In the online perimenopausal community, there appear to be some battle lines drawn. If you thought these virtual watering holes were full of women supporting one another with no judgement or disagreement, then you would be mistaken. Just as in real life, factions are present, and strong opinions drive polarities that sometimes erupt in typed jabs and laughing, angry and crying emojis.

One of the more obvious and ever-present ones is the pharmaceutical vs. natural camp.

Simply put, one group of women is more open and receptive to prescribed medications that have been battle-tested in clinical trials, and this includes FDA-approved hormone therapy (estradiol and progesterone) that is produced by major pharmaceutical companies and available in generic and name brand formulations (vs. hormones made by compounding pharmacies). This group of women may include those who tried natural remedies that proved inadequate, harmful or ineffective as well as those who trust conventional medicine because it has been trialed, tested, in many cases with proven efficacy, and is produced according to regulations, with known and documented side effects.

The other group of women trends toward the “natural at all costs” philosophy. This is the group that may discourage going to conventional doctors and favors naturopathic and functional medicine practitioners instead. They are also the ones likely to caution against using prescribed medications, such as antidepressants (including but not limited to other drugs prescribed off label to help with perimenopausal hot flashes, night sweats, anxiety and more), as well as pharma-grade HRT. Their rationale may be that Big Pharma drugs have harmed them personally or those they know, that there is an unsavory profit motive involved in the practice of medicine that doesn’t put people first and that natural alternatives can’t harm you.

Naturally (pun not intended), there is a deep affinity among women thrust into perimenopause to try what’s close at hand, readily available and perceived as harmless. So many of us had no warning and little or no education about what would happen to our bodies and minds in midlife. We just knew that when we hit our late 30s to mid 40s, we started feeling different, off-kilter and a bit abnormal. Thus, we are fending for ourselves – at least those of us with the grit and resilience to even try to address the panoply of hormonal change symptoms. And that self-advocacy often starts with over-the-counter supplements and various concoctions, potions and pills recommended by word of mouth and easily obtained.

The problem is that just because something is natural, doesn’t mean it’s good for you, beneficial to your individual biochemistry or without side effects. Here are some commonly suggested natural remedies, bandied about through the grapevine among communities of women, or offered to us by supplement companies and holistic non-MD providers whose biggest competitors are, in fact, the commercial pharmaceutical industry and the very few mainstream physicians skilled in caring for midlife women (oh, those precious few!).

5-HTP:

• A nervous system and brain neurochemical used to boost serotonin, a mood regulator, in the body with the goal of reducing depression.
• Sometimes used to help treat insomnia and anxiety.
• Possible risks include heartburn, nausea, diarrhea, stomach pain, drowsiness, muscle spasms. Avoid use if taking antidepressants.
• May be safe if taken for up to one year.

Black Cohosh:

• An herb original to North America commonly deployed as an estrogen booster, even casually called “herbal estrogen.”
• Often sought to help with hot flashes and commonly included in so-called menopause supplements.
• Potential side effects are upset stomach, rashes, headaches, weight gain, bloating and liver damage.

Chasteberry / Vitex:

• Also known as Vitex agnus-castus, chasteberry and monk’s pepper, an herb used to help with infertility, PMS (migraines, depressed mood and breast pain in particular), menopause (specifically mood and sleep improvement), acne, breastfeeding, inflammation, bone repair, headaches and epileptic seizures.
• Potential risks: nausea and upset stomach, skin rashes, acne, headaches, heavy menstruation and should not be taken with antipsychotic medications, birth control pills and HRT.

Evening Primrose Oil:

• Comes from a plant and used historically to treats skin problems, wounds and hemorrhoids; also contained omega-6 fatty acids.
• Often used for breasts pain, PMS, arthritis, asthma and eczema.
• Possible side effects: upset stomach, dizziness, nausea, headaches, rashes and not recommended for those taking anticoagulant, antiplatelet, blood pressure, antidepressant and phenothiazine medications.

