EVERYTHING YOU NEED TO KNOW ABOUT PERIMENOPAUSE

I don’t know about you, but in my younger years I didn’t really think much about menopause and I never really heard anything about perimenopause.  I knew menopause happened at some point in the distant future.  I had heard my mom and her friends speaking about it and all I really knew is that your periods stopped and you got hot flashes. 

The great thing is that through social media and with women being more open about their body’s women are networking and talking more about the hormonal changes that women go though not only through menopause but in the years leading up to menopause, also called perimenopause.

As a Naturopathic and functional medicine Doctor I have heard thousands of women share their stories and their experiences.  Many of them, thanks to social media and the internet have done research and are aware that their hormones are changing and that they are in perimenopause.  Yet that are many who have no idea that their changing hormones are at the root cause of their symptoms. 

Many have gone to their doctors who have put them on medications for anxiety, depression, insomnia, who have told them to eat less and exercise more to get rid of excess weight and who have been told that it is all in their heads as their lab tests all come back normal.  Some have been offered hysterectomies to manage heavy or long periods.  Or are told this is all a part of aging and to just expect things to continue to go downhill.

So what exactly happens in perimenopause

Perimenopause is defined as the years leading up to menopause where significant hormonal changes are occurring.  These perimenopausal years can last 10 years!  Can you imagine…. 10 years before you go into menopause you may start experiencing hormonal shifts.  No wonder we women wonder what on earth is going on.

The Different Stages of Perimenopause to Menopause

I have noticed that there are difference stages of menopause.

Stage 1

In the first stage a number of hormonal changes are happening.  With regards to menopause, we tend to hear about is estrogen and we forget about the lesser-known hormone called progesterone. 

In the first stage of perimenopause, it is changes in progesterone levels that drive the hormonal shifts.  Progesterone levels typically drop. 

Your body is used to a balance between estrogen and progesterone.  As the progesterone levels drop this shifts the balance between estrogen and progesterone.  Instead of these levels being in a certain ratio to each other, when progesterone drops this leads to a state of estrogen dominance. 

It is possible that you were in a state of estrogen dominance before going into perimenopause and so this just further exacerbates this.  Progesterone also blocks the detrimental effects of estrogen.

A few signs of estrogen dominance are:

• very heavy periods
• periods with clotting
• history of fibroids
• Breast tenderness before your period
• Fibrocystic breasts

Estrogen is highest in the first half of your cycle which is from the first day of your period up to day 14.  Midcycle which is around day 14, you ovulate and then the egg or more specifically the corpus luteum makes progesterone for the second half of your cycle. 

At midcycle your estrogen levels drop and then in the second half of your cycle which goes on from day 15 to the first day of your period progesterone levels increase.  When fertilization does not occur then progesterone levels decline and you get your period.

Some signs that may indicate lower progesterone levels include

• Spotting before your period
• Shorter cycles (e.g., they come every 21 days instead of 28)
• Changes in mood in the second half of the cycle such as anxiety, depression and or feelings of irritability
• Headaches before your period
• Difficulty losing weight (what you would normally do to shed a few pounds no longer works)
• Insomnia
• Increased water retention especially before your period.
• Brain fog
• Trouble focusing–
• May notice more yeast infections before your period
• Fatigue
• Joint pain

These are just a few signs that your progesterone levels are on the decline.  Progesterone has so many amazing benefits.  It is the calming hormone and as it lessens, we tend to feel less calm.  Hence those feelings of anxiety and irritability.  I know for myself, I had to ask myself “who on earth was that?”  Suddenly I was reacting to things that I normally would not have been irritated at.

When you are going through perimenopause not only do your progesterone levels decline but often your testosterone levels too. 

Some signs of lower testosterone levels include:

• Lower libido
• Decreased sexual arousal
• Depression
• Loss of public hair
• Less vitality

Stage 2

In the next phase of menopause, we see estrogen levels starting to decline along with progesterone levels.  

