Perimenopause: Navigating Body Changes and Symptoms with Intuitive Eating and Self-Compassion
Do you remember your first perimenopausal symptoms? Or at least the first time you realized the weird thing happening to you might just be perimenopause?
I have been luckier than many, with very regular cycles and minimal to no PMS for most of my menstruating life. I have also lived most of my adult life without chronic pain or other regularly occurring, life-disrupting signals from my body. But I sure can remember when things started to change, when things related to my body started to impact the normal flow of my daily life.
The most noticeable disruption started a few summers ago when I had a stretch of night sweats. I would wake up in the middle of the night, my shirt and skin wet, damp, and quickly becoming clammy from just under my boobs to my neck and hairline. What I wanted to write off as a normal body response to a hotter-than-average summer, I soon realized was a normal body response to fluctuating and changing hormone levels.
Since that summer, I have continued to have a barrage of new-to-me symptoms that come and go as they please, including shorter (and sometimes longer) menstrual cycles, hormonal migraines, waking at 3 am and not falling back to sleep, brain fog, tooth sensitivity, irritability (sometimes rage), and bouts of out-of-nowhere anxiety. Oh, and my tolerance, and therefore interest, in alcohol is pretty much zero. Delightful.
I also noticed a shift in my body. I have always been a person in a larger body, but seemingly overnight, my midsection expanded while the rest of my body remained the same. This, too, is a normal body response to fluctuating and changing hormone levels. And even for an anti-diet and body-accepting nutritionist, it can take a toll.
What is Perimenopause?
Perimenopause is a transition period from the reproductive stage of life to the non-reproductive stage of life (aka post-menopause). Perimenopause is sometimes it is referred to as second puberty or reverse puberty, which I think gets at the vibe even if it isn’t entirely biologically accurate.
Perimenopause is not a disease. If you are a person who menstruates and you live long enough (or if you undergo a hormone-disrupting surgery like a total hysterectomy), you will go through perimenopause and menopause. It often starts in the 40s, with the average age of menopause (defined as the day you haven’t had a menstrual cycle for one year) around 51 years old.
The exact length of perimenopause varies from person to person. Because hormones can fluctuate both higher and lower at different points during perimenopause, you can’t reliably test to determine where you are in the process. This unknow length and duration can really add to the challenge of riding the wave. It is much easier to face something when you can reassure yourself it is just for 6 months or a year. The whole transition through perimenopause, menopause, and post menopause, including some symptoms, can last for 10 or more years.
Common Perimenopause Symptoms: From Hot Flashes to Mood Swings
The symptoms of perimenopause can be surprising. Estrogen and progesterone, a few of the key players that fluctuate and ultimately decline during perimenopause, have receptors all over the body and have roles beyond reproduction. This means the impacts of the change can affect almost any part of the body. It is suggested that up to 20% of people will not have additional symptoms outside of menstrual cycle changes. Of the remaining 80%, about 30% of those will only have hot flashes. The remaining people will have some symptoms but which one(s), how often, and how intense will vary.
Below is a (not complete) list of possible symptoms. Many of these symptoms can have other causes, so if something isn’t feeling right to you, make sure to get it checked with your doctor or healthcare provider.
Menstrual Cycle Changes:
Shorter or longer cycles
Increased PMS
Changes to flow
Vasomotor Symptoms:
Hot Flashes
Night Sweats
Urogenital Symptoms:
Vaginal Dryness
Pain with intercourse
Urinary tract infections
Genitourinary syndrome
Incontinence
Psychogenic, mood, and Cognitive Symptoms:
Anxiety
Brain fog and memory issues
Depression
Difficulty concentrating
Irritability and rage
Musculoskeletal Symptoms:
Joint and muscle pain
Frozen shoulder
Osteoporosis
Muscle loss
TMJ
Skin, Hair, and Nail Changes:
Acne
Brittle nails
Dry eyes, mouth, skin
Eczema
Itchy eyes, ears, skin
Oily skin
Thinning hair and skin
Whiskers
Gastrointestinal Symptoms:
Acid reflux/GERD
Bloating
Constipation
Diarrhea
Other Physical Symptoms:
Alcohol tolerance changes
Body composition changes/increased belly fat/weight gain
Body odor changes
Breast tenderness/soreness
Dental problems
Dizzy spells or vertigo
Fatigue
Headaches or migraines
Heart palpitations
Higher cholesterol levels
Insulin resistance
Sleep disturbances and sleep apnea
Tinnitus
Perimenopause and Disordered Eating: Navigating Body Changes and Diet Culture
Changes to body shape, size, and composition are common during perimenopause. One of the most common things I hear about in my practice (and have experienced personally) is a bigger midsection or belly. The composition of the body also tends to change, with a decrease lean muscle mass and an increase in fat mass. And to be clear, these changes can happen without changes to eating patterns or activity levels. Changes in body shape or size can often impact body image, and during this stage of life, often detrimentally.