Inositol:

• Also known as myo-inositol, a type of sugar involved in bodily insulin response and hormones linked to mood and cognition, also called vitamin B8.
• Has antioxidant features that may counteract free radicals in the brain and circulatory system and naturally occurring in fiber-dense foods, such as beans, brown rice and wheat bran.
• Used to treat high cholesterol, insulin regulation, anxiety and panic, depression and polycystic ovarian syndrome (PCOS).
• Potential side effects: stomach pain, headaches, nausea and dizziness.

Kava Kava:

• Sourced from the pipe methysticum plant, often purported to help with anxiety, drug withdrawal, insomnia and stress due to impact on the brain and central nervous system.
• May be safe to use for up to six months, but is linked to liver damage and should be avoided by breastfeeding women, those with Parkinson’s disease and at least two weeks prior to surgery.

Maca:

• A root vegetable known to be used for at least 3,000 years, sourced from the Andes Mountains.
• Used to help male infertility, decrease depression, aid hair growth, stimulate libido and address menopausal symptoms (hot flashes).
• Side effects could include unpredictable impact on hormone levels and should not be taken by those with fibroids, thyroid issues, breast cancer, uterine cancer, ovarian cancer or endometriosis.

Red Clover:

• A plant used in traditional medicine to treat osteoporosis, heart disease, arthritis, cancer, menstrual symptoms and menopausal issues.
• Contains isoflavones, a variety of phytoestrogen, that weakly mimics estrogen in the body, with most research inferring benefits for menopause produced by supplement manufacturers. 
• Also claimed to help with anxiety, depression and even vaginal dryness.
• Possible side effects: vaginal bleeding, skin irritation, headaches, nausea and potential contraindications with various medications.

Tryptophan:

• Also known as L-Tryptophan, an amino acid needed for protein production, naturally occurring in protein-rich foods such as poultry, eggs and red meat.
• A precursor to 5-HTP, which converts to serotonin, a mood-balancing brain neurotransmitter that is also responsible for a host of other bodily functions, and used to help with PMS, depression and insomnia.
• Possible side effects: drowsiness, stomach pain, vomiting, blurry vision, diarrhea and, potentially, a neurological disorder called eosinophilia-myalgia syndrome (EMS) [possibly connected to contaminated products].

Valerian Root:

• Commonly used for insomnia, believed to affect GABA receptors in the brain responsible for controlling fear and anxiety.
• Also used to address headaches, anxiety, digestive problems, menopause symptoms (hot flashes), pain and fatigue.
• Possible side effects: headache, dizziness, itchiness, upset stomach, dry mouth, vivid dreams, daytime drowsiness and liver damage.
• Probably should not be combined with over-the-counter cold and flu medicines, antidepressants, sleeping pills or alcohol.

As you can see, there are side effects and risks associated with “natural” agents as well as pharmaceutical prescriptions – the most commonly cited and warned against in perimenopause being antidepressants and HRT. Coincidentally, many of the side effects of these supplements mirror some of the side effects associated with certain medications.

Many supplements have not been thoroughly tested through randomized, double-blind clinical trials, and many reports of potential benefit for the symptoms they are said to address are limited at best. In perimenopause and menopause, women ultimately must decide which options work best for them. For some, it will mean medications of any type are off limits. For others, they will embrace FDA-approved medicines. And many, many more will adopt an integrative approach, blending options from both worlds.

By Claudette Labriola

My 40s was a time of young children, lack of sleep, youth sports and constant renovations. It felt like I was on a perpetual sprint toward an infinitely out of reach finish line.
 
Then I entered peri-menopause with its hormonal fluctuations, heightened anxiety, irrational mood swings and rage. 
 
But that wasn't all. 
 
Every month or so I was treated to a fortnight of periods resembling murder scenes straight out of the Walking Dead. I literally and figuratively almost bled to death every couple of weeks.
 
At the risk of sounding like a drama queen I'll stop now. The point, however, is that I was less concerned about my so-called physical beauty during my 40s than I ever was before because of all these distractions. 
 
