Perimenopause: A Critical Time for Chronic Disease Prevention

Written and edited by Sarah Bonza MD, MPH, FAAFP, Dip-ABLM, NBC-HWC

The changes I see women go through are sometimes so subtle that it’s easy to chalk them up to “just getting older” or stress. But getting older does not mean we need to get weaker and sail off quietly into the sunset. Perimenopause, the transitional phase before menopause, is a critical time for women’s health. This is the time for women to wake up and take notice of their health and wellbeing. The habits women adopt now will impact the trajectory of their longevity.

What is Perimenopause?

Perimenopause is a significant life stage for women, typically occurring in the late 30s to early 50s, during which hormonal changes begin to take place. These hormonal changes can have a profound impact on a woman’s health and well-being, as well as her risk for developing chronic diseases such as osteoporosis, heart disease, and cognitive decline (Shipp, 2005). During perimenopause, the body undergoes a gradual decline in estrogen and progesterone levels, leading to various symptoms such as hot flashes, irregular periods, mood swings, and changes in sexual function. At this critical life stage, a holistic approach to wellness becomes crucial in order to address the physical, emotional, and mental changes that occur during perimenopause and to prevent or mitigate the onset of chronic diseases. A holistic approach to wellness includes a three-pronged approach with lifestyle medicine, functional medicine, and conventional medicine or hormone therapy. Lifestyle medicine focuses on implementing healthy habits and making lifestyle changes that support overall well-being. This includes adopting a nutritious diet, regular exercise, stress management techniques, and prioritizing sleep.

The Critical Role of Perimenopause in Long-Term Health

Perimenopause is a crucial period for women to pay attention to their health and take proactive measures to prevent chronic diseases. During perimenopause, hormonal changes can significantly impact a woman’s health, making it an opportune time to address any underlying health concerns and implement preventive measures. Several changes take place as estrogen and progesterone levels decrease. These changes impact long-term bone health, osteoporosis, brain health, cardiovascular health, and metabolic health. Osteoporosis, a condition characterized by weakened and brittle bones, becomes a significant concern during perimenopause.

Bone Health

Source: National Center for Biotechnology Information — “Perimenopause as a Gateway to Preventing Chronic Disease” (Ji & Yu, 2015)During perimenopause, the decline in estrogen levels can lead to bone loss and an increased risk of osteoporosis. This highlights the importance of addressing bone health during perimenopause and taking proactive measures such as adequate calcium and vitamin D intake, weight-bearing exercises, and regular bone density screenings.

Muscle Health

Women are at risk for sarcopenia , a condition characterized by muscle loss and decreased strength, during perimenopause as well. Source: National Center for Biotechnology Information — “Perimenopause: A Critical Life Stage to Prevent Chronic Disease and Promote Wellness.”

Brain Health

Estrogen receptors are located in the brain and estrogen plays a key role in cognition and dementia prevention. As estrogen levels decrease, brain health may be impacted, and individuals may experience symptoms such as brain fog, memory issues, and mood changes(McCarthy & Raval, 2020). Therefore, addressing brain health through lifestyle changes, cognitive exercises, and possibly hormone therapy can be crucial during perimenopause. Source: American Academy of Anti-Aging Medicine — “The Role of Estrogen in Cognitive Function and Dementia Prevention(Russell et al., 2019)”

Heart Health

Estrogen also plays a key role in cardiovascular health by protecting against heart disease(Mendelsohn & Karas, 1999). Therefore, during perimenopause, it is vital to prioritize cardiovascular health through lifestyle modifications such as a heart-healthy diet, regular exercise, stress management techniques, and regular cardiovascular screenings. Source: Mayo Clinic — “Heart-healthy diet: 8 steps to prevent heart disease”

Metabolic Health

Declining estrogen also results in increased insulin resistance. Insulin resistance leads to metabolic health issues such as weight gain, difficulty in managing blood sugar levels, and an increased risk of developing conditions like type 2 diabetes. This also results in low grade inflammation which increases risk for certain types of cancers(Løbo et al., 2014)(Patni & Mahajan, 2018).

Embracing a Holistic Approach to Wellness During Perimenopause

A holistic approach to wellness during perimenopause involves addressing the physical, mental, and emotional aspects of health. This encompasses a three-pronged approach that includes lifestyle medicine, functional medicine, and conventional medicine or hormone therapy. Lifestyle medicine focuses on making healthy lifestyle choices such as maintaining a balanced diet, engaging in regular exercise, managing stress levels, and prioritizing sleep.Functional medicine takes a personalized approach, considering the unique factors affecting an individual’s health and utilizing interventions such as nutritional support, supplementation, and addressing underlying imbalances in the body. Conventional medicine or hormone therapy may be utilized when necessary to address specific symptoms and imbalances. By combining these three approaches, individuals can optimize their health and well-being during perimenopause.

