Perimenopause 101 - How to tell you are in it

Diagram from Lara Briden’s Hormone Repair Manual

Perimenopause is a gradual transition that typically begins in a woman's 40s, marking the lead-up to menopause. It's important to note that for women over 45, perimenopause is typically a clinical diagnosis and does not require lab assessment for confirmation. To help you recognize if you're entering this phase, here are some key signs to look out for:

  • Changes in menstrual patterns: Your periods may become irregular, with cycles becoming longer or shorter. You might still have periods, but the consistency and frequency may vary. Often your period becomes shorter before it gets less frequent.

  • New physical symptoms: You may experience hot flashes, night sweats, or changes in your skin and hair. Vulvar and vaginal symptoms can also occur while you're still menstruating. You may also have an exacerbation of pre-existing symptoms such as breast tenderness.

  • Insomnia and sleep changes: As your hormones fluctuate your sensitivity to that could cause worsening of sleep, either a few days before your period or throughout the cycle.

  • Mood changes: Some women notice shifts in their emotional state, including increased irritability or mood swings. It's important to note that while mood changes are common, severe depression should be addressed with a healthcare provider.

To better understand and manage your perimenopause journey:

  • Track your symptoms: Keep a record of your menstrual cycles and any new symptoms you experience. This can help you identify patterns and provide valuable information to your healthcare provider.

  • Get appropriate testing: Again hormone testing does not diagnose perimenopause however getting baselines of B12, ferritin, liver enzymes, lipid panels can be helpful to assess your overall health and cardiovascular risk (one thing we care about the most!)

  • Consider your family history: Ask your mother about her menopause experience, as there can be genetic similarities. Ask about family history of osteoporosis and cardiovascular disease. These areas of health are important to monitor in women’s health.

  • Seek expert help: Consider seeing a menopause practitioner who specializes in this life stage to get targeted support and avoid misdiagnosis.

Remember, every woman's experience with perimenopause is unique. By staying informed and proactive about your health, you can navigate this transition more smoothly and ensure you receive appropriate care and support.

Chicken Schnitzel & Pesto Pasta

A simple but classic meal and with any vegetable you like on the side. Consider grilled zucchini or peppers, green salad, steamed broccoli or even frozen peas (for the kiddos!). This chicken schnitzel recipe is very easy, delicious and can transform into several different recipes and pesto pasta is just always a hit in our house. Both the chicken and the pesto can be prepped ahead of time if you’d like and both can be eaten separately of course with other sides.

Chicken Schnitzel

I have been really enjoying recipes from Nicole from Simplehomeedit lately and her chicken schnitzel is one I have repeated lately. She has a great video and additional tips on how to make this so I will just share the link to her blog post here. My variation is using gluten free flour and breadcrumbs (when needed) and I usually air fry them and they turn out perfectly. Baking is definitely an option but consider browning the breadcrumbs first for that classic golden look. I avoid frying to avoid more mess. I have batched prepped these as well for the freezer when I have fresh chicken breast. That way I can just pull from the freezer and cook. These are also delicious in a chicken sandwich with simple romaine or iceburg lettuce and mayo or a little of the pesto below with tomato. Yum!

Recipe Here - Chicken Schnitzel

Pesto Pasta

Caro Chambers (from What to Cook When You Don’t Feel Like Cooking - cookbook or substack) is someone I get food inspiration from as well and her write up about an easy pesto formula was great. My go tos for pesto are basil, walnuts or hemp hearts and parmesan cheese. I have liked this formula better than my original pesto pasta recipe and I use my fresh basil growing on my deck.

My usual variation:

  • 2 cups basil (or 1.5 cups basil + 1/2 cup parsley)

  • 1/2 cup walnuts (or pine nuts if you can find them or hemp hearts)

  • 1/2 cup grated parmesan cheese

  • 1/2 cup extra virgin olive oil

  • 2 tbsp lemon juice

Blend all ingredients in a small food processor like this (adding oil slowly while blending if possible). Taste and add salt if preferred.

Mix a few tablespoons with cooked pasta (gluten free if needed). You don’t need too much pesto. Rotini is my preferred pasta for pesto in order to grab the pesto better. Serve warm or cold. Top with sliced chicken schnitzel or chicken on the side. Or you could mix in slightly cooked asparagus, peas or broccoli.

