Something we love about our Primally Pure community is that it includes a blend of unique and beautiful women of all ages and all walks of life. Most of all, we love that our community feels safe with us, exploring and asking the important questions. 

Several women in our community are interested in learning more about the stages of menopause. They’re curious about how it relates to the concept of living cyclically. 

Cyclical living is a beautiful, holistic concept. But of course, it could feel confusing as you transition into your mature years (aka menopause) and lose the innate “cycle” within your body you’ve grown accustomed to. 

Thankfully, cycles surround us naturally: circadian rhythms and seasons. Though it can feel daunting, menopause is part of the larger cycle of your biology (it’s how we were designed!). This time of deep change can bring about empowerment and wisdom in the most impactful ways.

But since we’re admittedly not experts on menopause, for this conversation, we brought in someone who is. Respected midwife, women’s family physician, and herbalist Dr. Aviva Romm. With over 30 years of experience, Dr. Aviva generously shared her knowledge with us. 

The conversation inspired a new sense of gentleness and encouragement around the scary feelings and unknowns associated with perimenopause, menopause, and post-menopause. 

Before we hop into our conversation with Dr. Aviva, let’s recap the menopause stages.

Transitioning to Menopause: The Menopause Stages

Menopause is a natural event in a woman’s body that marks the end of her reproductive years. For most women, menopause happens naturally. Over time, your body produces fewer hormones, and your monthly cycle gradually halts. 

For some women, menopause can happen as a result of surgical procedures that remove your ovaries. Chemotherapy and radiation for cancer treatments can also cause menopause –  sometimes, this is a permanent condition, and other times it’s temporary.¹

Everyone’s experience with menopause differs, but here’s what you can generally expect with the menopause stages. 

1. Perimenopause 

The first stage typically occurs somewhere in your 40s as your hormone production begins to decline. Perimenopause causes: 

• Irregular cycles (longer or shorter, or no ovulation)
• Cyclical PMS symptoms (like breakouts around the average time of your period)
• Typical menopause symptoms (like hot flashes, vaginal dryness, and mood swings)

2. Menopause

The average age for menopause in the U.S. is 51, but it can also happen earlier or later.¹

You’re officially in menopause when you’ve gone 12 months without a period. Menopause symptoms vary for everyone, but generally, women experience symptoms like: 

• Mood swings
• Insomnia
• Dry skin
• Vaginal dryness
• Dry eyes
• Slower metabolism (and weight gain)
• Hot flashes or chills
• Thinning hair

3. Post-menopause

This is the time after you’ve gone over a year with no period. You’ve gone through the most intense changes and are beginning to adjust to your new normal. Post-menopause includes: 

• Milder symptoms (for most people)
• Increased risk of osteoporosis, heart disease, and incontinence 

Going through these changes can feel extremely exhausting and challenging. As creatures of habit, we don’t like change because with change comes the unknown and uncertainty. So, if this all sounds stressful or overwhelming, you’re not alone! This is a safe space to explore, question, and learn together. You’re going to love this conversation with Dr. Aviva. 

Q&A With Dr. Aviva Romm on Menopause

Dr. Aviva was so kind to sit down with us. She helped shine a light on some of the mysteries about menopause that make it feel so scary (and honestly, sometimes depressing). 

What’s your background? How did you become known as the expert on all things period, menopause, and birth control? 

I’m a midwife, women’s health family physician, and an herbalist. I've been providing gynecological care as a midwife since 1987. I’m also a women’s health family physician, so I’m fully trained in obstetrics and gynecology. 

I’m also an herbalist. I’ve been studying and practicing herbal medicine since the mid-1980s and I’m trained in integrative medicine too. 

So, there’s a lot of expertise across the board. You know how people say they wrote the textbook on something? Well, I can actually say I wrote the textbook on herbal medicine for women – because I did! 

With the loss of a consistent “cycle” in the transition to menopause, how can women still feel like they’re living in sync with cycles in their bodies? 

I love this question because when we think about perimenopause and menopause, we kind of think about everything stopping, right? And yeah, if you have surgical menopause or medication that causes menopause, that can certainly happen. But as we’re entering into perimenopause, our body is actually trying to continue to cycle – your brain is stimulating your ovaries. 

It’s going, “Come on, come on, a little more!” 

A lot of women, even when they first enter into true menopause, notice they still have that little breakout or zit at the time when they would have a period. Or maybe their mood is really low. And they go, “Wait a minute, I’m not cycling.” But it really is that initially, you’re not cycling as much as you were. And then when you’re fully in menopause, you’re not cycling anymore. 

But your hormones are still alive, just fewer, and there’s less of them. So I think anything you can do to stay in tune with whatever rhythm your body still has and nourish yourself a little extra goes a long way. Food, rest, and all the good things we do during our menstrual cycle can be really powerful. 

Once fully in menopause, can women still live cyclically? Is it still possible to tune into cycles in nature or even within their own bodies?

