Written by Dr. Jordan Robertson, ND
The definition of the word perimenopause may not be one that most people could recite and yet, this may be the most impactful hormonal season in a person’s lifetime.
Perimenopause encompasses the last 1-8 years of menstruation, and although people continue to menstruate, the underlying hormonal changes that are occurring are significant and cause significant health changes.1The term menopause refers to a person who has not menstruated for 12 months and signifies the end of ovulation and a decline in hormone production.2People can often name the symptoms of menopause such as hot flashes, but don’t realize that these symptoms, and others can occur 10 years earlier, even if menstruation is still occurring.3 The symptoms of perimenopause can include cycle length changes, hot flashes, vaginal dryness, mood changes, insomnia, and changes to body composition and weight.2 These symptoms may be intermixed with months with less symptoms or even with PMS, as women haphazardly ovulate in the final few years before the final menopause transition.
Hormone production in this phase of life is best described as “disorganized” as people have more frequent cycles without releasing an egg (called an anovulatory cycle) and as a result have less consistent hormone production. Cycles may also come closer together causing a ‘stacking’ effect of estrogen from one cycle to the next.1,4 This creates a challenge when testing hormones in perimenopause, even though women can identify that their symptoms are “hormonal” in nature. Testing sex hormones in perimenopause often returns normal results, even though the pattern of hormone release each month is changing. Testing women in perimenopause should include tests such as thyroid function, vitamin D and iron status, especially since many people experience an increase in menstrual flow and may develop iron deficiency during this time. Testing estrogen and progesterone is possible but has to be interpreted carefully.2 For the most part testing estrogen and progesterone can confirm ovulation or that perimenopause has begun but often test results fall in the normal range, which can leave people feeling unvalidated for their experience.
Symptoms such as night sweats, mood changes and sleep disturbance have a significant impact on how people function in their day, their ability to eat well and move their bodies. These symptoms create a significant barrier for people in perimenopause from feeling their best and participating in the lifestyle actions that will support them in their menopausal years.
When looking for support during this time, people should be considering nutrients and botanicals that have been shown to support these symptoms of perimenopause. These can help smooth out the transition and the accompanying irregular hormone production.
Chaste tree is a botanical best known for its ability to support the symptoms of PMS. Chaste Tree (also known as Vitex) improves mood symptoms related to PMS as well as the physical symptoms such as breast tenderness and bloating.5,6 Recent studies have considered the use of Vitex either alone or in combination with other herbs for symptoms of perimenopause and have found that Vitex improves hot flashes7 and mood symptoms8 of perimenopause.
Sage is a herb well known for its use in the kitchen and lesser known for its benefit for hot flashes. Sage has been studied in the hot flashes and people transitioning through menopause.9Sage decreases the frequency and intensity of hot flashes over a period of 4-8 weeks which may support better sleep and quality of life in menopausal people.10,11
Ashwagandha is a herb that supports the stress response, and has been studied in for its impact on cognitive health,12 sexual function,13 and sleep14 and may support people in menopause with similar symptoms. Ashwagandha’s benefit comes from its ability to reduce cortisol levels and improve resiliency to stress.15
Rhodiola has been studied extensively in people with burnout and athletes to improve energy and resiliency.16 This botanical may support people in menopause through its action on mood.17 Rhodiola has a similar molecular mechanism as some of the hormone modulating medications used in menopause. Future research is hoping to highlight this herb for use specifically during this phase of life.18
People in their last 10 years before menopause deserve to not only understand the hormonal changes happening that validate their symptoms but, also deserve to be supported with safe and effective solutions to improve how they feel. The symptoms of perimenopause are significant and can have lasting effects on a person’s health if left unaddressed. Seeking solutions such as botanicals, nutritional support and lab testing are great first steps towards understanding and treating the symptoms of perimenopause.
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- Santoro, N. Perimenopause: From Research to Practice. J. Womens Health 25, 332–339 (2016).
- Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
- Allshouse, A., Pavlovic, J. & Santoro, N. Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms. Obstet. Gynecol. Clin. North Am. 45, 613–628 (2018).
- Hale, G. E., Hughes, C. L., Burger, H. G., Robertson, D. M. & Fraser, I. S. Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual cycles in the menopausal transition. Menopause N. Y. N 16, 50–59 (2009).
- Die, M. D. van, Burger, H. G., Teede, H. J. & Bone, K. M. Vitex agnus-castus Extracts for Female Reproductive Disorders: A Systematic Review of Clinical Trials. Planta Med. 79, 562–575 (2013).
- Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement. Ther. Med. 47, 102190 (2019).
- Naseri, R. et al. Comparison of Vitex agnus-castus Extracts with Placebo in Reducing Menopausal Symptoms: A Randomized Double-Blind Study. Korean J. Fam. Med. 40, 362–367 (2019).
- van Die, M. D., Bone, K. M., Burger, H. G., Reece, J. E. & Teede, H. J. Effects of a combination of Hypericum perforatum and Vitex agnus-castus on PMS-like symptoms in late-perimenopausal women: findings from a subpopulation analysis. J. Altern. Complement. Med. N. Y. N 15, 1045–1048 (2009).
- Zeidabadi, A. et al. The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women. J. Fam. Med. Prim. Care 9, 1086–1092 (2020).
- Dadfar, F. & Bamdad, K. The effect of Saliva officinalis extract on the menopausal symptoms in postmenopausal women: An RCT. Int. J. Reprod. Biomed. Yazd Iran 17, (2019).
- Bommer, S., Klein, P. & Suter, A. First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Adv. Ther. 28, 490–500 (2011).
- Choudhary, D., Bhattacharyya, S. & Bose, S. Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J. Diet. Suppl. 14, 599–612 (2017).
- Dongre, S., Langade, D. & Bhattacharyya, S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. BioMed Res. Int. 2015, 284154 (2015).
- Langade, D., Thakare, V., Kanchi, S. & Kelgane, S. Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study. J. Ethnopharmacol. 264, 113276 (2021).
- Lopresti, A. L., Smith, S. J., Malvi, H. & Kodgule, R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract. Medicine (Baltimore) 98, (2019).
- Anghelescu, I.-G., Edwards, D., Seifritz, E. & Kasper, S. Stress management and the role of Rhodiola rosea: a review. Int. J. Psychiatry Clin. Pract. 22, 242–252 (2018).
- Gao, L., Wu, C., Liao, Y. & Wang, J. Antidepressants effects of Rhodiola capsule combined with sertraline for major depressive disorder: A randomized double-blind placebo-controlled clinical trial. J. Affect. Disord. 265, 99–103 (2020).
- Gerbarg, P. L. & Brown, R. P. Pause menopause with Rhodiola rosea, a natural selective estrogen receptor modulator. Phytomedicine Int. J. Phytother. Phytopharm. 23, 763–769 (2016).