When we think about hormone imbalance in women, we often think about PMS and menopause, and that’s about it. One is more prevalent in the earlier years of menses, one in the later years. But what about in between those two? Perimenopause refers to the hormonal shifts that can happen in our 30’s and 40’s – those shifts may not be as dramatic as those in menopause, but can still cause issues that can be corrected with good nutrition, herbs and in some cases bio-identical hormones.
During menopause, there is a fairly sudden decline in estrogen levels and progesterone levels, that gives rise to symptoms such as hot flashes, night sweats, vaginal dryness and mood changes. That typically happens in a woman’s 50’s. These symptoms often come on fairly suddenly (meaning over months to a year). They are quite dramatic, and so women really know it when they become menopausal. Of course, stopping their periods is another key sign!
Peri-menopause can start as early as the mid-30’s, but most often happens during our 40’s. In peri-menopause, the estrogen levels are not declining dramatically; what is happening is a more gradual and insidious decline in progesterone. With that decline can come more pronounced PMS-type symptoms, mood changes especially anxiety, sleep disturbance, weight gain and hair loss. Menstrual cycles often get shorter, so women have their period every 25 days for example, where they might have historically been on a 28-day cycle.
Another hallmark of peri-menopause is estrogen dominance. As I mentioned, estrogen usually tanks during menopause, not during the years leading up to menopause. Progesterone is on the decline during these years. The problem here is that progesterone is a balancing and protecting hormone – it balances estrogen in the body. So if there are declining levels of progesterone, with estrogen staying the same, it can still create a situation of estrogen dominance because the ratio between the two changes. Excess estrogen, or too much estrogen in relation to progesterone, can give rise to hormonal symptoms, as well as a higher risk of estrogen-dependent cancers.
Testing will help to identify if this peri-menopausal pattern is taking place – I have used both saliva testing and blood testing with good results. I like to run tests between day 18 and 22 of the menstrual cycle, earlier if the woman has shorter cycles and later if they have longer cycles. I look at estradiol (the predominant form of estrogen, progesterone, and also testosterone – free and total). It can be good to look at DHEA and pregnenolone too – while they are officially adrenal hormones, they can influence the hormonal balance.
There are a few herbs and nutrients that I use a lot in peri-menopausal women.
- DIM and I3C (indole-3-carbinol) – these are supplements that help with the healthy metabolism of estrogen. They help break down estrogen, and in particular to break it down into the less cancer-causing metabolites. In situations of estrogen dominance to help regulate excess estrogen levels.
- Chaste Tree (aka Vitex) – this is a herb that supports progesterone production via it’s influence on the pituitary gland. It can help boost progesterone levels, but it can take several months to really make a difference. Chaste tree is a more subtle way of enhancing progesterone levels, but some women prefer it over using progesterone support directly. As opposed to progesterone itself, the herb would be taken every day.
- Progesterone supplementation – in some women where we see progesterone levels declining, and/ or estrogen dominance, we can actually use bio-identical progesterone to boost levels. There are some progesterone creams that one can get without a prescription – they contain lower amounts, but still do contain USP progesterone. When we need higher levels, we use a prescription strength from the compounding pharmacy – but often the gentler approach is better. In women who are still cycling, we give progesterone only in the second half of the cycle, to mimic the natural hormone cycles.
35% of our reproductive hormones are produced by the adrenal glands, and even more post-menopause. So in any situation of hormone imbalance it is important to address adrenal problems too.
Women in their 30’s and 40’s often experience a change in their menstrual cycles, but also shifts in mood, weight gain, sleep, energy and overall sense of well-being. Peri-menopause doesn’t come on suddenly and can creep in over the years, so we often don’t think about it. We just know that as time goes by, we don’t feel as good as we used to. Regulating hormones in our 30’s and 40’s can be just as important as during menopause, and can even set us up to sail through menopause without any of the typical symptoms!