Yes! As we move out of having monthly cycles and stop menstruating, there are three main rhythms we can align with and attune to. 

• Seasons: The biggest rhythm is the seasons, which are super dependent on where you live. But adjusting the way you sleep, eat, and nourish yourself throughout those bigger seasons is helpful. It can be a really beautiful touchpoint for your feminine connection to nature that women often feel they lose. 

• Circadian Rhythms: We have cycles that are 24-hour rhythms. Paying attention to circadian rhythms in menopause and trying to align yourself with them is harder because, for many women, it gets harder to sleep. Do what you can to live a little bit closer to those rhythms (getting up with the sun, not going to bed too late, trying to have 7–9 hours of rest, even if it’s not all sleep).

• Ultradian Rhythms: Humans have bio-rhythms that we typically experience every 90-120 minutes. So, if you’ve ever noticed you're sitting at your desk for two hours and your body wants to move, that's normal. Your body wants a “bio-break.” 

We need to change or shift out of what we’re doing into something different. 

→ Many of us crave for a snack at that time. But we surf the internet, or check our Instagram instead of saying, “Oh, okay, I’m hungry for a snack. How can I nourish myself?” 

→ Or: “Oh, I’m antsy to have something different than the computer screen I’m looking at.” So instead of going from your computer screen to your phone, thinking about, “How could I step outside and get 15 minutes of sunlight and movement right now?” 

Ultradian rhythms are really fascinating and give us a lot of insight into the discordance in our culture, which wants us to sit at a desk for 8-9 hours per day. Our natural rhythms want more movement, change of scenery, and change of activity. 

That fits in really well with menopause. A lot of women find themselves more irritable, antsy, and lacking the desire or ability to have uninterrupted sustained focus for four hours on a computer. But now their brains are different. 

You’re essentially trying to fit a round peg in a square hole. So honoring those little daily rhythms can really be a helpful way to check-in.

Is there anything you can do to delay menopause or halt early menopause? Many people are wondering if you can reverse menopause.

The longer you have your cycles, it’s a reflection that your ovaries are still working  – that you’re still ovulating. We can’t necessarily force our body to keep a cycle, right? But if you’re in perimenopause, there are a few things you can do to hit the brakes a bit and reverse things. 

Once you’re in menopause, typically, you have a planned “obsolescence,” if you will, for your ovaries. So it’s not like you can “stop” menopause if that’s where your body is heading.

That said, there are a lot of factors we’re exposed to in our environment. Environmental toxins, stress, or nutritional issues may predispose you to an earlier onset than your own natural rhythm or innate programming. So, one of the things you can do is mitigate those factors in your life. Make sure you’re:

→ Getting good sleep.

→ Eating a diet rich in colorful fruits and vegetables (and their anti-inflammatory and antioxidant activity). 

→ Nurturing those circadian rhythms. 

→ Avoiding environmental toxins and triggers that may send your ovaries into red alert (and make them not work). 

I actually just had this very situation recently. A patient came to me in her mid-40s and started to have all the signs of perimenopause. She was still cycling but very irregularly (and had always had a regular cycle). She wasn’t quite ready for menopause yet. So I told her we could consider some supplements and other ways to nourish her ovaries into regular ovulation again. 

So we worked on her diet and blood sugar balance. She was perpetually under-eating, so we made sure she was getting enough nutrient intake, calories, and fat in her diet. In addition, she started taking some botanicals and nutrients that I actually talk about in my book Hormone Intelligence (riboflavin, melatonin, CoQ10, and the herb Vitex/Chasteberry). 

She, in fact, did nourish her ovaries back into ovulation! She started cycling regularly and has been for a couple of years now.

How can women nurture themselves during menopause to improve their experience + relieve symptoms?

There’s so much we can do to nurture ourselves at this time. I think the first thing is recognizing (and I'm speaking to myself, too, because I'm menopausal) that we are at a really different time in our lives. It’s a little bit like relearning yourself. 

Which is, “Okay, I’m not in puberty anymore – I'm not pregnant and nursing anymore. I’m not in my 30s or 40s now. My hormones are different.” In a sense, once we go into puberty all the way through until we hit menopause, we’re really kind of basking in all the wonderful things estrogen does. 

Once we stop cycling and are in menopause, estrogen (estradiol) goes way way down, and we’re mostly producing something called “estrone.” And its impact on us is just not as potent. It’s not as nourishing and softening as estradiol. 

So we can start to have irritability, changes in our sleep, hot flashes, mood swings, and cognitive changes where we feel like we’re not as focused, and some women experience rage, depression, or anxiety. Vaginal dryness, dryness in our skin, (and one thing no one ever taught me about was dry eyes!), or joint aches and pains. But sleep disturbance is huge. 

So it’s helpful to be aware that these are part of menopause, especially for women in the U.S.. (Not every woman in every culture goes through menopause quite as hard as women in the U.S. do – for a variety of reasons, including our belief about menopause, believe it or not!)

