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Navigating Perimenopause

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Navigating Perimenopause: A Naturopathic Guide to a Graceful Transition

Navigating Perimenopause: A Naturopathic Guide to a Graceful Transition

by Dr. Faryal Luhar, ND

Embracing a natural transition

Perimenopause marks a woman’s journey into a new phase—where hormonal shifts ripple through physical, emotional, and mental landscapes. While this transition is inevitable, suffering debilitating symptoms is optional. Perimenopause is not a cliff one falls off; it’s more like a winding scenic road with a few unexpected potholes and surprise detours. With the right map and some self-care pit stops, it is possible to cruise into this next chapter with confidence, vitality, and maybe even a little sass!

The naturopathic perspective on this journey incorporates various natural and whole-body strategies to address the root causes of unpleasant symptoms. Preventive measures are also utilized to optimize health as the body ages. Naturopathic support shifts women from feeling helpless and overwhelmed onto a path of empowerment, balance and vitality.

Understanding Perimenopause: What It Is and When It Begins

Perimenopause is the body’s natural lead-up to menopause, signalling the gradual decline of female hormones and typically occurs around age 40-51. During this phase, the ovaries begin to produce less estrogen and progesterone triggering a cascade of changes – including fluctuations in menstrual cycles and irregular periods.  The timeline for this phase can vary significantly ranging from 2-10 years with some women complaining of symptoms as early as age 35.

When the ovaries take their final bow on the reproductive stage of life, and the menstrual period ceases for 12 months consecutively, this is known as menopause. At this point the primary reproductive hormones – estrogen and progesterone, are at their lowest. Testosterone levels which play an important role in women’s health also begin to decline. For many women, the experience of menopause is more stable and settled compared to perimenopause, when hormone levels fluctuate erratically while declining. As such the symptoms can be varied, unpredictable and often go unrecognized as the body shifts into this phase.

Signs & Symptoms: What to Watch For

An array of symptoms spanning physical, mental, and emotional domains occurs. Let’s not forget that hormone receptors are present all over the body including the brain, bones, skin, heart, digestive system and more and as hormones decline, symptoms related to these organ systems will appear.

Typically, the first hormone to decline is progesterone and women can continue to have healthy 28-day menstrual cycles without realizing that they are not producing sufficient progesterone. Progesterone changes affect women profoundly and its benefits go far beyond preparing and supporting the body during pregnancy. Progesterone calms the brain and nervous system and allows women to have more psychosocial resilience. This is largely due to its interaction with GABA (gamma-aminobutyric acid); the body’s main calming neurotransmitter which produces anti-depressant, stress-reducing, and slightly sedative effects. As such initial symptoms include:

·         Anxiety and mood changes: unease, sadness or irritability

·         Sleep disturbances: difficulty falling or staying asleep which can be related to night sweats or anxiety

·         Decreased resilience to stress

·         Cognitive issues: forgetfulness or “brain fog”

·         Fatigue: often linked to poor sleep or increased stress

·         Joint Pain/Muscle aches: a secondary effect of weight distribution and disrupted sleep

·         Menstrual changes: short luteal phase, spotting, heavier periods, prolonged periods, worsening PMS

·         Migraines: these may worsen

Estrogen influences breast development and sexual maturation, feminine curves, pregnancy and lactation, vaginal lubrication, and the health of the heart, bones, skin and immune system.  Declining levels manifest in various symptoms such as:

·         Hot flashes and night sweats: sudden waves of heat accompanied by sweating and flushing, particularly at night

·         Vaginal dryness: thinning and drying of vaginal tissues, leading to discomfort, itching, or pain during intercourse, frequent urinary tract infections

·         Brain fog: difficulty concentrating, forgetfulness, or feeling mentally sluggish

·         Weight gain: especially around the mid-section

·         Decreased libido: disinterest in sexual activity or difficulty with arousal

·         Accelerated skin ageing/Thinning hair

·         Loss of bone density

Estrogen plays a protective role in women’s health. In perimenopause and menopause, as estrogen levels steadily decline, the risk for chronic diseases such as heart disease, osteoporosis, and dementia increases.

