Perimenopause and Menopause
Perimenopause and Menopause are powerful transitions in a menstruators life. In the past, menstruators did not have a voice or treatment options and suffered in silence. Now there are conversations, products and treatments that are allowing for an easier transition. I will explore these in this blog.
Menstruating people transition through several hormonal changes in their lifetime. These changes are part of a normal life cycle but many will need support through these transitions depending on their unique symptoms and history. It is important that every menstruator understands these changes and advocates for themselves.
Perimenopause usually occurs during the 40s. Here the number of eggs decreases to very low levels, progesterone decreases and estrogen is more erratic. First progesterone decreases and then 6 months to one year before true menopause, estrogen decreases. Around menopause, estrogen can spike before it decreases rapidly. Menopause usually occurs around 50 when a menstruator stops bleeding for 12 months. Here both estrogen, progesterone and testosterone decrease and in postmenopause, estrogen and progesterone will have leveled out to low levels. Symptoms arise due to these changes in hormone levels and in changes in the relation of hormones to each other. Stress, thyroid and insulin issues can exacerbate these symptoms as there is a relationship between sex hormones thyroid, cortisol and insulin. Some menstruators start perimenopause early due to extreme stress. The 40s are an important time to check your stress levels and implement selfcare. It is also important to have your annual blood work done to follow trends and also make sure your levels are in range.
Let's talk about what estrogen, progesterone and testosterone do in the body. Estrogen stabilizes mood through activating GABA (calming neurotransmitter), serotonin and dopamine and it counteracts the effects of insulin and cortisol (stress hormone). It also decreases fat in the abdomen and enhances growth throughout the body especially in breast and uterine lining. Progesterone balances estrogen. It also acts on mood through enhancing GABA causing anti-anxiety. It is also a cortisol antagonist. It is the first hormone to be depleted during stress. Testosterone stimulates libido, helps with mood stabilization and is also a cortisol antagonist. It stimulates muscle gain. It can also be a weak source of estrogen.
Menstruators cycle estrogen and progesterone throughout the month. In the follicular phase (day 1 to day 14 of a cycle) estrogen is higher and spikes at ovulation and progesterone is low. The rise of estrogen enhances athletic performance and may make a menstruator more extroverted. In the luteal phase (day 15 to 28 of a cycle) estrogen decreases and progesterone rises. In this phase, a menstruator may need more rest and gentler activities.
During perimenopause, estrogen is erratic and progesterone is decreasing which may give rise to various symptoms. The first symptom of perimenopause is usually hot flashes and night sweats, insomnia, mood swings, brain fog, and changes to one’s cycle. The changes to one’s cycle can be increased or decreased bleeding and shorter or longer cycles. Vaginal dryness and atrophy, collagen loss in skin, fatigue, decreased libido, hair loss on head, hair growth and acne on face, palpitations, nausea, headaches, urinary tract infections, joint pains and increased risk and heart disease are also symptoms. Fat distribution also changes with one losing muscle and gaining weight on their belly. These symptoms may occur for a time period or last several years and also vary in severity. For each symptom there are various treatment options that can be discussed.
During this time, a perimenopausal person may have mood swings and need more rest and recovery. As progesterone is decreasing, its protective nature against stress is lost. The mood stabilization of both estrogen and progesterone through GABA, serotonin and dopamine is also affected. A perimenopausal person may not be able to cope with stress during perimenopause at the level they did in the past. This is due to hormonal changes and its effects on other neurotransmitters and hormones. In Dr Jade Teta’s Mastering menopause course, he relates this to a menstruator losing their shield. Here new lifestyle and self care is very important. Also during perimenopause and menopause old traumas or unprocessed emotions may also emerge allowing healing if the right supports are in place. It gives one a time to process and re-emerge stronger with more self awareness and wisdom. .
In postmenopause, the hormones have settled but symptoms may start or may persist. The lower estrogen and progesterone levels allows a perimenopausal person to be more vulnerable to stress (diet, exercise, lifestyle, work, finances, relationships) and one may need to re-evaluate their lifestyle and self care. And, with every transition in life, it is important for one to explore their purpose, identity and meaning in this next phase of life. They need to know their self worth going forward. Menopausal people have wisdom, courage, strength, beauty and lots to share in the world.
As a Naturopathic doctor, diet, exercise, stress relief and sleep will be assessed as they are the foundation of health and may need to be adjusted in this next phase. Life labs and hormone tests (serum and Dutch sex hormone test) may be run to assess overall health and hormone levels. Treatments will vary depending on one’s needs and lab results. Treatments will include lifestyle changes including diet, sleep hygiene, exercise recommendations, meditations, biofeedback training and natural supplements for treatment and prevention. Other tests used in the ongoing care are: bone scans, colonoscopy, mammograms and breast ultrasounds, abdominal and transvaginal ultrasound and a thorough cardiovascular work up.
I am here to support you through this transition. Together we can explore and create a protocol to help you feel better, transition with ease and plan for wellness in the future.
References:
Jade Teta Mastering Menopause Course
Women’s Encyclopedia of Natural Medicine, Tori Hudson, ND
Fundamentals of Naturopathic Endocrinology, Michael Friedman, ND
Women’s Bodies, Women’s Wisdom, Christine Northrup, MD