When it comes to menopause, I think we are all thinking of cycle changes and hormone changes. But we also forget this is the time in our lives when our risk of cognitive decline, high cholesterol, and heart disease all increase. 

So try to be really gentle with yourself and ask: “How do I need to repattern my life? What new things do I need to do? How do I need to switch things up?” It may mean, for example:

→ When you drink alcohol, you have a dreadful night of sleep, so you need to rethink your alcohol use. Add in magnesium before bed to support sleep. Try magnesium and tart cherry juice for a menopause evening cocktail. 

→ Nurture your skin by using moisturizer.

→ You may need to work a little harder to maintain or build muscle tone than you did previously. So rethink your workout strategy, exercise, and movement practices. 

→ A lot of women find their digestion changes a little bit in perimenopause and menopause, and they don’t tolerate carbs as well as they used to. Go for more protein and other good nutrients, paying attention to what is and isn’t working for your body. Make sure your diet is anti-inflammatory to take care of your brain and your joints. Diet has a huge impact on pretty much everything about women’s health. 

I also recommend doing things that nurture your brain! Whether that’s taking walks in nature to create more calm, meditating, or doing puzzles and games. 

I think one of the most important things we can do as women is staying connected to other women. We know from every bit of evidence that loneliness is bad for our hearts, it’s bad for our brains. But when we stay connected to women going through this life cycle at the same time as we are, it can help normalize things and give you perspective. 

And, of course, there are things we can do for added assistance for potential symptoms we could be having. 

How do you recommend women in perimenopause or menopause care for their skin? What type of changes can they expect, and are there any ways to combat them tangibly?

Women can experience breakouts, dryness, and skin hyperpigmentation. And, of course, as we get older, we accumulate more sun exposure. So, our risk of melanoma and skin cancer goes up. 

I think it’s really important to love our wrinkles and aging and not use products with a ton of chemical ingredients sold to us as “anti-aging.” I'm very much a minimalist when it comes to skincare. Less is more. 

If you use makeup, keep it simple. Use clean, organic-based good quality products, and use a gentle cleanser to remove it. Then, use a very simple ingredient moisturizer that is as close to nature as possible. 

You’ll also want to use good skin protection. That can be a hat, long sleeves, and good coverage when you’re out in the sun. It can also be a really good, clean sunscreen.

For those who feel like menopause sounds depressing, what’s your take on how to view it with more grace and in a positive light? 

This goes for myself as well! There’s a ton of anti-aging pressure in our culture. The more we can surround ourselves with women who are incredibly positive images of strong, bold, shameless aging, the better. Both in our community and through the media we view. 

I think that can be one of the beauties of social media: seeking out those empowered sites. I love watching French and British movies because women in those cultures tend to have less facial work done (and not that I ever judge any woman for whatever she feels she wants or needs to do, but we’re so pressured in this culture to appear a certain way). 

When I go to Paris or Italy, and I see these gorgeous women who look like a woman would if she wasn’t getting Botox and fillers and all the things, it starts to normalize your experience. 

And remember, we have so much lived experience at a certain point in our lives we don't have to care what people think. I think it’s about having those positive images and really working on the self-talk. 

And then, address your symptoms! Of course, if you feel awful and have a terrible experience in menopause, it’s hard to see a positive perspective. So, getting your symptoms taken care of can be really helpful, too. So whether it’s mental health, hormonal, or physical, all things are available to us. We get to choose what we do that makes us feel good in and about experience. 

One other thing we can do is take on a new challenge or reclaim an old thing we loved to do. Maybe you always wanted to go back to dance classes, or you always wanted to train for that hike or cross-country bike experience. Or get that degree, or learn that language. This is a great time! It’s never too late unless you don’t do it. 

(Dr. Aviva also spoke about an interview she saw recently about Jane Fonda. She said the most important thing Fonda did to age healthily was to get strong – and stay strong. As someone who’s currently going through menopause, Dr. Aviva felt incredibly touched and inspired by Jane’s graceful aging.)

Embracing Menopause, Even When It Feels Challenging

We’re so thankful for Dr. Aviva’s candidness and expertise about such a taboo topic. We hope this post helps you live a little bit lighter in the encouragement that there are always ways to ease the transition and find abundant health, naturally. 

If you’re currently in this season of life, whether you’re in the beginning stages of perimenopause, somewhere in between, or full-swing menopause, there’s hope. 

We’re proud to be part of a community of women who continually empower themselves with knowledge. Plus, the better informed you are, the better equipped you’ll be to handle the changes of this new season. 

Keep in mind that while you may lose the cycle within your reproductive system, cyclical living is still within reach – just in new ways. So we encourage you to embrace cyclical living both throughout your days and in the larger picture of your life. 

Here’s to the possibility of a deeper and more meaningful connection with yourself.

XO

---

Sources:

1. Mayo Clinic | Menopause: Symptoms & Causes

---

 

Pin This Post: Save for fresh inspo on your fav Pinterest board.