Navigating Perimenopause with Lifestyle Medicine

Lifestyle medicine plays a crucial role in navigating perimenopause.It emphasizes making healthy choices in various aspects of life, including nutrition, exercise, stress management, and sleep. These lifestyle choices can help to mitigate the effects of declining estrogen levels and promote overall well-being during perimenopause. The key pillars of Lifestyle Medicine according to the American College of Lifestyle Medicine are nutrition, physical activity, sleep, stress management, avoiding risky substances, and cultivating healthy relationships. Improvement in these key areas results in optimized health. Source: (Lippman et al., 2024)

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Wellness coaching goes hand in hand with Lifestyle Medicine. Because Lifestyle Medicine focuses on changing habits, behaviors, and mindset, having a wellness coach can provide guidance and support throughout the process. Wellness coaches practice motivational interviewing to help guide clients to identify their goals, create action plans, and overcome any barriers they may face along the way.(Bodai et al., 2018).

Functional Medicine: Tailoring Perimenopause Care to the Individual

Functional medicine takes a personalized approach to perimenopause care, recognizing that each individual’s experience and needs may be unique. By addressing underlying imbalances in the body, functional medicine seeks to optimize hormonal health and alleviate symptoms associated with perimenopause. This may include evaluating hormone levels, nutritional deficiencies, gut health, and stress levels. Functional medicine practitioners often utilize comprehensive lab testing to assess these factors and develop individualized treatment plans that may include targeted supplementation, dietary changes, stress management techniques, and lifestyle modifications. By addressing the root causes of imbalances, functional medicine aims to restore overall health and well-being during perimenopause.

Conventional Medicine and Hormone Therapy in Perimenopause Management

Conventional medicine, including hormone therapy, plays a crucial role in perimenopause management by providing symptom relief and hormonal balance. Hormone therapy, such as estrogen replacement therapy or bioidentical hormone therapy, can effectively alleviate symptoms like hot flashes, nightsweats, and vaginal dryness. Additionally, hormone therapy can also help prevent chronic diseases associated with perimenopause, such as osteoporosis and heart disease.

Integrating Multiple Medical Disciplines for Perimenopause Health

Integrating multiple medical disciplines is essential for comprehensive perimenopause health. This includes utilizing a holistic approach that combines lifestyle medicine, functional medicine, and conventional medicine or hormone therapy. By integrating these three approaches, women can address the physical, emotional, and hormonal changes of perimenopause from multiple angles. This multi-pronged approach recognizes that perimenopause is a critical life stage that requires a comprehensive approach to prevent chronic diseases and promote overall well-being By incorporating lifestyle medicine, women can make significant changes to their diet, exercise routine, stress management techniques, and sleep habits. These lifestyle modifications are crucial for optimizing hormone health and managing symptoms of perimenopause.

Preventing Chronic Disease Through Perimenopause Education

Preventing chronic disease is a key focus during perimenopause, as this life stage can increase the risk of conditions such as osteoporosis, cardiovascular disease, and cognitive decline. A holistic approach to wellness recognizes that perimenopause is a critical life stage for preventing chronic disease. This comprehensive approach includes educating women about the importance of lifestyle modifications, such as maintaining a healthy diet, regular exercise, stress management, and adequate sleep. By promoting perimenopause education, women can make informed decisions about their health and have the knowledge to actively participate in their own well-being. Source: Sapre S., Thakur R. Lifestyle and dietary factors determine age at natural menopause.

The Intersection of Perimenopause and Holistic Health Practices

Perimenopause is a unique time in a woman’s life where hormonal changes and the risk of chronic disease intersect. To effectively navigate this stage, a holistic approach to wellness is crucial. This approach involves integrating lifestyle medicine, functional medicine, and conventional medicine or hormone therapy. Lifestyle medicine focuses on making healthy lifestyle choices, such as maintaining a balanced diet, engaging in regular physical activity, managing stress, and getting enough sleep to support overall well-being during perimenopause. Lifestyle Medicine serves as the foundation for Functional Medicine. Functional medicine takes a personalized approach to healthcare, examining the underlying causes of symptoms and addressing imbalances in the body’s systems. This may involve functional testing, targeted supplementation, and lifestyle modifications tailored to each individual’s needs. Conventional medicine or hormone therapy is another important component of a holistic approach to perimenopause. For women who are experiencing severe symptoms or have underlying medical conditions, hormone therapy can provide relief and support.

In conclusion, perimenopause is a critical life stage where the prevention of chronic disease is essential. A holistic approach to wellness that includes lifestyle medicine, functional medicine, and conventional medicine or hormone therapy can help women navigate perimenopause and reduce the risk of developing chronic diseases.

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References

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