, anxiety, depression, increased susceptibility to infections, reduced tolerance for stress, craving for sweets, allergies, chemical sensitivities and a tendency to feel cold.

You can begin to support adrenal function on your own by avoiding hydrogenated fats, excess caffeine, refined carbohydrates, alcohol, and sugar. Get plenty of quality protein and eat regular meals of high nutritional value.

The key to success is to discover and practice stress management in whatever form works for you personally. Take time out, evaluate the stressors in your life, and find ways of expressing yourself creatively. Get enough rest and sleep. And last but not least, keep a sense of humour!


Estrogen, progesterone and testosterone are key players in the maintenance of circulation, nerve transmission and cell division, so an imbalance of these hormones can easily lead to changes in sexual response. Declining estrogen levels common to the menopausal years can dampen nerve impulses during sex, making us less sensitive to vibration and touch. And since estrogens increase blood flow to sexually sensitive areas, decreased levels can slow or diminish the arousal response.

Imbalances of estrogen and testosterone can cause dryness and thinning of vaginal tissue making intercourse uncomfortable or downright painful—an effect that does absolutely nothing for libido. Key to a normal sex drive is the right balance of estrogen to progesterone. An excess blocks thyroid function, which can inhibit libido. A balance stabilizes mood and supports thyroid function, which enhances libido. Significantly, progesterone is also a precursor to estrogen and testosterone so we need it in steady supply for optimal sexual pleasure.

Testosterone and DHEA also have a major impact on sex drive. Levels gradually decline in the years leading to menopause and can drop dramatically with hysterectomy, chemotherapy, surgery and radiation. If you have a low libido and have lost interest in sex, a measure of estradiol, progesterone, testosterone and DHEA-s can establish probable cause and a rationale for correcting the imbalance.


Bone is a hormonally sensitive tissue that is affected by age-related decline in production of these hormones. Many studies show that both men and women as they age begin to lose bone as the drogens—testosterone and DHEA in particular—start to fall off. When these hormones are low and cortisol is high, bone loss increases at an even more rapid pace. We know that too much stress raises cortisol output, interfering with calcium absorption and bone-building activity, while at the same time stepping up the activity of bone destroying cells. Cigarette smoking, alcohol intake and a lack of physical activity are associated with increased bone loss.


More than 10 million Americans have been diagnosed with thyroid disease, but interestingly, women are at greatest risk, developing thyroid problems seven times more often than men. Thyroid hormone regulates metabolic rate so low levels tend to cause unwanted weight gain, depression, low energy and cold intolerance. Excess thyroid causes higher energy levels, a feeling of being too warm all the time and weight loss. But it’s hypothyroidism, or low thyroid, that is most common in women during the perimenopausal and postmenopausal years; in fact, some 26% of women in or near menopause are diagnosed with hypothyroidism.


As women age, the number of viable ovarian follicles decreases. It becomes more difficult to stimulate the remaining follicles to release an egg. Still, the body struggles to stimulate ovulation by increasing FSH and LH production. Occasionally, FSH and LH succeed in developing a follicle to maturity and ovulation occurs. However, as menopause nears, these attempts are increasingly ineffective and the menstrual cycle begins to sputter.

Menstrual periods become irregular as a result of repeated failures to ovulate. Missed ovulation leads to an excess of estrogen over progesterone, because the follicle did not rupture, no corpus luteum exists to produce progesterone. Consequently, symptoms of estrogen excess, like headache, fluid retention and irritability can occur. Declining estrogen and progesterone levels can change the frequency, length and intensity of menstrual periods. (Note: irregular periods and heavy bleeding can be signs of a more serious condition. Please contact your physician if you experience these symptoms). The changes in hormone balance can result in a variety of symptoms. In the end, the few remaining follicles are too worn out to respond, and menstruation ceases entirely. The change has begun!


In general, menopause is considered complete when a woman has not menstruated for at least 1 year.

Conventionally accepted medical approaches of assessment for this condition may include a Pap smear, blood tests to determine hormone and cholesterol levels, and a bone density measurement. It is important to have a thorough discussion with your healthcare provider regarding the benefits and risks of different options for reducing symptoms and health risks associated with menopause. If vaginal bleeding resumes unexpectedly once menopause has occurred, your healthcare provider may consider a test called an endometrial biopsy. In this test (performed in the office), a gynecologist takes a sample of the uterine lining (the endometrium) and examines them under the microscope for abnormal changes.


At our naturopathic clinic, during your initial 1 hour one –on – one consult, you will be undergo a comprehensive symptom intake in detail, and at the end of the visit, you will be required to do some blood – hormonal, saliva and urine testing. The assessment is oriented toward determining what is impeding your body's ability to function normally. The assessment tools that are most helpful in establishing a treatment strategy specific to your health needs will be used.

You may be required to some specialized hormonal testing, blood tests to determine your hormone and cholesterol levels, and a bone density measurement, if need be in order to get all the necessary physiological information and to get a more complete picture of your symptoms. Following this visit, you will be coming in for your second visit, a full physical check up, including a breast exam, a traditional Chinese medicine tongue and pulse diagnosis, body fat analysis and blood glucose testing is carried out. After having gone through your case, you will be given you an INDIVIDUAL TREATMENT PLAN *, that is specific to the symptoms you have.


The following preventive measures may help diminish symptoms and reduce the risk of serious complications (such as osteoporosis and cardiovascular disease) associated with menopause:

  • Quitting smoking—smokers tend to begin menopause 1 to 2 years earlier than nonsmokers; smokers are also at an increased risk for heart disease and osteoporosis

  • Taking calcium supplements—helps protect against bone loss

  • Exercising—slows the rate of bone loss, reduces hot flashes, and improves mood

  • Consuming low-fat diets—helps prevent cardiovascular disease by decreasing LDL "bad" cholesterol and by lowering the chances of weight gain

  • Avoiding caffeine—some studies suggest that caffeine consumption may be a risk factor for osteoporosis in postmenopausal women

Please ask your doctor or naturopath before starting on any supplements. Its is better to first identify the cause and then treat it with the right remedies, even though those mentioned above have minimal side effects.

The information on this article is the property of SUSHMA SHAH N.D., and is not intended to treat, diagnose or cure any disease. For any questions, or concerns, please contact me at 416 913 4325 (HEAL) or email me at

* DISCLAIMER: The information on this article is the property of Dr. Sushma Shah, Naturopathic Doctor, and is not intended to treat, diagnose or cure any diseases or promote any services or products mentioned on the website.

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