There are lesser known or unusual symptoms that can be experienced by many women, which are often dismissed. Some of these are related to changes in histamine tolerance which can cause allergies or the sensation of itchy skin. Tinnitus, metallic or burning taste in the mouth, gum sensitivities or even digestive disturbances are other perimenopausal symptoms.

A common frustration women encounter upon seeking conventional medical assistance for symptoms is that they are commonly met with a doctor who may prescribe a different medication for each symptom. Examples include antidepressants for mood swings, sleeping pills for insomnia, or hormonal birth control to ‘’regulate cycles’’. Women are often told ‘’it’s just stress’’ or that they are ‘’too young for menopause’’ or ‘’ your blood work looks normal and you still have a period’’. This symptom-by-symptom approach fragments care, often leaving women feeling unheard and unsupported. The naturopathic perspective shifts the focus back to the whole person, recognizing that all these issues may stem from the same hormonal transition.

Perimenopausal hormonal swings can feel like a wild rollercoaster, almost like puberty in reverse. In addition, women also face health concerns related to heart health, weight loss resistance or metabolic sluggishness, and muscle and bone loss. Estrogen and progesterone fluctuations are central to symptoms and managing their balance is foundational.

The Naturopathic Approach

Using a framework that is holistic and comprehensive, naturopathic medicine emphasizes the importance of identifying and addressing root causes while supporting the body’s natural healing capabilities. Insightful testing paves the way for custom-made interventions through the use of functional laboratory tests to assess sex hormones, blood sugar regulation, thyroid profile, cortisol, lipids and heart health and even body composition. Treatments are then personalized to each woman’s unique symptoms and long-term health goals.

Naturopathic strategies include:

·         Targeted nutrition for healthy hormone production and detoxification focused on whole-foods and phytoestrogens such as flaxseeds and organic soy to ease night sweats and hot flashes. Anti-inflammatory foods such as fatty fish and olive oil support heart health and improve mood and cognitive function.

·         Optimizing gut health is crucial to enhance absorption of nutrients. Regular bowel movements support clearance of hormones. A healthy gut microbiome specifically related to estrogen known as the estrobolome is vital and can be supported with fibre-rich plants and fermented foods such as sauerkraut and kimchi.

·         Botanical medicines such as Vitex, Black Cohosh or Maca are incorporated according to individual needs to support hormone pathways. Supplements such as vitamin D and calcium for bone health are considered as the risk of osteoporosis increases during this stage. Magnesium is another important mineral and plays a crucial role in muscle relaxation, sleep quality, and mood stabilization, all of which can be disrupted during perimenopause.

·         Stress management which emphasizes self-care practices become essential to improve resilience and keep cortisol levels balanced which otherwise negatively impact estrogen and progesterone. Meditation and other creative outlets are ways of learning to ‘’let go’’ and prioritize wellness. Adaptogenic herbs such as Ashwagandha or Rhodiola can also be used to maintain healthy adrenal output.

·         Movement is essential for optimizing body composition and minimizing abdominal weight gain. Strength training to maintain muscle mass and bone density along with cardiovascular exercises are encouraged. Movement also releases endorphins enhancing mood and mental resilience.

·         Prioritizing sleep is challenging but necessary during this transition as it affects metabolic health such as insulin resistance, as well as energy, moods, immunity and weight. Morning exposure to sunlight impacts healthy melatonin output at nighttime. Thyroid imbalances can affect sleep quality so evaluating hormones to determine unique patterns can point to helpful sleep support supplements such as GABA, l-theanine, or passionflower as needed.

·         Consider BHRT which is the use of prescribed plant-based hormones and is a safe and effective tool during this transformative process. Seeking out a qualified health professional to explore this option is important.

Perimenopause need not be a mystery or a misery. It may feel daunting, but with a naturopathic compass, women can navigate with strength, grace, and autonomy.  This life stage is complex, but the right support eases this transition into a phase of empowerment rather than surrender and allows for renewal, balance and a deeper connection to one’s own health.

