The 3 Stages of Menopause

Women’s Hormonal Health: What YOU Need To Know about the Stages of Menopause

Pre-menopause, peri-menopause and menopause make up years of a woman’s life, and it’s important to understand the way your body changes during these phases to achieve optimal health and well-being as you age.

Stage 1

Pre-menopause: The Reproductive Years

During the reproductive years, women should normally not have any symptoms other than blood loss each month. Unfortunately, up to 75 per cent of women experience the symptoms of excess harmful estrogen (also called estrogen dominance) associated with PMS. Also, fluctuating thyroid, estrogen and progesterone during the menstrual cycle can cause an array of symptoms. It is never too early (or too late) to have your hormones assessed and get a comprehensive and individualized lifestyle plan to help you with all the stages.

Stage 2


The Lead Up to Menopause

Peri-menopause, or menopause transition, begins several years before menopause. It usually starts in a woman’s 40s but can start in her 30s or earlier. The ovaries gradually begin to make less estrogen during peri-menopause, but it is progesterone that declines first during this stage. In the last one to two years of peri-menopause, this drop in estrogen speeds up. Peri-menopause lasts up until menopause, when the ovaries stop releasing eggs altogether.

Signs and symptoms of peri-menopause:

• Hot flashes

• Breast tenderness

• Worse premenstrual syndrome

• Lower sex drive

• Fatigue

• Irregular periods

• Vaginal dryness; discomfort

during sex

• Urine urgency or leakage when
coughing or sneezing

• Mood swings

• Trouble sleeping

In my clinic, we often establish the diagnosis of peri-menopause based on symptoms and blood tests.

Recommendations for peri-menopause:

You can assess your stress hormone cortisol and check how well your adrenals are working; once you are into peri-menopause, your adrenals and your fat cells are the only sources of estrogen so adrenal gland support may be needed. Consider herbs like Clear Ashwagandha (balances cortisol and boosts thyroid function), Clear Energy (improves mood, motivation and energy) or Clear Balance (reduces cortisol, raises DHEA and reduces night waking).

Natural progesterone cream can
also help balance hot flashes, reduce anxiety, headache, improve sleep
and reduce spotting and PMS. Bioidentical Hormone Replacement (prescribed by NDs or integrated MDs) is available in pill or cream form and the herb Chasteberry Plus can regulate periods and improve progesterone. Red clover can also help to lower FSH and keep healthy estrogen levels.

Stage 3


Menopause is diagnosed after a period of 12 months without any menses—menstruating woman between the ages of 40 and 55 are naturally approaching this phase.

Signs and symptoms:

Symptoms of menopause may begin suddenly and can be mild or very noticeable. They may happen all the time, or only occasionally. Most of the symptoms are due to a deficiency of estrogen.

• Periods stopped for at least one year

• Hot flashes and sleeping problems

• Mood swings and irritability

• Vaginal dryness; discomfort during sex

• Lower sex drive and it may take longer
to get aroused

• Increased abdominal weight gain

• Thinning skin due to lower estrogen

• Memory changes—especially for names
of people and things

Other changes are less noticeable. For example, declining estrogen levels may cause you to begin to lose bone density, increasing the risk of osteoporosis. Estrogen decline is also linked to increased risk of Alzheimer’s disease and heart disease and stroke.

IMPORTANT: If you develop uterine bleeding after one year period-free, go to your doctor for a pelvic ultrasound as this
is considered abnormal uterine bleeding.

My Seven Recommendations for Menopause:

1.Essential recommended testing that is part of our Women’s Hormonal Health Program includes tests such as a cholesterol panel, complete thyroid panel, hormone testing, vitamin D, vitamin B12, and more. We may also request that you visit your MD for a breast ultrasound, pelvic ultrasound and a bone density test. If you are losing bone mass, the faster you start hormone replacement, the better. Don’t wait until you are 65 to get this test done!

2. Once the testing has been done, we can handle the declining levels of estrogen and progesterone with Bioidentical Hormone replacement in the form of estrogen cream, progesterone cream. Vaginal suppositories of estrogen can also help treat dryness and urinary urgency. Herbs like red clover, hops, black cohosh, dong quai and sage can help.

3.Strength Training is a must. Invest in 30 minutes three times a week to build strength and bones and to prevent the spike in cortisol or suppression of thyroid function. This should be combined with walking one hour daily, four to six times per week. Also, take melatonin for sleep, breast and bone health.

4.Diet: Your ability to metabolize carbs decreases with menopause so choose one serving daily (ideally at dinner) of beets, carrots, peas, quinoa, squash rather than rice, potatoes and sweet potatoes. Protein is a must! You will lose muscle
as you age, so you must consume at least 30 grams or four to five ounces, four times a day. Even if you do not strength train, the protein will maintain your muscle.

5. Use a plant-based omega like Pure Form Omega as it maintains hormone balance, and unlike fish oil, preserves bone density. Combine this with vitamin D3.

6. Take a formula for bone health such as Clear Bone Protect and Repair.

7. Add extra B12 for brain and bone health. University of Toronto researchers found that B12 should be well into the high end of the reference range for brain health, so I strive to get my patients levels between 600 – 1200.



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About the Author

Dr. Natasha Turner

Dr. Natasha Turner

Dr. Natasha Turner is a New York Times bestselling author and one of North America’s leading naturopathic doctors, a sought-after speaker, natural health expert, and the founder of Clear Medicine Wellness Boutique in Toronto. In2014 she was recognized by her professional organization as a leader in her field and in 2016 was awarded the top […]

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