As estrogen levels decline women tend to notice some of the following:

• Hot flashes
• Night sweats
• Sweating

Stage 3

In the final stage estrogen and progesterone levels are extremely low or non-existent. 

Other symptoms that may arise include:

• Vaginal dryness and where the vaginal walls thin (atrophy)
• Bladder irritation

There are many other circumstances that determine the degree to which women experience the symptoms above and how early.  The sex hormones – estrogen, testosterone and progesterone are linked with other hormones too including the thyroid, insulin, leptin, and cortisol just to name a few.  

You should also know that if you have had a partial hysterectomy (your uterus was removed but you still have your ovaries) you can still experience these hormonal shifts even though you don’t get a monthly period.  You should start by tracking your symptoms and see if they follow a pattern. 

If you have had a complete hysterectomy (uterus and ovaries have been removed) then your body is sent into menopause.  You may or may not have been given hormones to support your body adjusting to new levels.

Your body always likes hormones in balance and when one is out of balance it follows that it throws the others out of balance too.

Factors that affect perimenopause

Stress

Stress is a big factor.  When you are under stress your body makes cortisol. 

Our body does everything it can in order to survive and your body perceives stress as a threat.  Your body does not know if your stress is because you are trying to escape from a lion or if you are late for a meeting.  Your body just perceives stress and reacts to it by producing cortisol which sends blood flow to your muscles so that you can escape.

 Your body in its innate wisdom will direct the ingredients necessary for progesterone over to cortisol.  This means lower progesterone production and higher cortisol levels.

 Generally, your sex hormones are produced by your ovaries but as you enter perimenopause and menopause your adrenal glands take over sex hormone production.  If you are under stress this puts your adrenals in overdrive and sends more energy into producing cortisol than sex hormones.

Diet

Your nutrition affects hormones.  A diet high in refined sugars means higher insulin levels.  Progesterone blocks insulin receptor sites.  When your progesterone levels decline this frees up the receptors sites and gives insulin more receptors to bind to which means giving them more power.  This enhances the effects of insulin.  Insulin speeds up the aging process and leads to more weight gain especially around the middle.  This also puts women at greater risk for insulin resistance and diabetes.

Egg quality

You are born with a set number of eggs.  Since your eggs or more specifically, the corpus luteum produces progesterone then if you have run out of eggs or if your egg quality has diminished then this will also affect the levels of progesterone that your eggs will be able to produce. 

Protecting egg quality helps with keeping progesterone production up in those perimenopausal years.

Gut Health

Your gut health affects your hormone balance.   Your gut microbiome is essential for hormone balance and for clearing excess estrogens.  There is the estrobiome – gut bacteria that balances estrogen levels.

Your gut health also goes hand in hand with your nutrient status.  If your gut health is off then more than likely nutrients are not absorbed. 

Hormones too also affect gut function.  High estrogen levels tend to slow down the gall bladder and you then have an increased risk of gall stones.  This leads to a poor functioning gall bladder which affects fat digestion and your fat-soluble vitamins.  See how one system affects another.

Thyroid Health

Your thyroid is affected by your sex hormones. 

Estrogen in particular affects the conversion of T4 to T3 which is your active thyroid hormone.  In perimenopause when progesterone levels drop and women are often in a state of estrogen dominance then this affects the T4 to T3 conversion and leads to feeling tired and also weight gain. 

So often I hear from patients who say “yes my doctor checked my thyroid and it is fine.”  Typically, it is TSH that is checked and this is a good overall marker of thyroid health but you do need to dig deeper and check T4, T3 as well as thyroid antibodies. 

The other point is normal is not optimal.  Just because you are in the normal range does not mean that you are in the optimal range.  There is a big difference.

Liver health

Your liver is responsible for regulating your sex hormones - breaking down hormones and removing any excess.  If your liver is in need of some love, it may be less efficient at doing this job.  Things that affect liver health include your diet, medications, environmental exposures and deficiencies to name a few.

