early signs of menopause: what to watch for and what may help

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dr. shari caplan, a women’s health expert at vitality md in toronto, has women as young as their late 30s coming to her for help because they don’t feel like themselves. they can’t think clearly, aren’t sleeping well and have little energy to get active.

these changes can be linked to shifting hormones as women age.

patients explain that they feel like “an imposter. i’m fatigued. i can’t think. i can’t sleep,” dr. caplan says. “and i think moody and irritable and anxiety is a huge piece that starts happening. so, women who were coping quite well and then something else happens, they have a stress in their life. and then perimenopause also layers onto it, so it’s like the rug’s being pulled out from underneath them.”

when they see their family doctor, typically they’re told that they are fine because they are still menstruating, so symptoms can’t be related to menopause.

“that’s not true. the average age of menopause symptoms keeps getting earlier and earlier, but it could be late 30s, early 40s.” these younger women have not stopped menstruating, but their hormones are already changing in perimenopause as estrogen starts to fluctuate and progesterone dips, she explains. it’s generally understood that menopause happens a year after someone’s last period.

could your symptoms be linked to menopause?

dr. caplan acknowledges that her perspective on early menopausal distress is not conventional, but she’s had more than a decade of success helping women improve their health through “functional medicine.” the approach is designed to get to the root cause of symptoms and develop treatment where the patient participates “to do the work” with lifestyle changes, supplements and medication, including hormone replacement therapy (hrt), when needed.

“if we have a car, we need to make sure we’re using the right gas, oil, spark plugs, so that everything’s working because if not, it’s not going to perform. and yet we don’t do that for ourselves. we choose our nutrients based on taste, availability and so many other things, and we’re not actually eating necessarily what is good for our body, right? and then we expect it to perform well.”

eating habits and nutrition are foundational to overall health and disease prevention, so they are a great starting point for managing menopausal symptoms like hot flashes, sleep disruption, mood changes, fatigue, body-composition changes, and declining bone and muscle health. she says there’s a long list of symptoms to investigate and an extensive treatment toolbox.

“we can do hormones in a much safer way,” she notes, referring to prescribing bioidentical hormones which are processed from plant sources and designed to match human hormones exactly.

“actually, not taking hormones also can be detrimental, right? because people don’t appreciate that when you’re having hot flashes and night sweats, your vascular system is also opening and closing. women can have a cardiac event, even with clean coronaries, when you’re having hot flashes and arrhythmia is higher.”

there are still many doctors who link perimenopause or menopause with hot flashes and night sweats, but “ignore everything else. we have estrogen and progesterone receptors on every cell of our body. so basically, if the hormones are off, you’re not getting the same signalling, so you can have brain fog, fatigue, depression and lack of sleep,” dr. caplan adds, explaining that estrogen isn’t necessarily down when these symptoms occur. estrogen fluctuates up and down.

progesterone is the one that tends to drop first, she says, so her focus typically is increasing progesterone. interventions don’t have to include hrt, but adding vitamin c, stress reduction or a chasteberry supplement. as well, she might recommend more dietary fibre and cruciferous vegetables that help to rid the body of excess estrogen.

“if you reduce stress, if you replace those deficient nutrients, if you augment or help with detoxification and improve your diet—so it’s all those things,” she explains of symptom management.

menopause support is not one-size-fits-all, but being proactive and preventative with healthy habits can help mitigate symptoms as you age. just as regular blood work can indicate elevated blood glucose levels as much as 10 years before diabetes is diagnosed, functional medicine practitioners will do blood work and genetic testing for any markers of deficiencies or concern, developing a treatment plan based on a person’s risk profile.

how can you tell what’s driving your menopause symptoms?

for dr. christine cho-d’souza, naturopathic doctor at the pain and wellness centrein vaughan, ont., perimenopause and menopause are a growing part of her practice as her patients age. she also holds a menopause society certified practitioner certificate (mscp) designation, which reflects additional expertise in treatment guidelines and recommendations.

for example, in 2023, the journal menopause published the nonhormone position statementof the north american menopause society to evaluate the options for treatment of vasomotor symptoms, the common hot flashes and night sweats. the researchers noted that hormone therapy “remains the most effective treatment for vasomotor symptoms and should be considered in menopausal women within 10 years of their final menstrual periods” unless women have contraindications like cardiovascular disease or estrogen-related cancers. they also recommended lifestyle and nutrition approaches for effective treatment.

