Understanding Perimenopause: Insights from a Conversation between Hormone Expert Dr. Sara Gottfried and Andrew Huberman
Perimenopause can feel like a daunting transition for many women, yet understanding its intricacies can empower them to navigate this life stage with confidence. Recently, Dr. Sara Gottfried shared valuable insights on this subject in her podcast with Andrew Huberman. Their discussion touched on the importance of intergenerational health, hormonal dynamics, and lifestyle adjustments to ease the transition through perimenopause.
What is Perimenopause?
Perimenopause is the transitional phase leading up to menopause, typically occurring in a woman's late 30s to early 50s. It's important to understand because it can impact a woman for 10-15 years prior to menopause. It marks a period where hormonal fluctuations begin, resulting in various physical and emotional changes. Dr. Gottfried emphasized the importance of knowing your maternal lineage—grandmother, mother, and great-grandmother— because genetics play a large role in how each woman will experience perimenopause. Additionally, intergenerational trauma is another factor to consider and can significantly affect endocrine function and stress response.
Intergenerational and Environmental Influences
Women today may experience heightened environmental influences, including exposure to toxins, which can alter hormonal development from puberty through perimenopause. The discussion highlighted how the shape of the pelvis and genetic factors can also influence childbirth and conditions like endometriosis, fibroids, and polycystic ovary syndrome (PCOS).
Common Symptoms of Perimenopause
As women transition through perimenopause, they may encounter a range of symptoms. Some of the most common include:
- Irregular Periods: Changes in menstrual cycles can signal the onset of perimenopause. Women may notice their cycles becoming shorter (their periods may get closer together with cycle lengths shortening from an average of 28 days to 25 or 26 days). This is usually the result of a decrease in progesterone production.
- Hot Flashes and Night Sweats: These sudden temperature shifts can disrupt daily life and sleep.
- Mood Swings: Hormonal fluctuations can lead to increased anxiety, irritability, and depression.
- Sleep Disturbances: Insomnia and restless nights are often reported, partly due to hormonal changes.
- Weight Gain: Changes in metabolism can lead to increased abdominal fat.
- Vaginal Dryness and Changes in Libido: Declining estrogen levels can affect sexual health.
Key Lifestyle Changes to Consider
1. Nutritional Awareness
Nutrition plays a critical role in managing perimenopause symptoms. Dr. Gottfried highlighted the importance of a diet rich in:
- Fruits and Vegetables: Aim for at least five servings a day, focusing on colorful options that provide essential vitamins and minerals.
- Healthy Fats: Incorporating sources like avocados, nuts, and olive oil can help support hormonal balance.
- Micronutrient Support: Nutritional testing can help identify deficiencies in magnesium, vitamin D, and B vitamins, which are crucial for hormonal health. This testing can happen at any age, and may be very beneficial for women starting in their 20s to preemptively recognize nutritional gaps.
2. Hormonal Monitoring
Monitoring hormonal levels can provide insights into your health. Consider testing for estrogen, progesterone, testosterone, and cortisol. Dr. Gottfried recommends dried urine (the DUTCH test) or saliva tests (specifically for cortisol) for a more comprehensive analysis, especially since blood tests offer a static snapshot of hormone levels. It's beneficial to get testing done as early as your 20s and 30s to establish a baseline, and then again as you begin to see shifts in symptoms of early perimenopause.
3. Exercise and Movement
Regular physical activity is vital during perimenopause. A balanced routine of cardiovascular and resistance training can help manage weight, improve mood, and promote overall health. Dr. Gottfried advises at least 150 minutes of moderate exercise per week, tailoring it to fit your body's needs. Aiming for 2-3 strength training sessions per week, combined with at least 2 HIIT sessions is a great mixture of activity type and cadence during this phase of life. This is often very different from the long-cardio sessions that many women in their 30s and 40s are used to doing (long cardio can actually increase cortisol levels in this phase of life which can have the opposite affect on weight gain and fat retention).
4. Stress Management
Stress can exacerbate perimenopausal symptoms, especially through its effect on the hypothalamic-pituitary-adrenal (HPA) axis. Strategies like mindfulness, yoga, and breathing exercises can help alleviate stress levels. Andrew Huberman discussed a scientific study he conducted at Stanford that was published with results showing the benefit of cyclic sighing—long inhales followed by extended exhales—as a simple technique to reduce stress¹.
5. Gut Health
The gut microbiome plays a crucial role in hormonal balance. Dr. Gottfried noted the importance of the "estrobolome," the subset of gut microbes that influence estrogen levels. Fostering a healthy gut through prebiotics, probiotics, and a fiber-rich diet can support hormonal health and reduce the risk of conditions like breast cancer.
Biomarkers to Monitor
For those in their teens, it may be helpful to monitor cortisol and other hormone levels, as the HPA axis is still developing. In the 20s, 30s, 40s and 50s, a comprehensive hormone panel, including estrogen, progesterone, testosterone, and their metabolites, can provide critical insights into one’s hormonal health.
Conclusion
Perimenopause is a multifaceted phase of life that deserves attention and understanding. Insights from experts like Dr. Gottfried and Andrew Huberman highlight the importance of intergenerational knowledge, lifestyle changes, and proactive health management. By embracing these principles, women can navigate perimenopause with greater confidence and vitality, ultimately leading to a healthier, more balanced life. Remember, knowledge is power—understanding your body’s rhythms and needs can empower you to thrive during this transition. If you want help navigating some of these changes occurring in your health, or want to know if this is even something you should be thinking about, contact me by email me at Payal@arorawellness.com to set up a free chat to find out how functional medicine health coaching can help you.
Citations:
¹ https://www.cell.com/cell-reports-medicine/pdf/S2666-3791(22)00474-8.pdf
To listen to the entire podcast referenced: https://www.hubermanlab.com/episode/dr-sara-gottfried-how-to-optimize-female-hormone-health-for-vitality-and-longevity