Perimenopausal Hormone Health

Hormones are chemical messages, like text messages sent from an endocrine gland through your blood to target cells. Hormones influence your behavior, emotions, brain chemicals, immunity, and metabolism.

When your hormones are in balance, you look and feel your best. But when they are imbalanced, they can make your life miserable. You can feel lethargic, irritable, weepy, grumpy, unappreciated, anxious, and depressed.

The message from most conventional doctors is that it is normal to feel like this as you age and that you should just accept it. As a functional medicine doctor specializing in women’s hormones, Dr. Sara Gottfried, MD can assure you it’s not normal. You can balance your hormones and get back to feeling vivacious and genuinely content.

Each life stage has its hormonal benefits and challenges for women. Dr. Sara Gottfried, MD shares her hormonal knowledge on perimenopause in this article.

Ages 35−50+: Perimenopause

Perimenopause refers to the ten years of hormonal upheaval that precede a woman’s final menstrual period. 

Most women start to notice signs of perimenopause around age forty: 

You can’t roll with the punches as well as you used to, meaning you may find yourself experiencing:

• Tiredness
  
• Mood swings
• Sleeplessness
  
• An unforgiving metabolism
  
• Obsessive thoughts
• Brain fog
• Hot flashes
• Weight gain
• Loss of energy

During perimenopause, your ovaries begin to falter in their once-reliable production of the sex hormones progesterone and estrogen, and ovulation becomes intermittent. As a result, your periods may be irregular and heavy or light, or alternately both.

Other hormones also start to fade or deregulate; your ovaries, thyroid, and adrenals start to work against you, not for you. To confuse matters even further, the brain becomes less responsive to the hormones that your body does still produce. Perimenopause can feel like puberty in reverse! 

Generally, most women who are in perimenopause fit into one of two phases.

Stage 1 of Perimenopause

You’re running out of ripe eggs in your ovaries, progesterone has started to drop, and estrogen is fluctuating wildly. That can lead to more PMS, depression, and issues with sleep. Progesterone is like nature’s valium, so low levels make many women between forty and fifty feel like they’re going nuts, they’re overwhelmed, they’re premenstrual, they can’t sleep, they want a divorce, or they’re having a personal global warming crisis (hot flashes or night sweats) or all of the above. 

Lower progesterone can also make one’s period come more often. For instance if you used to be once-every-twenty-eight-days, you may notice menstruation happens once every twenty-three or twenty-five days. 

Note: if bleeding occurs more often than once every twenty-one days or is heavy, please see your health provider for a full evaluation as it may be a serious issue.

Most women at this stage become estrogen dominant because of the drop in progesterone (Pg). Estrogens are a family of hormones, including estradiol, which is the main estrogen (also known as E2) of your reproductive years, estriol (or E3), which is the main estrogen of pregnancy, and estrone (E1), which is the main estrogen of menopause. You want the ratio of Pg/E2 to be about 300 optimally, or at least in the range of 100−500. A functional or integrative medicine practitioner can help you find the right range.

Estrogen-dominance symptoms can also occur due to:

• overweight or obesity
• Not enough fiber
• Too much red meat
• Exposure to xenoestrogens

Note: xenoestrogens are fake estrogens that mimic estrogen in your body and bind to the estrogen receptor.

Stage 2 of Perimenopause

Your estrogen levels start to drop, which usually happens between forty-five and fifty. This is often when women notice low sex drive, vaginal dryness, brain fog, slower thinking, and perhaps depression. About 20% to 30% of women are sensitive to estrogen and need it to bolster their mood and prevent depression, which is possibly related to serotonin pathways in the brain that are connected to mood, sleep, and appetite. 

Lower estrogen greatly impacts serotonin, which is what some women notice and experience postpartum. When it comes to women and depression, my bias is always to address the hormonal root cause first before reaching for a prescription.

In this stage, you can have three simultaneous sets of symptoms: low progesterone, high estrogen, and low estrogen. The low estrogen symptoms are related to the estrogen levels you had in phase 1 of perimenopause, maybe five or ten years ago, and are low for you. The estrogen dominance is about your estradiol levels now versus progesterone levels, so the ratio of Pg/E2 is less than 100. Low progesterone is a result of ovarian aging, which is normal and natural but can cause more problems in some women than others, including PMS, difficulty sleeping, and anxiety.

Let’s Talk Perimenopause Relief

• Eat foods rich in vitamin C (e.g., papaya, bell peppers, citrus, dark leafy greens) to increase progesterone levels naturally, or take a supplement of 750mg daily.
• Reduce Caffeine consumption, and try yoga to balance cortisol and relieve mood swings, difficulty sleeping, and lack of energy.
• Check your thyroid. You may notice that tricks to lose weight no longer work—and that may be because your thyroid is slowing down or your testosterone fell off a cliff. Be sure to get your levels checked with your healthcare professional, and follow the recommendations I provide for optimal ranges rather than conventional numbers.
• Try a Sugar Detox to counteract weight gain and keep your insulin in check.
• Make sleep a priority, which will put your growth hormone (it does repair work in your body while you sleep) production back on track.

It is possible to find a new semblance of balance during the perimenopausal stage! In the meantime, this article can serve as a tool to develop a balanced hormonal lifestyle.

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