“when women come to see me, there’s sort of more than one concern or more than one symptom that’s happening,” says dr. cho-d’souza of women in their late 30s, early 40s to early to mid-50s. her first step beyond questionnaires and a physical exam is often blood work to investigate if concerns are related to perimenopause or something else.

“hot flashes and vaginal dryness and atrophy and those kinds of things are distinctly hormone-related. but for all the other things, so change in mood, whether it’s anxiety or irritability or low mood, that can be multiple factors. fatigue, that can be hormones, that can be stress, that can be thyroid, that can be iron and b12,” she says of the investigative work needed to provide a more holistic picture of health.

she sees the value of hrt for hormone-related symptoms, but when there are multiple contributing factors, diet and lifestyle changes play significant roles. supplements, herbs and nutrients can help the body system that regulates stress hormones and stress response. “the more stressed you are or the more your body feels stressed, the worse you’re probably going to feel some of those other hormone-related symptoms.”

what lifestyle changes can help manage menopause symptoms?

her top dietary recommendation is protein, based on body composition, especially in the morning when you’re breaking your fast.

“we’re either we’re busy packing other people’s lunches and making other people’s breakfast. and then we kind of might have like a bite or two of something else, or we’ll end up grabbing a muffin or a bagel or something pretty high carbohydrate to start the day. and then that kind of creates a little bit of glycemic chaos in our bodies throughout the day.”

a close second is getting enough fibre in the day, so making a chia seed pudding with berries or using fibre powders to have before a meal. a third is having phytoestrogenic foods that mimic estrogen in the body, like ground flax seeds and quality soy products like edamame and tempeh.

studies evaluating dietary patterns show an association between lower intensity of psychological symptoms, sleep disorders and vasomotor symptoms and higher consumption of vegetables, whole grains and unprocessed foods, according to a review of the science in the journal of the international menopause society in 2021. also, the intensity of symptoms is linked to highly processed foods, saturated fats and sugars.

as dr. caplan says, “it’s going back to the basics, like clean, healthy food, not processed, or binge eating in stress management. if you eat great, exercise, but if you’re a stress cat [stressed out], that trumps everything. and stress knocks out all our hormones.” she adds that stress causes leaky gut, where the lining of the gut is compromised and leaking nutrients into the bloodstream. this can stimulate an immune response and cause inflammation.

vitamins she often suggests for patients include ones that support the energy cycle of the cell, including b2, b6, b12, magnesium and coq10. these can help with brain fog, tender muscles and fatigue, and b vitamins also act as mood stabilizers. another must is vitamin d, although requirements differ for each person and guidance from a health-care provider is recommended.

both experts agree that physical activity is one of the most important habits to add to your routine for everybody. it makes a difference with aging as women lose bone density and muscle mass as time goes on.

“we need to exercise and do some resistance workouts. a lot of times people think that you have to do it every day, but that’s not necessarily the case. doing small amounts for 20 or 30 minutes works and it doesn’t have to be with super-heavy weights,” says dr. cho-d’souza. “doing what you have the capacity for and building up is always the goal in terms of a starting point.”

even walking 30 minutes, although it’s not building a lot of muscle mass, helps to prevent the risk of cardiovascular disease. if weight management or weight loss is your goal, there’s a need to incorporate moderate to high intensity activity.

dr. cho-d’souza says fitting in activity that you enjoy is what matters most. she makes time when she’s with her young children. “so, it’s going to the playground, hanging on the monkey bars with them, doing all these things and trying not to just sit and watch.”

she also emphasizes the need to solve sleep disruptions because they impact so many other things related to quality of life. “is it changes in estrogen and progesterone that’s driving some of the symptoms with sleep? it can be a little bit tricky because you may have young kids, you’re working late, you’re doing all these things. but let’s say someone has perfect sleep hygiene; they still have difficulty either falling asleep or they have disrupted sleep at 2 a.m. or 3 a.m., and they feel wired. then they’re tired for the entire day.”

where some people just wait to see if sleep improves, she recommends seeking help because poor sleep affects energy, stress resilience and metabolism. “it’s an earlier sign of perimenopause but can happen for a number of different reasons.”

treatment perspectives have advanced, and dr. cho-d’souza is hopeful about the movement to have open conversations with health-care providers about menopausal symptoms. “they were viewed almost like a no man’s land where ‘okay, you know what, it’s going to end at some point. you just have to wait it out.’ that’s changing.”