A widespread misconception about perimenopause and menopause is that weight gain, hot flashes, night sweats, being scatterbrained, and mood swings are normal. Women are lulled into believing that this is “how it is.”

Unfortunately, these symptoms are, indeed, a common experience for many. But they’re not normal. “Normal” would be 12-18 months of mild symptoms with gradual cessation of your menstrual period. End of story.

“Perimenopause” wasn’t even part of our vocabulary until the last 20 or so years. Largely as a result of adrenal issues (unrelenting stress) and hypothyroidism, for some women, perimenopause is starting eight to ten years before menopause—sometimes earlier. Many women are experiencing heavy periods (sometimes hemorrhaging), night sweats, hot flashes that last throughout the day, sleep disturbances, anxiety, and uncontrollable weight gain. (These can all be symptoms of estrogen dominance, by the way.)

The average age of menopause is 51 and is defined as 12 consecutive months without a period. The time leading up to menopause is a time of incredible change to a woman’s body. Starting around age 35, our reproductive hormones begin to shift. Estrogen declines slowly and progesterone, more quickly. These different rates of decline cause the progesterone/estrogen ratios to wax and wane.

The health of your thyroid and adrenals has everything to do with how you move through your pre-menopausal years. An under-functioning thyroid can worsen the symptoms of perimenopause, but the symptoms of low thyroid function and menopause mimic one another, often making it difficult to tease out what’s what (“thyropause”).

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Many in the functional medicine community state that the most important factor in a smooth and symptom-free transition is healthy adrenals. Leading up to menopause, these tiny glands take on a new role. As fewer reproductive hormones (progesterone and estrogen) are produced by the ovaries, the adrenals serve as a backup system. They begin taking on the role of four glands—two adrenals and two ovaries. In fact, the adrenals produce a whopping 50% of these hormones post-menopause. If, during our pre-menopausal years, the adrenals are exhausted and the back-up system is asleep at the wheel, symptoms can be disruptive.

The root of many women’s adrenal dysfunction is that they’ve put off taking care of themselves—emotionally, mentally, spiritually, and physically. Other people in their lives have come first. The result can be difficulty in menopause.

Some minimal weight gain (5-10 lbs) can be due to not producing as much progesterone while estrogen continues production. Mild hot flashes are due to follicle stimulating hormone surges that have a warming effect on the body. But these symptoms should be short-lived and shouldn’t be disruptive to a woman’s wellbeing.

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During the years prior to this transition, the perception of wellness is important. For some women, this is a healthy, happy, productive time—“the change” is embraced and accepted. For others, it represents the “end of youth” and is sad, difficult, and spiritually, mentally, and emotionally challenging. According to Dr. Janet Lang, “How we think about this transition has a powerful effect on our hormones and the physical manifestations of menopause.”

Dr. Aviva Romm, author of The Adrenal Thyroid Revolution, states, “While the physical changes you are going through may cause you varying degrees of discomfort, it’s important to remember that menopause can mark the beginning of an empowering transformation. Embracing ‘the change’ as something natural and honorable can decrease the variety, frequency, and severity of symptoms. Your positive attitude can increase the transformative power—and ease—of your experience.”