Your Comprehensive Guide to Perimenopause: From An Expert

Your Comprehensive Guide to Perimenopause: From An Expert

So much of what women experience, from painful periods, to trying birth experiences is brushed aside. Perimenopause can easily fall into that realm. The best way to counteract that is to empower yourself with knowledge and take control of your own health. Agent Nateur spoke with Dr. Dominique Fradin-Read about all things Perimenopause—from what exactly it is, to how to delay it, live through it symptom-free and maintain your whole health and well-being as you enter your 40s, 50s, and beyond. Take a deep dive into the sometimes wild world of Perimenopause with Dr. Dominique. 

What is your background Dr. Dominique?

Dr. Dominique:

I have a practice in Los Angeles, VitaLifeMD. I have been a physician for almost 40 years, I have been practicing in the United States since 2006 and I have done residencies in internal medicine and preventive medicine. I prefer the kind of medicine that is unique in the sense that we want to prevent disease as much as we can and work on healthy habits, and a healthy lifestyle to prolong life, and have optimal health.

How do you define Perimenopause?

Dr. Dominique:

Perimenopause has a very broad definition. It can start as early as 35, 40 years old, but most of the time it's around 45, 46 years old. So we know that in America, for full menopause the average age is 51 years old. As the name says, peri, is everything before menopause when you are not yet there. Women begin to have symptoms, but they still have some good ovules, or eggs. So they are not completely finished with ovulation but it's becoming very erratic and they may have a lot of symptoms. So that's the broad definition, it's the large period of uncertainty. Hormones go up and down.

What could those symptoms be? What can women expect to feel?

Dr. Dominique:

So the symptoms are going to be extremely variable depending on each woman. You have symptoms that are going to affect your mood and your sleep and some that are going to affect your body. So let's talk about the body first because it's usually one of the first two to occur. 


It's going to be an irregular cycle. So you might skip a cycle one month and then it comes back. Or you could have an extremely long cycle—maybe 35 days instead of the regular 28 that you were having before. You may have extremely heavy periods or extremely light periods. So it denotes an imbalance in your hormones that does not regulate the 28-day cycle with 14 days before ovulation, ovulation at day 14 and 14 days after ovulation and then you bleed. So that's usually what happens.

At the same time physically, these ladies are going to feel extremely bloated. They retain water, they put weight on, which is really one of the major complaints. Or sometimes they cannot lose weight because it seems that their metabolism is getting sluggish. They don't burn calories as fast, they can eat the same way, exercise the same way and yet their weight is going up. 

Another physical symptom can be pains and aches all over the body. So one of the major presentations could be rotator cuff, shoulder issues. So there's some kind of inflammatory process that occurs during these years and mostly when ladies are a little bit older, 45 and over. But even at 40, you can start having those pains and aches. Your muscles are not as strong. You can see at exercise that you are not going to recover as fast. So your body is not as vital, if I can use that word. My company is called VitaLife because I think that's how you define good health, optimal health.


And then besides the physical symptoms, you have the mood change. I also put sleep in this category, which is impacted by neurotransmitters. So suddenly these ladies, they have a burst of anxiety, they're less patient with their kids, they can be a bit short-tempered and they're going to have these moments of being a little bit sad but more anxious than sad in general. The sadness comes more when you are finished completely with your hormones and then experience extremely variable mood swings.

Sometimes the husband comes to me and tells me, "I don't know what's going on with my wife. She goes from being completely down and crying and wants to be alone and then she's full of life and she wants to do all kinds of things." So the kind of imbalance that you have in your body reflects in your mood too. It’s not them, it’s their hormones, neurotransmitters in our brains talk to our hormones, so when your hormones are not at the right place, then we are going to have neurotransmitter imbalances. And one of them that's very, very important is the gamma aminobutyric acid. It's the neurotransmitter of being cool, relaxed. 

Anxiety, not sleeping well at night, worrying for no reason—these are the symptoms that we will have. And then you also have some brain fog. These women are going to tell me, "I can't concentrate, suddenly my brain is not there. I can't focus." So cognitive function can be also implicated.

Can you delve into the role hormones play and the actions women can take to help themselves?

Dr. Dominique:

We have two kinds of hormones that are the female hormones and we have male hormones. For the female hormones, we have estrogen, or what I call the sexy hormone, it makes you full of life. But if you have too much, you can become a bit nervous, you can become a little bit impatient, moody, it's too much if you are not compensating with the good progesterone. The progesterone is the female hormone of calming, ‘everything is good, I can relax. The world is not going to change. I am happy with my family.’ It's the hormone of balance. So when you are pregnant, you have a lot of both hormones and that's the moment of your life that some women feel fantastic because they are loaded with these female hormones.

