Finding Motivation

As a physician, I am so interested in the WHY of things. I think it’s important and useful to understand what is happening in your body in general, although we’re focusing on perimenopause specifically. I think about the changes that are happening with a perimenopausal woman’s hormones a lot in helping her navigate treatment options. It’s helpful to understand what’s happening and how it relates to the symptoms your unique self is experiencing. Not all treatments work for everyone in every situation.

A treatment will work better if you understand how and why it works. Knowledge about how your treatment works and why you’re doing it can motivate you to be consistent with the treatment. You’re more likely to take the prescribed nutrients, herbs or medications on a daily basis. This routine is key for your treatments to work. You have to take the prescribed nutrients/herbs/meds in order for them to be effective! That seems obvious but is a wall I run in to often in my practice.

Consistency is key, but I know it’s difficult to be consistent when you feel like you’re on an emotional and physical roller coaster, as many women do in perimenopause. Women tell me they don’t feel like themselves. Their life experiences are sometimes radically changed and for no apparent reason; this is disorienting. I’ve found that most women have a morning routine that adjusts well to adding in a supplement or two. This is usually a good time to add in a new therapy. Bedtime routines are often pretty set, too, and since so many perimenopausal women struggle with sleep, it’s often a motivating time to take another round of meds.

It’s the lifestyle changes that are a real doozy. Change my diet? Exercise more? Get more sleep? Meditate?? Who has the time? These adjustments do take time to fit in to our lives. There’s a lot of push back about not being able to make the kinds of changes necessary to truly live well. I know this personally. I have always struggled to exercise regularly. It was never reinforced on me as I grew up in Southern Louisiana, a state not particularly known for healthy habits. Exercising regularly makes me feel better. I feel strong, proud of myself and better able to handle the stress of the day. Yet, I am constantly fighting to fit it in to my life. Restarting an exercise routine sucks. It’s hard. Being out of shape feels terrible. Constantly restarting at that place is demoralizing. I keep trying!

My point: Lifestyle change is hard. Taking pills is easy. Doing both together is what will bring long-lasting results.

It’s important to remember that Perimenopause is not a disease. Diseases often motivate people to make big changes. Perimenopause at it’s best is interesting, uncomfortable for many, and down right painful for some women. It makes sense that the women who are in pain and struggling are more likely to make changes. Anyone will take a pill (well, as I’ve said, more so if they know why they’re taking it). Fewer will make the changes that are more profound and will not only ease the roller coaster ride but also prevent disease in later life.

Here are the motivating factors I hear most commonly in my practice:

I don’t feel like myself.

I want to be kinder to my partner.

I want to want and enjoy sex again.

I want to be a good mom.

I don’t want to yell at my kids.

My periods are crazy heavy/painful.

My PMS is terrible and getting worse/longer.

I would like my hair to grow back and my skin to clear.

I want to age well and prevent disease.

I am not enjoying my life right now.


So, what is motivating you?


Biology of a Cycle, the short-short version

There are major hormone changes happening in perimenopause. Let me back up. There are major hormone changes happening constantly in a woman’s body from puberty through menopause. Our bodies get in to a nice rhythm once periods are regular, sometime in our teens to our early 30’s on average. For most women, periods are a monthly hiccup where the daily routine changes a bit for a few days but we march through and go about our business. Please know that I’m talking about the majority of young women who have normal cycles. I see women every day in clinic that struggle with their cycles; they are a huge upheaval in their lives and a major challenge each month. I’m not talking about these women right now. Most young women find their cycles to be an annoyance and nothing more (and that, perhaps, is a topic for another discussion!).

In a normal cycle, you have two distinct phases. The whole cycle lasts on average about 28 days, with each phase lasting 14 days. There is huge variability here. A normal cycle can be anywhere from 21 to 35 days long, which would make the 2 phases more variable in length. Almost always, the second phase is 12-14 days, which means the first phase is usually the one that is longer or shorter. Anyway, the take-home point is there are 2 phases of a menstrual cycle.

The first phase is called the Follicular phase. Day one of your cycle is the first day you have a normal bleed (spotting doesn’t count!) and the first day of this phase. At the same time you have your period, your ovaries begin again to get ready to ovulate an egg. An egg follicle starts to mature and is typically ovulated or hatched around the 14th day of a normal cycle. Again there’s variability here. A healthy ovulation occurs between days 11 -17 of a cycle and usually depends on how long the full cycle is. Many hormones are involved in the menstrual cycle but the main player here is Estrogen.