Meet the Amrita Voice

Dr. Faryal Luhar,

Naturopathic Doctor

Dr. Faryal Luhar, ND is an internationally recognized Naturopathic Doctor with 20 years of clinical experience spanning Canada, South Africa, Saudi Arabia, and Dubai. Known for blending science, tradition, and innovation, she specializes in uncovering the root causes of illness and designing personalized, results-driven treatment plans that harness the body’s innate ability to heal.

Her integrative approach combines functional medicine with clinical nutrition, botanical medicine, Chinese medicine and acupuncture, combination homeopathy, and genetic-based healthcare. This diverse toolkit allows her to treat a broad range of conditions—from complex women’s health concerns to chronic diseases like diabetes, and pain syndromes such as migraines—while also focusing on prevention, healthy aging, and optimal vitality.

Dr. Luhar is passionate about translating advanced laboratory insights, including gene-based assessments, into practical, empowering strategies that help patients become the authors of their own health stories. She sees every patient as a partner and teacher, believing that education and empowerment are the most powerful prescriptions.

Beyond her clinical work, she has authored numerous articles in leading wellness magazines and is a sought-after voice in the media, with multiple appearances on television and radio. Her global practice gives her a unique lens on health that bridges cultures, traditions, and cutting-edge science.

At the heart of her work is a mission: to inspire people to live balanced, vibrant lives filled with clarity, resilience, and possibility, no matter where in the world they call home.

Visit Amrita Nutrition at

https://amritanutrition.com/en/news/navigating-perimenopause-a-naturopathic-guide-to-a-graceful-transition

Blog

Thyroid disease includes Grave’s and Hashimoto’s

dr.faryal.luhar

Faryal Luhar

July 5, 2018

According to statistics revealed at the Middle East Otolaryngology Conference & Exhibition last year, about 5 percent of people in the UAE suffer from thyroid disease.

Many more suffer from symptoms of low or dysfunctional thyroid, which are often misdiagnosed or undiagnosed. Thyroid problems in women occur up to seven times more often than in men. Globally, it is estimated that 200 million people live with thyroid disorders.

Not only has thyroid disease has become a silent epidemic of our times, it can create more serious health problems down the road. The metabolic responses from abnormal thyroid function can lead to high blood pressure and cardiovascular disease, chronic fatigue syndrome and an increased risk for cancer. 

The thyroid explained

The thyroid is a butterfly-shaped gland that sits just below the voice-box in the neck and is responsible for producing hormones that regulate growth and energy production in the body, making it the master gland of metabolism. But that’s not all. The thyroid influences and interacts with other hormones in the body and is essential for proper functioning of all organs, including the heart, musculoskeletal system and brain.

Hypothyroidism and hyperthyroidism are at opposite ends of the spectrum of thyroid disease. A healthy thyroid gland is initially governed by the pituitary gland in the brain, which senses low thyroid hormone in the blood and sends a messenger to instruct the thyroid to make more hormone. This messenger is TSH, or thyroid stimulating hormone. The thyroid gland then produces the hormones T3 and T4, and only the biologically active T3 hormone exerts physiologic effects in various cells throughout the body.

An underproduction of these hormones will slow down metabolism, resulting in hypothyroidism that creates symptoms such as weight gain, feeling cold, fatigue, irregular menstruation, brain fog, depression, increased blood pressure and cholesterol, dry skin, hair loss and constipation. On the other hand, overproduction leads to hyperthyroidism that speeds up the body’s metabolism. Classic features include weight loss, nervousness, anxiety, intolerance to heat, excessive sweating, palpitations and insomnia.

Hashimoto’s and Grave’s diseases are autoimmune conditions of the thyroid, where the immune system begins to attack the thyroid gland. Hashimoto’s is the most common cause of hypothyroidism and can be diagnosed by testing thyroid antibodies. Some studies suggest that up to 90 percent of people with hypothyroidism have Hashimoto’s disease. Grave’s disease causes the thyroid to become enlarged and overactive, which results in hyperthyroid symptoms. 

