Half of the women in the United States are menopausal. There are different types of menopause. Natural menopause is defined as the ceasing of menstrual periods for 12 months. The average age of menopause is around fifty two years. It is often preceded by two to eight years of mild to moderate symptoms and is called the perimenopause period. This blog will focus mainly on the natural perimenopause transition. Premature ovarian insufficiency is menopause that occurs before the age of 40. It is often sudden and associated with autoimmune diseases. Surgical menopause can occur at any age usually due to a complete hysterectomy (removal of the uterus) with bilateral oophorectomy (removal of both ovaries). Medical menopause can also occur at any age and can be due to chemotherapy or gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists are medications like orilissa or lupron which suppress the production of sex hormones like estrogen and testosterone. These medications are given for estrogen-sensitive conditions like endometriosis and uterine fibroids.

Until recently, menopause was considered a taboo and hushed topic. This change can be freeing (such as sexual freedom) or can be seen as a time of contemplation and mourning. It can be a time of transition in a woman’s life. Perimenopause can be associated with mild to severe symptoms as hormones fluctuate (particularly estrogen and progesterone) but it can also be a welcomed phase in a woman’s life. This is an under-celebrated transition. Instead of being celebrated for reaching a phase of wisdom and power, it is often culturally unwelcome and even insulted. This needs to change so that women are empowered. This can be a period of creativity, expression, speaking up, travel, study, and reinvention.

“Once a woman reaches menopause, life gets simpler. Post-menopausal women can maintain regular cycles of energy with much less
fatigue. Plus, strange food cravings and binges disappear, as do
monthly mood swings and breast tenderness. And there are no
more awkward moments walking backward out of a restaurant with
your sweater tied around your hips.”

~ Marcelle Pick. 

I had a 47-year-old patient named Mary who struggled with night sweats and depression. After working with me for a few months, she adopted a Mediterranean-style diet and took adaptogens, B vitamins, and magnesium. Soon she felt more balanced with improved symptoms. If you’re dealing with perimenopausal symptoms, working with a functional medicine physician can help you create a personalized plan to support your body’s unique needs during this transition to your wisdom years. Perimenopause can be a challenging phase, but functional medicine provides a comprehensive approach that addresses the root causes of symptoms.

Perimenopause can be a confusing and challenging time for women as hormones fluctuate. Functional medicine is a holistic, patient-centered approach that looks at the root cause of the symptoms and aims to restore balance through lifestyle, nutrition, and herbal treatments, instead of focusing on symptom management. Functional medicine aims to support women during this transition by focusing on the whole body and identifying triggers in the diet and environment, stress, and nutritional deficiencies. Functional medicine creates individualized treatment plans, including dietary adjustments, supplements, exercise, and stress management. Rather than simple symptom management, this approach addresses inflammation, gut health, and adrenal function, all of which play an important role in managing perimenopause symptoms. 

Nutrition plays a key role in functional medicine, with an emphasis on whole foods that stabilize blood sugar and support hormone production. Supplements like B vitamins and magnesium can help with fatigue, mood swings, and sleep. Herbal remedies like black cohosh, St. John’s wort, and valerian help with sleep, depression, and hot flashes. Some women have increased vaginal bleeding in the perimenopause years. Botanicals were commonly used to manage dysfunctional uterine bleeding, including lady's mantle (Alchemilla vulgaris), arrow (Achillea millefolium), and shepherd's purse (Capsella bursa pastoris), along with others.

It is also thought that sex gets better with age. This might be due to higher levels of confidence, more adventurous, more interested in pleasing their partner, and sex can be more gratifying in long-term relationships. Some studies show that multiple orgasms and a woman’s capacity to orgasm increase with age. At the same time, the symptoms and risks are also real. Physical symptoms include hot flashes, night sweats, vaginal dryness, frequent urinary tract infections, decreased bone density (osteoporosis), and decreased libido. Cognitive changes include a decline in motivation or drive, and memory challenges. Emotional changes can include anxiety, depression, irritability, and insomnia. The rollercoaster of symptoms that many women experience during perimenopause is driven by fluctuating hormones such as estrogen and progesterone.

By focusing on nutrition, lifestyle changes, and natural
supplements, women can navigate this transition smoothly
and feel empowered. I would love to guide you to a smoother and
more balanced lifestyle as you navigate your wisdom years.

- Dr. Sushma Sadula

“Although women have been taught to dread menopause, this life
stage ushers in the springtime of the second half of life and is often accompanied by surges in creativity, vitality, newfound ambition, and
the need to be of meaningful service to the community in a larger way. During perimenopause and beyond, our goals and behavior become more motivated by the demands of our souls, not just those of society.”

~ Christiane Northrup, MD