Perimenopause and Menopause: Symptoms, Hormones and Treatment Options

Perimenopause and menopause are inevitable for all women. Some experience symptoms that can be mild while others may be more severe. Our philosophy is that everyone is different which means that everyone’s experience will be different. There is no one-size-fits-all approach to treatment, and here at Forum Health, we understand this and create a customized treatment protocol for each individual based on your unique symptoms, and lab test results.

The symptoms of perimenopause and menopause can overlap. Perimenopause is the transition between child-bearing years and menopause. Pregnancy is still possible because ovulation does still occur, but this is the time when hormones begin to fluctuate. The average age that a woman enters perimenopause is 40, however, everyone is different and it could be earlier or later. It can last just a few years, or it can last up to 10 years. It all depends on the individual.

Symptoms of both can and will overlap, however as a woman gets closer to menopause, symptoms can increase in number and severity.

Menopause “officially” occurs when the ovaries stop producing and the menstrual cycle ceases altogether. A woman is not confirmed to be menopausal until her cycles have ceased for one year, so it’s easy to see that you’re not necessarily perimenopausal one day, and then menopausal the next. Perimenopause and menopause aren’t events; they are transitions and gradually move from one into the other. However, there are things that can contribute to a more difficult transition, including some of the following:

• Surgical removal of the uterus and/or ovaries – this can bring on sudden menopause and symptoms are generally much more severe
• Smoking
• Obesity
• Diabetes and other chronic health conditions
• Insulin resistance
• Family history of early menopause
• Some types of cancer; additionally, some cancer drugs cause the ovaries to stop producing hormones
• Estrogen dominance
• Imbalanced hormones prior to the life change occurring
• Poor diet
• Chronic, high-stress levels
  
  

The average age for menopause in the United States is 51 years old, however, this can also vary based on different factors, and each woman is different. By the time menopause is reached, hormone production will have significantly declined and menstruation stops altogether.

However, in perimenopause, hormones can fluctuate up and down. This fluctuation can cause women to have especially heavy or irregular periods. Estrogen, progesterone, and testosterone levels begin to change, and thyroid hormone production can also be affected.

Normally, the hormones estrogen and progesterone both increase and decrease according to a woman’s cycle and maintain a delicate balance with one another.

In early perimenopause, progesterone usually starts to decrease first. Progesterone helps to regulate the cycle; its main job is getting the uterus ready for pregnancy by thickening the uterine wall to prepare it for an egg. If there is no egg, progesterone levels drop, and the lining is discharged via menstruation. As progesterone levels begin to fall in perimenopause, the ratio between estrogen and progesterone can become off balance which can feel like estrogen is the dominant hormone. This can cause more thickening of the uterine lining and create fibroids and may cause endometriosis. Prolonged or heavier periods, and even clotting, may start to occur since these conditions are both fueled by estrogen.

Not only can these hormonal fluctuations produce unpleasant symptoms, but the balance between the two can widen and increase symptoms and/or the extent of how they are experienced. Usually one of the first symptoms noticed in perimenopause is trouble sleeping due to progesterone levels declining.

Testosterone is the third sex hormone, however, its wane is more gradual, beginning at around age 30 and continuing to decline as a woman gets older. 

It is not uncommon for women to also experience depression while going through these life changes. Unfortunately, a lot of doctors will want to treat this with antidepressants, however, most of the time those just treat the symptoms and not the actual cause. Conversely, our providers understand that the root cause of depression can also be caused by imbalanced or low hormone levels. Treating the root cause of the symptom is much more effective than prescribing an antidepressant.

There was a study published in the January 10^th issue of Jama Psychiatry that was reported by Harvard University’s Women’s Health Watch. There were 172 perimenopausal and early menopausal women who participated between the ages of 45 and 65. These women were followed for six years. One group was given estradiol and intermittent progesterone pills and the other was given a placebo. 32% of the placebo group developed significant clinical depression compared to only 17% of the group taking the hormones.

Not all women will experience significant symptoms of perimenopause, but some can feel them intensely. There have been research studies completed as to why this is, but so far, nothing has been conclusive. However, generally, the healthier someone is, the better they will tolerate these changes, though that isn’t always the case.