Causes of thyroid dysfunction

Thyroid physiology is complex and is interconnected with other endocrine glands, immune system, the gut and various cellular signals. A multitude of factors influence thyroid function, which if overlooked may worsen the condition.

• Stress is an inescapable part of modern-day life and is a major contributor toward thyroid issues. Chronic or high stress elevates cortisol, which when prolonged, fatigues the pituitary and adrenal glands and interferes with TSH. Infection and blood sugar imbalances further elevate cortisol levels resulting in inadequate TSH production, and therefore insufficient T3 and T4 levels. Many overweight individuals attribute weight gain to low thyroid function, not realizing the connection to high stress and cortisol levels, which further inhibit weight loss. 

• Conversion of T4 into T3 is another key component. Remember that T3 is a biologically active thyroid hormone and T4 is inactive. Most thyroid patients receive a medication called Thyroxin, which is mostly T4. This is not effective if conversion into T3 is problematic. T4 comprises 90 percent of thyroid hormone, however up to 60 percent of conversion into the active T3 form takes place in the liver. 

• A sluggish liver, despite normal liver enzymes on lab tests, will impede conversion. Toxins from the environment and food need to be detoxified effectively by the liver. Some 20 percent of the conversion into T3 takes place in the gut, so healthy digestive function is vital for thyroid health. Leaky gut syndrome, caused by food intolerances from gluten or dairy, and malabsorption of nutrients and minerals can cause or contribute to autoimmune and low thyroid function. Dysbiosis, or unfriendly gut bacteria, interfere with conversion into active thyroid hormone as well.

• Mineral and vitamin deficiencies are common since iodine (present in T3 and T4), selenium, iron and even vitamin D are all necessary for proper thyroid function and are involved in converting T4 into T3. Tyrosine, zinc and methylfolate are also major players, which if deficient can lower T3. Genetic variations in the enzymes that use and activate these nutrients (such as the MTHFR gene) further impact thyroid health.

• Hormonal imbalances, in particular excess estrogens from birth control pills, xenoestrogens from plastics and toxins in the environment, and hormone-injected meats – all of these lower thyroid hormone. Hormones interact with each other and excess estrogens interfere with thyroid function by increasing the protein that binds to thyroid hormone (TBG) making it inactive.

Thyroid testing

Most physicians believe that the thyroid is fine if TSH values are within the normal range. However, the TSH value is unreliable at determining low thyroid function. Often, patients are either given prescription medication for low thyroid or dismissed because their TSH and T4 levels are “normal” according to the conventional understanding.

The upper limit for TSH accepted conventionally is between 4 and 5 milliunits per liter (mU/L). However from a naturopathic perspective, the acceptable upper limit is 2.5 mU/L, with most patients feeling best at 1.5-2 mU/L. This discrepancy of opinion is one of the main factors resulting in under-diagnosis that affects health and quality of life.

• Measuring free T3 and free T4 levels is essential. Fluctuating levels along with TSH measurements can distinguish between cellular resistance to active T3 or conversion problems from T4 to T3.

• Thyroid antibodies must also be tested to ascertain any autoimmune issues and is the best way to diagnose Hashimoto’s. The common antibodies tested are Anti-TPO (thyroid peroxidase) and Anti-TGA (thyroglobulin).

• Reverse T3 testing is crucial as it is the third most abundant form of thyroid hormone. Active T3 can sometimes be diverted back into an inactive “reserve” form that happens during times of illness or stress. 

Look at lifestyle

For those who continue to suffer physically despite having had thyroid issues ruled out medically, a professional will seek the root of a patient’s continuing problems through functional blood tests, cortisol and reproductive hormone panels, and tests for food intolerances, nutrient deficiencies and toxicities. Then a treatment plan can help to regulate or restore thyroid function, as well as improve gut imbalances and function.

Gene-based testing offers an important glimpse at genetic susceptibilities and weaknesses. Stress management and adrenal health are equally important because mental or emotional concerns that increase the stress response, also increase inflammation and disrupt thyroid health. Exercise, meditation, developing a sense of purpose and appreciating beauty are all necessary elements for healthy thyroid function and vitality.