Perimenopause & Menopause, what’s the difference?
Written by guest writer : LISA BRENT, ND, LAc
Perimenopause is the time period in which women transition from premenopause (the reproductive years) into menopause. Typically, these changes occur between the ages of 40 and 51 and usually last about 4 years.
Perimenopause ends 1 year after a woman’s last menstrual period, at which point she is officially in menopause.1 Symptoms of perimenopause can be mild, such as slight changes to the menstrual cycle, or much more severe, including heavy periods and debilitating mood swings.
I love treating women in this phase of their lives, as they are so often misunderstood and undertreated by the conventional medical community. Most women do not realize that, due to the extreme hormonal fluctuations of perimenopause, the experience can be rockier and more challenging than menopause itself.
Women who do seek help from their primary-care provider or OB-GYN are often prescribed an antidepressant or oral contraceptives to manage their symptoms. Some women will not even mention their symptoms to their doctors because they believe they have to “tough it out” or that there is nothing that can safely help. That is absolutely not true.
Naturopathic medicine has many tools for supporting this patient population. A thorough evaluation of the thyroid, adrenal, and reproductive hormones, as well as an assessment of the gastrointestinal system and the influence of environmental toxins, can be very helpful in determining a course of treatment that will help bring vitality and optimum health into the lives of these women.
Onset & Symptoms
Perimenopause can begin anytime between a woman’s late 30s and early 40s. Many women are caught by surprise when these changes start to occur, as they assume they are too young to be having hormonal issues. . Many women in this age group are busy – raising children, building careers, caring for aging parents – so when they start to experience changes to their health, they will often overlook them, assuming they are due to inevitable age-related decline.
Perimenopause is highly symptomatic for about 20% of women; however, almost all women experience symptoms to some degree.2 The complaint I most often hear in my office is, “I don’t feel like myself anymore.” The details of this statement can include any or all of the following:
- Weight gain (especially around the middle) in spite of good diet and exercise
- Insomnia and sleep disturbances
- Loss of libido and sexual function
- Hot flashes and night sweats
- Heavy and frequent periods
- Breast tenderness and enlargement
- Headaches and migraine
- Inability to tolerate alcohol
- Insulin resistance
- Mood changes, including anxiety, depression, and irritability
- Dry and thinning hair
- Dry skin, loss of elasticity of facial skin
- Onset or worsening of “estrogen dominance” symptoms, such as uterine fibroids, fibrocystic breast disease, ovarian cysts, and endometriosis
Blood testing is useful for determining ovarian reserve, thyroid function, iron deficiency, and vitamin D status. If the menstrual cycle has started to become irregular, then a cycle day-3 blood panel including follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol can provide valuable data on menopausal status. A fasting panel for lipids, insulin, and HbA1c can highlight risk factors for cardiovascular and metabolic diseases that increase for women at menopause. Specialized blood tests can rule out chronic infections, food allergies, leaky gut, and other potential contributors to the symptom picture. (I will include these in an initial work-up if history and clinical presentation indicate that symptoms may be due to factors outside of age-appropriate hormonal shifts.)
We use salivary testing to assess cortisol rhythm and bioavailable levels of the reproductive hormones. Because of the variability of hormone levels throughout the day, a 4-point collection allows for a more accurate average of daily production. Laboratory testing will often reveal a decline in progesterone, due to intermittent ovulation. But because the ovaries are still producing estrogen, a relative “estrogen dominance” can result. This can lead to many of the most common symptoms, in addition to an increased risk of endometrial hyperplasia and cancer.3 During the 2-10 years before true menopause, estrogen levels can fluctuate wildly. Most women in perimenopause have higher estrogen levels than women in their 20s and 30s.4 The most symptomatic women have both higher estrogen and lower progesterone.5
Functional stool testing allows us to evaluate levels of beneficial vs pathogenic bacteria, intestinal immune function, overall intestinal health, and inflammation. Since many chronic disorders stem from digestive imbalances and inadequate nutrient absorption, assessing the microbiome can be very helpful in clearing the path to successful hormonal treatments.
Endocrine disruptors, such as toxic chemicals, mycotoxins, tick-borne illnesses, heavy metals, and chronic infections, can influence hormonal function and exacerbate imbalances. A thorough intake and possibly a specialized questionnaire will help clarify whether these factors should be investigated. It is increasingly common to see hormonal disruption in females of all ages as a result of, or at least influenced by, environmentally acquired illnesses.
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