At the moment of perimenopause, because the ovary is a little bit weaker in the production of the ovules, the eggs, the regular production of hormones is disturbed. So what is implicated is the pituitary. The pituitary is the gland that produces FSH, Follicular Stimulating Hormone. The FSH gives the message to the ovary to ovulate at day 13, 14, 15. It depends on each woman.

The ovulation is followed by production of estrogen and progesterone. Before ovulation we only have estrogen and after ovulation the ovary opens up, lets the ovule, and then we have the progesterone that is produced, which comes to its max around day 20-22. But the eggs are not as good as the eggs that we had when we were 25. As we age, the eggs  have a bit of difficulty evacuating the ovary. So the pituitary says, ‘I need to push a bit harder.’ So the FSH goes up, you can see that in the blood and then the ovary says, ‘’I need to produce more estrogen now.’ So usually you have a spike in estrogen to try to help and... What happens? You have good months where the ovary does a good job and you have a good egg and then you have your progesterone at a good level. And you have months where despite the trying from the pituitary to push the ovary to work, there's no good eggs and you’re going to miss that one month and you will have no cycle at all.

Or you could have the cycle at day 30, 40, so everything is delayed…So these two hormones really need to be in great balance. Too much estrogen is not good. Anxiety, bloating, big boobs. So that's usually the pattern of perimenopause. Estrogen can be normal or high, but still present and progesterone tends to be on the low side.

How long can the span be going from getting initial perimenopausal symptoms to full menopause?

Dr. Dominique:

It's very interesting because everyone is different. I have a woman, for example, that had a kid at the age of 35 and then started having some symptoms shortly after. Sometimes I've noticed that if you do IVF or some stimulations of the ovary to be able to conceive that the time of the change can come a little bit earlier in life. In general, if I had to say an average, it peaks really intensively around the age of 45. So I would say five years before menopause mostly, but everybody is different. There's no real math that we can use here.

Are there ways that women can try to delay it?

Dr. Dominique:

So first of all, the ovary, like any other organ, is very sensitive to lifestyle. We were born at birth with a certain number of eggs. So if you can preserve that capital of eggs, that's great. You are going to have very long menstrual periods, and you are going to delay menopause. This morning I had a patient, she is fantastic with her lifestyle. Believe it or not she's 51, she still has regular periods and she has the hormones of a 35-year old.

That’s amazing.

Dr. Dominique:

I'm joking a little bit, but definitely you can do something. One thing that we now consider is  stress. The role of stress on the preservation of your capital of eggs is important. So if you have too much cortisol, it seems that the cortisol has some impact and might make some of these eggs not be as efficient. Then you have conditions like polycystic ovarian disease that can also disturb the way hormones are going to be able to be produced in the long run. IVF or anything that's going to precipitate the retrieval of some eggs, that could activate your usage a little bit faster than if you don't use them.

So definitely there are ways to decrease the symptoms and to make the transition much more acceptable or even non-existent. I personally could say that being a physician, I was able to anticipate everything that would happen to me and for me, I think I never really had much perimenopause, and menopause lasted one day.

And how can women achieve this?

Dr. Dominique:

First of all, when you have some imbalances in your hormones there are supplements that can really help moderate your symptoms. The mood part of it can really be regulated very well with L-methionine. It's an amino acid that is a precursor of the famous GABA aminobutyric acid. So you are going to be able to relax that neurotransmitter a little bit and make the mood swings a little bit less strong. You can also use something which is a supplement, not the medication, called lithium. A little lithium orotate, five milligrams, is a supplement that is fantastic for mood balance. It also helps a little bit with cognitive function. There are a lot of studies now that show that it's a neuro protector. In my last newsletter I talked about it as a longevity element. I take it myself and I have had so many young women in perimenopause that were helped with it.

Another good supplement is called Serenol (the brand name). It's basically an extract of bee pollen. It comes from Norway and it has been proven to reduce the mood effect of those hormonal changes. It has virtually no side effects. You can also use it to help during the luteal phase, or the second part of the cycle, after ovulation. And EPO, evening primrose oil, has a fantastic effect to regulate that second part of the cycle and how it affects the period. It could really regulate the period.