Once an egg is ovulated, the 2nd phase begins. It’s called the Luteal phase. The shell of the egg, called the corpus luteum, sticks around for a while and makes a hormone called Progesterone. It’s the main player of the luteal cycle. If there is no pregnancy, the luteum gets smaller and smaller, the body makes less Progesterone and it signals another period to happen. The whole cycle then begins again.

I’ll come back to this biology lesson frequently in future posts. These two phases and the changes that occur with them as we age are key in understanding perimenopause and its symptoms.

Silver Linings?

I write this at 5am, in our temporarily quiet home while everyone is asleep. I used to get frustrated when I woke up early like this. Now, I relish in the peace and quiet. Before I had kids, I remember talking with a mom-friend who said she recently started getting up at 5am to write. It was the only time she had to herself. A long time lover of sleep, I was disgusted at the thought. I totally get it now…

This isn’t specific to perimenopause, but in my practice I do counsel women on seeing the bright sides of certain negative situations (like when your body wakes up earlier than your soul wants to). In this example, waking early offers an important opportunity for ME-time, something we all have less of as we age and have more and more responsibilities (whether or not that involves kids).

Another example is PMS. Long ago, I read Christiane Northrup’s book, Women’s Bodies, Women’s Wisdom. It inspired me to look differently at the phases of our cycles. She talks about PMS being a time when our bodies are more sensitive to the world around us. This is an obvious statement, I know! I don’t mean sensitive as in emotionally reactive, but sensitive as in more perceptive and more receptive. It’s like the blinders are taken off for a few days. This is uncomfortable.

But Dr. Northrup writes about it being an opportunity for us to receive information, process that information and make decisions. It’s a unique time and an opportunity to be introspective, realize what is and is not working for you and come up with an action plan.

Perimenopause, for many women, feels like PMS on steroids. For many of the women I meet in my practice, I probably wouldn’t recommend taking action based on their PMS experiences (most would end up in jail, I think). I do like Dr. Northrup’s idea, though, that during those days that we are more sensitive, we can’t ignore the daily annoyances of life. Some of these irritations are silly, some are really big and yet we go about our day-to-day lives and try our hardest to push through and not see them. I talk to women who are in unhappy relationships or jobs that are not fulfilling. PMS can be a time to reflect on these areas of our lives and at least set an intention for change.

I would recommend not acting on that plan until the PMS is over, however…And talk to your girlfriends and mentors and therapist to make sure you don’t sound like a crazy person.

Could this be the “P” word?

I have a medical clinic in Seattle where I practice naturopathic medicine ( I am a primary care physician focusing on women’s health issues for women mostly in the 25-50 year old range. This is a little story about one of those women, who is so like many of the 35-45 year old women I talk to every day.

I met Elaine about one year ago in my practice  (her name has been changed to keep her confidentiality). She was a 46 year old woman struggling with her weight, which continued to go up despite increasing exercise and diet changes. She also talked about PMS symptoms that seemed to be getting worse over the year and had noticed her periods were starting to change. We discussed the possibility and likelihood of Perimenopause given her age and symptoms. I’ll never forget the look of shock on her face when I said the P word. She burst in to tears at the thought. She was truly taken aback.

After meeting with her and talking about the lack of information “out there” about what happens to women’s bodies as we approach menopause, I decided to take action and get the word out. Hence, this blog. Since meeting Elaine, I’ve met many women in similar situations, myself included. No one is quite as shocked as she was, but almost daily I hear, “No one talks about this. I wish I would have known what to expect.”

Here are the top 10 symptoms of Perimenopause**:

  1. Your periods will change
  2. Your sex drive will change
  3. Your body will change and start to look different
  4. Your hair may start to thin
  5. Your skin will change (remember the acne you had as a teen? Yeah…)
  6. You will hate your husband/partner
  7. You will yell at your kids/pets
  8. Your sleep quality will change
  9. You will start to forget things (“wait, why did I come in to this room??”)
  10. You will feel like you have PMS all month long

**PLEASE NOTE: you may breeze through perimenopause and menopause without the slightest hint of any of these symptoms! A lot of women do. Many women struggle for years with one or more of these symptoms, however, so know that, and be gentle and kind with your lady friends.

In future posts, we’ll break each of these down and talk about natural and conventional medical treatment options (with a focus on natural ones, of course!). Stay tuned…


My mission in creating this site is to share information about the changes in women’s bodies as they go through perimenopause, the 10-year time period before menopause.


I’ve worked with many women going through this transition, confused about the changes their bodies are going through and desperate to understand and feel better. I’d like to share my own experience and offer tips and suggestions on how to make this transition a smooth one. Come along for the ride!