Other symptoms like thinning hair, random chin whiskers or other unwanted body hair, thinning skin, wrinkles, dry or oily skin, and acne can also contribute to body frustration.
Dissatisfaction with body image, including changes to body shape and weight, are strongly linked with disordered eating and eating disorders. Knowing that, it is of little or no surprise that people in perimenopause or menopause are at a higher risk for developing or relapsing disordered eating behaviors, perhaps second only to puberty and adolescence.
Why Do Body Changes Happen During Perimenopause?
Several factors can be at play in your changing body because, as mentioned above, estrogen and progesterone have many roles in the body. An increase in insulin resistance is common during this phase of life. That means your body is less efficient at moving sugar from the blood into cells for energy. If the glucose in your blood can’t be used for short-term energy, it gets stored as fat. There can also be changes to digestion, including increased bloating, constipation, or diarrhea, which can change how comfortable you feel in your body.
Poor sleep can exacerbate insulin resistance and also affect hunger cues and cravings. Lack of sleep and hormonal changes can lead to higher levels of anxiety, depression, and increased emotional volatility (hello rage!), which can impact eating behaviors and habits. Increased joint and muscle pain and fatigue can lead to changes in movement and activity levels.
Your body is wired to protect you and keep you alive. You might be pissed that your favorite jeans don’t fit anymore, but it can be argued that your body is trying to protect you.
Fat stored in the belly area tends to be more biologically active and can produce a form of estrogen. So, as estrogen levels from the ovaries decline, your body shifts fat distribution to try and ramp up production in other areas. Fat tissue also helps to cushion bones, which lose density with age. This cushion can help prevent a break during a fall.
Thanks, I guess?
The Toxic Impact of Diet Culture on Perimenopausal Body Image
Society has taught us that the people with the most value are young, thin, white, and male. This anti-fat and anti-aging bias is rooted in racism, misogyny, capitalism, and patriarchy. In other words, it is trash that needs to be taken out.
Since perimenopause is a privilege of aging, you may already feel like you need to change or preserve your body to maintain your worth. If, on top of that, your body is also changing further from the “ideal” by getting fatter or rounder, it is understandable why you might struggle with body image and consider unproven or dangerous measures to control it.
The same fatphobic society that taught you to base our worth on how we look, is more than happy to sell you the solution that promise to make you younger and thinner. Unfortunately, these solutions, even the ones that seem harmless, are not without out risk.
We have decades of research that show intentional weight loss or dieting not only doesn’t work, but that is can actually cause harm. Weight cycling, the most common result of weight-loss dieting, and weight stigma, negative beliefs and discrimination based on body size, are both independent risk factors for chronic disease, poorer mental health, increased mortality, and eating disorders.
Dieting often includes or results in common disordered eating behaviors like restrictions, binge eating, emotional eating, eliminating entire food groups, not meeting caloric needs, ignoring body signs of hunger and fullness, feeling out of control around food, frequent body-checking behaviors, rigid food rules, fasting or skipping meals, and more.
Restrictive dieting can lead to low or deficient nutrient intake which can further impair body functions including tissue repair, wound healing, immune function, further loss of muscle and bone.
Thriving Through Perimenopause: Self-Care, Intuitive Eating, and Body Acceptance
Wow, that sounds dire. I promise, all hope is not lost. There are things you can do to support your body, mind, and spirit through this natural change.
Prioritize Self-Care
I know self-care can feel a bit fraught these days. It is slapped all over the wellness world, promoting products and practices from bubble baths to sounds baths. And though these things can be nice, we are talking about fundamentals here.
Manage stress: This can mean so many different things, including but not limited to asking for help, setting boundaries around your time or commitments to others, move your body, go outside, connect with others, engage in hobbies, meditate, journal, rest, and more. You don’t have to do them all (that would be stressful!), but find the ones that help you. Start small and add as you are able.
Eat regular and nourishing meals: Remember that whole insulin resistance thing from above? One way to help the body better manage blood sugar and energy levels is to have a relatively consistent eating pattern that includes a mix of different foods including those with protein, fat, and carbohydrates.
Move your body: It is pretty undeniable that moving your body in the ways you can and that feel, ideally enjoyable, but minimally tolerable, is good for you. Strength training or weight-bearing exercise can help maintain not only muscle mass but also bone health. Cardio activities like walking (which is also weight-bearing for the lower half of the body) can support heart health. Stretching and balancing activities help maintain mobility.
Prioritize sleep: Perimenopause can make this one tricky, but you can still make an effort to give your body the opportunity to sleep, even if a full night of uninterrupted shut-eye is more elusive than in the past.
Hydrate: Hormonal changes can really dry things out from eyes to skin to vagina. There is no magic number for hydration. The best indicators are your thirst level and the color of your urine (ideally a pale watery yellow color). You get hydration not just from water and other beverages (yes, even caffeinated beverages) but also from foods like fruits and vegetables.
If you smoke, stop.