Then for patients who need to go to a higher level, we have natural micronized progesterone, which mimics the progesterone that our ovary makes, it is a supplement hormone to replace what is missing. So you usually start at day 14 after ovulation and you institute what should be produced by the ovary, which is missing and you stop at day 28. It can counteract the effect of too much estrogen, which is often very heavy periods. It balances the excess of estrogen.

What mistakes do women make when they’re in perimenopause and trying to regulate their hormones?

A mistake in perimenopause would be to add estrogen. I see that quite often. I saw someone yesterday that was sent to me because she had been seeing an OB GYN who said, ‘Oh, you have hormonal problems.’ Her doctor didn't test anything, didn't check her blood and gave her a mix of estrogen and progesterone. She was a bit hesitant, she said, ‘I'm so sorry, I don't want to start right away.’ So she came to me, we checked her hormones. She had tons of estrogen because she was in estrogen dominance.

The only thing she needed is a little bit of progesterone because her progesterone is on the low side and the lithium supplement, L-methionine for her mood. And she was very happy that she had not started estrogen. If she had done the estrogen, in a few weeks, she would have come to me with symptoms of estrogen dominance like horrible breast tenderness, bloating... she would have put on maybe put 5, 10 pounds. She would be nervous. She would not be sleeping at night. So you have to be very careful. I do want to note that once a woman moves from perimenopause to full menopause, at the she end might need a little bit of estrogen and that's where the art of medicine comes in, to be able to discern if we are at the beginning or at the end of perimenopause. She needs to be treated differently then, it’s a completely different condition.

How do you approach those constant changes?

There's a continuum in the need of hormones that need to be adjusted. I would not say on a daily basis, but for some women it may be on a monthly basis. That's why I always tell my patients, "We need to try this, but you are a moving target." I like that term. 

Can women still get pregnant when they are having perimenopause symptoms?

Dr. Dominique:

Yes. The likelihood diminishes over time. I like to say the eggs are not as good as when we were 25 years old. So if you still ovulate, would that egg be able to go to maturity and give a nice little baby? I'm not sure. It all depends, but there are some women who have been pregnant at a late age because they still have some good eggs.

And what specifically are the lifestyle changes women can make for more balanced hormones?

Dr. Dominique:


Opt for a diet that is rich in protein, rich in fruits and vegetables, that avoids artificial preservatives, and is a little bit more natural. I like the Mediterranean diet because I’m French, but sometimes during perimenopause, make sure that it's relatively low-carb. The Mediterranean diet could be a little bit high with bread or potatoes or couscous depending on where you live in Europe. Be careful with alcohol. I think that there are more and more studies that show that the less alcohol you consume, the better it is for general health and for the ovaries for sure. Also avoid mercury-loaded fish. I'm not eliminating dairy because it's a moment of your life that you need to preserve your calcium. So go for a good, maybe low fat if you have cholesterol issues, or full fat if you don't, plain yogurt. And then you can have a little bit of cheese here and there if you don't have cholesterol issues. So that will help with your bones and your calcium. It’s very important to preserve that. 


Hydration is extremely important because most of our symptoms are made worse by dehydration. Some women start having horrible headaches and migraines. If you hydrate yourself, if you take magnesium, that could also help.

Stress Management and Sleep:

Stress management is very important. There's real stress and there's the stress that we cause ourselves. So try to put things into perspective. If you are impatient with your kids, just go into the garden or take a little walk. Try to minimize your stress as much as you can because stress is the big one, especially if it impacts your sleep. During your sleep, you restore your health and you bring your hormones to the right level. A lot of people do not know that during sleep you bring your cortisol, your stress hormone to a good level for the next morning—it’s high in the morning and then goes down as the day goes on.

A lot of people also need to make sure that their vitamin D is good. We live in places where we have a lot of pollution, and you’re not receiving the benefits of the sun through a layer of pollution, even if it seems like a bright day, so you may need to supplement. 

Emotional Support:

Make sure that you have the cocoon part, the emotional support from your family. I can see a big difference in women who are, for example, in a divorce or in a situation where they have not received that emotional assistance, that tenderness that makes you feel good about who you are. And so their symptoms tend to be much worse. 

Seeing the right practitioners:

Go to someone that deals with hormones. There are fantastic OB GYNs, I respect them, but sometimes they don't have the sensitivity to approach mood change and the whole picture. I studied at Loma Linda, where we always look at everything that can cause disturbances in the body. I would apply that to perimenopause, we are looking to make women whole.

*Agent Nateur does not provide medical advice, always consult your physician.