Peri-menopause and Menopause
One of the main concerns that patients come to see me for help with is hormonal symptoms related to either peri-menopause or menopause. They may experience a wide variety of symptoms including difficult sleeping, weight gain, hot flashes, extended PMS symptoms, changes in bleeding, night sweats, vaginal dryness, hair loss, memory difficulties, fatigue, and/or decreased sex drive. That doesn’t sound like a lot of fun, does it? No wonder a lot of the women are also experiencing mood changes! The good news is that it doesn’t have to be a rough transition - there are lots of options that can help to make it much smoother. That’s the focus of what I do.
This is such a big topic and since this is an email newsletter and not a book (although someday I’d like to write one of those), I think it’s best to break it up a bit. Today I will talk about how hormones change in the time leading up to menopause and after. This isn’t something that most of us are taught well in school or elsewhere, and I think it’s so important to understand what is happening within your body when the symptoms show up.
Let’s start with what those terms mean:
Perimenopause is the time leading up to menopause when hormone levels start to change because ovulation isn’t happening every month. This can last up to 10 years in some women! It usually starts in the mid-40s, but for some women, this hormonal fluctuation starts even earlier.
Menopause officially happens when a woman hasn’t had a period for 12 consecutive months, or if her ovaries are surgically removed. The average age of onset is 51, but it generally occurs between the ages of 45-55. The age your mom went through menopause is often an indicator of when you will.
To better understand why these peri/menopausal symptoms appear, I think it’s helpful to do a quick review of how hormones fluctuate in a menstrual cycle when a woman ovulates. Keep reading even if you are menopausal - I promise this is relevant for you too!
The first half of the menstrual cycle is called the follicular phase - this is when an egg (follicle) is developing and being prepared to be released. Day 1 is the first day that bleeding begins and typically ovulation happens around day 14 (although it can be totally normal for it to happen a few days earlier or later). Estrogen production increases over the time leading up to ovulation, and causes you to feel more outgoing and social. This makes sense from a biological standpoint - if we are potentially going to get pregnant, we need to like being around people.
The second half of the cycle is called the Luteal Phase and ideally lasts for 12-14 days after ovulation. Progesterone increases over time, and it causes you to feel more introverted and less energetic. Again this makes sense from a biological standpoint - if we are pregnant, then we need to focus our energy on growing a human. If you have had this experience, you likely remember how tired you felt when you were first pregnant because your progesterone levels were very high during that time. If pregnancy doesn’t happen, then progesterone decreases which triggers the start of a period.
So to a degree, it is “normal” to feel more tired and quiet on the day or two before a period starts. Intense or prolonged PMS symptoms often happen when progesterone levels are lower than optimal.
The transition to menopause can affect a lot because this cyclical production of estrogen and progesterone stops happening related to the production and release of an egg. There are other places in your body that make hormones though, so your production doesn’t go down to zero. These areas include:
Adrenal glands - these small organs located on top of your kidneys are able to make cortisol (stress hormone), estrogen, progesterone and testosterone. For many women, they have been balancing a lot and their stress level is really high by the time they reach peri/menopause. That means that their adrenals are putting a lot of energy into making cortisol, and don’t have a lot of capacity left over to make more estrogen, progesterone, and testosterone. Regardless of whether someone opts for hormone replacement therapy or not, this is a really important area that I focus on in their treatment plan. It’s not as glitzy as HRT, but I think menopausal symptoms can be a sign from your body to look at what you can do to reduce stress and prioritize taking care of yourself instead of focusing on everyone else.
Fat Tissue, including breast tissue - produces a form of estrogen
The total amount of estrogen and progesterone produced in these areas is lower than the amount produced in a menstrual cycle, and the form of estrogen is different (although it can be converted into the same form as the ovaries produce).
I can say with certainty that there are a lot of options that can really make a difference in optimizing hormone levels and allow for smoother sailing through menopause, including hormone replacement therapy, herbal medicines, food, exercise (strength training and yoga), lifestyle changes (sleep hygiene, hydration, relationships), and optimizing nutritional status so body systems can function optimally. I will talk in more detail about these different treatment considerations in next week’s newsletter. In the meantime, if you haven’t already received my Hormone Hacks Guide, let me know and I will send it to you!
I’d love to hear your feedback on whether you found this information helpful… or does it feel too much like school? If you liked it and have a friend or family member who you think would find it helpful, please forward it to them. They can sign up for my newsletter on my website (www.drjenniferhaesslernd.com) or by emailing me back so they will get part 2.
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