 Your Genetics

Your genetics is a big one and one that I find fascinating.  I spent the early part of my career being part of the team getting the genetic sequence for the human genome project and then it was figuring out what all these sequences meant – what genes they coded for and how slight differences in the genes affected people.  Now a whole world has opened up in understanding how slight changes affect each individual and has allowed for personalized recommendations. 

Most genetic platforms just give you the raw data that doesn’t really give you the detailed information you need.  What is great is this information allows for a useful personalized health blueprint that addresses those genes that are truly relevant. What’s also important is that it is not just about looking at each individual gene but looking at how all of them work together.   This is exactly what I do in my coaching program.

Let’s talk testing for your hormones

So how do you find out where you are at?  Well, there are a few options.  It really depends on what you are testing for.  So, let’s go through some of that now.

Menopause

To test if you are in menopause, blood tests are great.  FSH is tested and depending on the range you are in will tell you in you are in menopause.  High levels suggest that you are indeed in menopause.

Hormones

Now to truly get an understanding of your hormones the DUTCH (Dried Urine Test for Comprehensive Hormones) test gives you detailed information on all aspects of your hormones.  This test is a urine test that is done on one day and tells you the levels of each hormone as well as how well they are metabolized.  This test has been a game changer for so many of clients as the level of information that you get is so detailed and allows you to really target certain areas. 

This test along with the genetic testing gives you the best of personalized recommendations for all areas of your health and wellness.

Thyroid

Because the thyroid plays such as big role in your hormones I always believe in knowing your numbers.  A lot of times only TSH is tested but in an ideal world you also want to know your T4, T3 and your thyroid antibody numbers.   Also remember normal does not mean optimal.  So just because you are in the normal range does not mean that your levels are optimal.

Prevention

Understanding what is happening to your hormones and why you may be feeling the symptoms you are feeling is huge but another missed part of the picture is about prevention.

Women in menopause increase their risk of osteoporosis, heart disease, dementia and cancer.

Osteoporosis

As estrogen levels drop there is a direct associated between estrogen and bone health.  As estrogen levels decrease bone loss increases. 

Bone health can be further exacerbated by

•  Being less than ideal before going into menopause
•  Going into early menopause
•  Being on certain medications that encourage bone loss such as steroids.
•  Smoking
•  Being inactive

There is an increased risk of mortality with hip fracture.  Keeping bone health optimal is an essential part of preventive care as women enter menopause

Heart Disease

As women go into menopause their risk of heart disease increases dramatically.  In fact, heart disease is the number one killer for women. 

Risks of heart disease can be further exacerbated by:

•  Smoking
•  Being inactive
•  Family history of heart disease
•  Having high LDL cholesterol
•  Having low HDL cholesterol
•  Diabetes
•  Being overweight

Dementia & Alzheimer’s

Falling sex hormone levels are thought to be responsible for the increased risk of dementia and Alzheimer’s for women.  Not just the falling levels but also with how rapidly they fall.  Optimizing hormones during perimenopause and menopause as well as optimizing brain health may help to delay or even prevent this.

Factors that can exacerbate dementia include

•  Family history
•  High blood pressure
•  Early menopause

Cancer

As we age our risk of cancer increases.  An important factor that increases cancer risk, specifically breast cancer is exposure to estrogen.  As hormones change in perimenopause supporting the metabolism / breakdown of estrogen is important to reducing cancer risk.  

Factors that increase the risk of cancer include

•  Some hormone therapies such as HRT
•  Family History
•  Smoking
•  Having dense breasts
•  Being overweight.

Just as puberty is a shift in a woman’s life, so is perimenopause and menopause.  This is a time when women can be empowered to take charge of their life and reduce their health risks and really enhance their health and vitality. 

Simone Burke is a Naturopathic and Functional Medicine Doctor located in Ontario, Canada. Simone also provides a unique coaching program to give you the best information on optimizing your hormone health.

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