I hope you enjoy these recipes as much as we do!

Dr. Karen

Food Friday: Garlic-Soy Tofu with Mushrooms and Napa Cabbage

This recipe is from a great cookbook "The Vegan Family Cookbook". This has been another favourite of mine and the kids for a quick veggie and protein packed meal. It uses tofu as the protein source, which provides 14g of protein for half a pack and a source of phytoestrogens to support our hormones. I love using tofu once a week since it is easy to cook, takes on different flavours and healthy for our bodies. You can change up the veggies in this dish as well. (Note - if you are avoiding garlic due to digestive concerns, you'll have to skip this one.) Let me know what you think! 

Ingredients:

  • 2-3 tsp avocado oil

  • 1 12oz block extra-firm tofu, cut into bite size squares and patted dry

  • 4 tbsp soy sauce

  • 2.5 cups cremini or shiitake mushrooms, sliced

  • 5 heaping cups napa cabbage, thinly sliced 

  • 8 cloves garlic, minced

  • black pepper

  • 1 tbsp cornstarch

  • 2 tbsp water

Directions:

  1. Heat a large skillet over medium-high heat. Add oil and then tofu to the pan. Shake the pan to help release the tofu and use a wooden spatula to turn it until it is brown on a few sides.

  2. Add 1 tbsp soy sauce and toss until it is mostly absorbed, 20-30 seconds.

  3. Add the mushrooms, cabbage, garlic and a few grinds of pepper. The veggies will release their water and start to soften and wilt down in 2-3 minutes. 

  4. In a small bowl, whisk the cornstarch with the water and pour the mixture into the stir-fry along with the remaining 3 tbsp soy sauce. Cook just until the sauce has thickened and all is well combined. 

  5. Serve over white or brown rice. Top with toasted sesame seeds or green onions if you'd like. 

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The Gut-Brain Connection - A BIG Piece of the Puzzle

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A few questions for you first - Is bloating your most prominent digestive symptom? Do your IBS symptoms worsen during periods of stress? Do you feel bloated with a certain food one day, but not another day? Do you get bloated even from water? Yes is a common answer I hear but it does not typically indicate any serious damage to the gut, or that you most definitively have SIBO. It could actually be a misfiring of signals from your gut to your brain and back…aka a gut-brain connection issue (or a disorder of gut-brain interaction - DGBI).

Bloating & Distension are Different:

Abdominal bloating and distension are 2 of the most commonly reported GI symptoms. For some they can be chronic and very uncomfortable, but for other it may be infrequent.

But there is a difference between bloating and distension! They can occur together or independently. To get technical, abdominal bloating is the subjective sensation of excess intestinal gas, but without obvious visible abdominal distension. People with bloating may feel a sense of fullness or discomfort. Abdominal distension is the objective physical manifestation of an increase in abdominal girth (aka “looking 6 months pregnant” for some). Unfortunately, because of how the health care system categorizes IBS, the differentiation is not regarded, but it can be very helpful to determine the cause of your IBS.

If you have bloating and/or distension but regular bowel movements, or if you have explored celiac testing, the lowFODMAP diet or SIBO testing and you still have bloating, it would be helpful to explore the idea of a disorder of gut-brain interaction (DGBI).

It's Not "Just in Your Head":

It’s important to understand that a DGBI is not "just in your head." While the brain and gut communicate closely, the symptoms are real and need proper management - these are gut conditions that can be affected by stress and mental health. But they are not just stress and mental health.

Think of your gut as a house and a DGBI as a highly sensitive fire alarm system. Normally, the fire alarm only goes off when there is an actual fire, alerting you to real danger. However, in DGBI, this fire alarm system is malfunctioning. It’s hypersensitive and can be triggered by everyday activities like cooking or lighting a candle, causing unnecessary panic and stress. Just as you would need to fix a malfunctioning fire alarm, DGBI requires a tailored approach to manage the symptoms and improve your quality of life.

What can help?

There are several things we need to explore in order to calm this hypersensitivity and correct a DGBI. Everyone in unique of course so unraveling the trigger and make the correction does need an individual approach. Do we need to start with correcting any imbalance of gut bacteria? Or does daily stress and anxiety have a bigger impact on your gut symptoms. These are things I love to explore with people.