Intuitive Eating for Perimenopause: Reclaiming Your Relationship with Food
As established, diets just don’t work. This is also true if it is called a wellness program or lifestyle change. Diets are a chameleon that change in language to fit the current culture. If something is telling what to eat and what not to eat, limiting the time you can eat, or having you count calories or macros, and/or basing progress on weight or inches lost, it is a diet.
My favorite framework to improve your relationship with food is Intuitive Eating. Intuitive eating is based on 10 principles including rejecting the diet mentality, honoring hunger and fullness cues, making peace with food, and gentle nutrition. At its core it is about more than food; it guides self-care and self-acceptance with kindness and self-compassion.
Eating nutrient-dense foods that help keep blood sugar more stable, contain fiber to support digestion, protein for muscles, skin, bones, and hormones, and fat for good cellular communication and brain health is important.
But tying those changes to something as fickle as weight loss or doing so with rigid rules you will ultimately rebel against doesn’t support well-being and can leave you at risk for guilt, weight cycling, and disordered eating.
Intuitive eating helps you cultivate health promoting habits in a weight-neutral way.
Body Acceptance During Perimenopause: Embracing Your Changing Self
I am not telling you to stand naked in front of a mirror, gently caressing your belly repeatedly saying, “I love my body.” That feels a little gaslighty to me. If you do love your body that is awesome (you still don’t have to stand naked in front of a mirror to declare it, unless that is your thing - you do you).
Most of us struggle with loving every part (sometimes any part) of our bodies, and that is ok.
Another principle of Intuitive Eating is respect your body. You don’t have to loudly love your body to accept that your body is mostly shaped by factors out of your control, like genetics, social determinants of health, family history, life experience, environment, age, and more. Take steps, however small, to show your body respect as it exists today. That could include:
Wearing comfortable clothing
Throwing out your scale
Stopping body-checking behaviors or comparisons
Appreciating what your body can do (it is really good at its job of keeping you alive – look it is doing it right now!)
Hormone Therapy for Perimenopause: Exploring Your Options
Hormone therapy has been through it. Many people and practitioners still have misconceptions about the safety of hormone therapy after a flawed interpretation of the Women’s Health Initiative Study made media headlines in 2002.
Hormone therapy is actually one of the most effective interventions for symptoms like hot flashes, sleep disturbances, bone loss, and vaginal dryness. It is available in several forms including pills, patches, gels that can be used locally or systemically. Hormone therapy should be prescribed based on an individual’s age, health history, and symptom severity. It may take a few tweaks to find the right dose or form for you.
Finding Support for Perimenopausal Body Changes
The, at times, overwhelming, body changes and symptoms of perimenopause can be a lot to manage on top of the regular mid-life stuff like caring for children and aging parents, work, cleaning the house, maintaining relationships (both romantic and platonic), saving for retirement, and trying to decode the meaning behind all the cool kid slang.
In our diet-culture-steeped and looks-obsessed world it is natural that you are looking for a solution to stop the changes, to reverse time, to get off the hormonal rollercoaster. However, like most things in life, the only way out of perimenopause is to go through perimenopause.
The good thing is there are more resources now than ever. Research is still scant compared to the number of people on this planet that will go through a menopause transition but what is available is being shared and discussed.
The bad news is not all the resources are great. Many of the books I have read on the topic include diet and weight loss-based recommendations. If you are firmly anti-diet and weight-neutral, it is possible to still get good information from these books about things like hormone therapy without getting sucked into the weight-based parts, but one must be vigilant because the siren call of diet culture can be so sweet. One book that keeps it real and diet-culture free is What Fresh Hell Is This? by Heather Corinna.
There is also little to no support for many of the supplement pills and powders that are being marketed for perimenopause. There is a time and place for supplements, but they are far from one-size-fits-all and are not without risks. Be skeptical and cautious (and avoid middle-of-the-night, insomnia-fueled online ordering). Look at the referenced research, ask questions, check-in with your healthcare provider or another trusted resource.
There is good support for hormone therapy for certain people and symptoms. The best way to figure out if hormone therapy is right for you is working with a menopause-educated doctor or nurse practitioner. The Menopause Society is a great resource for information and credentialed practitioners.
I work with clients one-on-one to personalize health promoting habits, increase nutrient-dense foods, and the Intuitive Eating process. I also offer an online 12-week Intuitive Eating for Skeptics class a few times a year if you are interested in diving into the principles with gentle guidance.
Perimenopause is a powerful life transition, not the end of the line. You will likely spend a third to a half of your life post-menopausal. If you work to ditch diet culture and problematic body ideals now, you open the door to a more peaceful and accepting relationship with your body and food that prioritizes self-care and compassion over shame, guilt, and rigidity.
The information provided is for educational and informational purposes only. It is not intended to be medical advice or to diagnosis, treat, cure or prevent any disease. This information does not replace a one-on-one relationship with a physician or healthcare professional. Dietary changes and/or the taking of nutritional supplements may have differing effects on individuals.
To learn more about how working with a nutritionist could help you, schedule a free 15-minute call.