My course of action at the time was to just ignore my body altogether. I needed it to function so I fed it nutritionally and tried to sleep when I could. To pamper myself with coiffed dos, flawless make-up and flattering clothes was beyond my capabilities; a ponytail was so much easier, and sunglasses hid my eyes anyway, so why bother with mascara?  And yoga pants were much more comfortable to chase children in than pretty dresses. Besides, I didn't care what anyone thought if me. 
 
One day in my late 40s I took a closer look at myself in the bathroom mirror while naked after a shower. 
 
Typically, my instinct was to look away. I wasn't a fan of how I looked naked. I felt uncomfortable in my birthday suit and had, for this very reason, given up my love for swimming long ago. I didn't like how I looked and didn't want to subject others to my body. Covering up my self-perceived flaws was more important than participating in activities requiring a bathing suit, no matter how much I used to love them. 
 
Acting this way bothered me. I knew it was wrong to be so dismissive about myself. I was raising a daughter who was inching closer to the tween, then teen years; what kind of role model was I becoming if I couldn't accept, and appreciate my own body?
 
As I approached my 50th birthday, I started to spend more time in the bathroom staring at my naked form. 
 
I especially hated my side profile. The scar tissue from the two c-sections formed a slight bulge on my lower abdomen that I zoomed in on whenever I turned sideways. I was also hyper-aware of my weak abdominal muscles which made my stomach area look less than flat. My butt and upper thighs showed those little dimples called cellulite which were amplified in the brightly lit bathroom mirror. And my breasts, of average size and shape for my body type, certainly wouldn't be called perky anymore.
 
The longer I stared at my body the more elaborate my negative self-talk became. I was on a roll. 
 
One day, I felt something flip in my brain. It was as if I woke up suddenly. I thought back to my own role models, I wondered if I picked up their discomforts with their own bodies over the years and projected those same negative vibes onto myself.
 
"It's ridiculous to desire perky breasts or a flat stomach in midlife," I scolded myself.
 
 Besides, if I truly wanted to improve my body to appease primarily my own self-esteem, I could do something about my general lack of fitness. 
 
My fitness routine during my 40s included chasing kids and pets, and picking up toys...
 
On my 50th birthday, I made a pivotal decision. My daughter was growing older, and I was sick of my doom and gloom attitude which I was afraid she would copy if I didn't stop right now.
 
I decided to change my mental perspective of my physical body and learn to project self-love to my reflection in the mirror and those around me.
 
If not now, when? This was my line of thinking and became my midlife mantra.
 
But how does one do this? 
 
Elaborate self-talk wasn't effective since I had trouble listening to myself, and media all around me wasn't particularly helpful either what with the celebrity-induced artificial beauty standards most regular folk were unable to strive for anyway.
 
So, I made a list:
 
Become comfortable with my nudity.
Accept my body in its natural, nude state.
Love what I see and project it onto others.
 
Nudity in October was tricky given my geographical region of Toronto, Canada. We were in fall with winter weather just around the corner. I tended to be cold even when dressed during those long and dark winter months; how was I going to get comfortable with being naked?
 
The solution proved simple. I owned an electric blanket and a warm housecoat. Instead of wearing bulky pjs to bed, I would take a quick hot shower at night to warm up. While in the steamy bathroom, I applied lotion all over and cherished the touch of my hands on my body. Each curve, each dimple, and yes, even the bulgy bits deserved some attention. This was an act of self-love, which in turn fine-tuned my mind into accepting my body in its natural state.
 
After I was well moisturized, I donned my housecoat over top of my naked body. My bed looked inviting and warm with the electric blanket giving off heat and comfort. I dropped my housecoat onto the dog crate on the floor next to my side and entered the bed naked.
 
Bliss. 
 
Over the months and years, I learned to feel comfortable in my skin because of this simple exercise of sleeping naked regularly. It wasn't always easy, and I still zoomed in on parts of me which I desired to look or feel different. But mostly, I learned to love sleeping naked.
 
Shortly after sleeping naked became the normal go-to, I joined a local mom-group's boot camp in a church basement, and later, after the pandemic began, I continued with a yoga-inspired exercise routine delivered from an app in my phone.
 
I knew that health was more than just excellent nutrition; it included a painless body, good posture, flexibility and strength. Never having been a fan of cardio, I applied a few gentle cardio exercises, but most of my attention went to my core, especially that tricky c-section part of my body. 
 
It worked. As I became more comfortable with my physical self, I gained mental and emotional clarity which I hoped translated positively to my teens, especially my daughter. 
 
It may be noteworthy to mention that the journey isn't finished, nor is it smooth sailing. I still have moments of insecurity or a drop in self-esteem... sure, a good haircut or some makeup might help, as will a short stint of retail therapy, but all in all, the overall effect has been progressive and beneficial. In addition, my posture improved which reduced the aches and pains in my neck, back and arms.
 
Do I still sleep nude today, three years later? The answer is not always. But that has more to do with room temperature than the desire to be naked in bed.

Claudette Labriola is a self-described "write of words, active blogger, self-published author, Beagle wrangler and hockey mom to two sporty teenagers." Her website is writerofwordsetc.ca.

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​I recently had the privilege of being featured on Menopause Coach Kitty Anderson’s YouTube Channel, Create a Menopause Recovery in the video titled “Keisha Is a Black Woman Using HRT in the United States: Perimenopause Was Traumatic Without HRT!”

I responded to Kitty’s call for women of color to come forward and share their experiences of recovery from perimenopausal or menopausal symptoms, especially those who are using hormone replacement therapy (HRT). I actually encountered Kitty Anderson before; I enlisted her help to coach me through some continued challenges I was facing after I had started HRT months before. I even featured her on The Real Peri Meno blog in the post “Kitty Anderson: Menopause As a Social Justice Issue,”profiling her own journey as a menopausal woman who uses HRT herself and her experiences in becoming an expert on the topic.

My journey, from the process of realizing I was perimenopausal and not suffering from some other malady, and the maze I went through in navigating the medical system, is here on my blog on the post titled “Shocked By Perimenopause? I Was, Too.”

I wish more Black women (and women in general) would go public about their perimenopausal woes and the solutions that are working for them. While I am using HRT, I don’t expect ALL women to do so. But I do explore the reasons why Black women seem less likely to pursue HRT in “Why It Seems Like Black Women Don’t Use HRT.”  Using HRT is a highly personal decision, just like choosing to use any prescription medication is.

Please watch / listen to the interview in depth. Here are a few points I considered after the fact that I want to state for the record:

Choose the medical practitioner, healthcare professional or physician who works for and with you! Regardless of color, too. That healthcare advocate who opts to partner with you in your care may not look like you, sound like you or any in way be like you, but they may be exactly what you need at that moment – and as a permanent ally in your long-term care. The best doctors in this journey for me have been an older (60+) white woman and a younger white man. It was a Black gynecologist who really let me down, along with a slew of others.

Be prepared to pivot. No day in perimenopause is guaranteed to be the same. Your symptoms may be well controlled and absent one day, and then they might pipe up the next. That may not necessarily mean that you need to reinvent the wheel, but it does mean that a versatile mindset is more important now than perhaps it has ever been. As symptoms change during perimenopause, and as hormones choose to cause a commotion every now and again (even while on HRT), realize that dosages may change, you may need to add in new medications and you may need to drop things that no longer work for you.
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If you speak out about perimenopause, be prepared for . . . silence. When I went public about my perimenopause experience, I knew it was going to require being vulnerable. I didn’t know how people would react or what they would say. So far, in terms of my personal sphere, the response has largely been one of silence. No one I know personally is really asking any questions or sharing any of their experiences, but I know they are reading the material here, taking notes and considering options. I started this blog to help others, even as I continue to help myself in the background.