Perimenopause: A Time of Transition
Perimenopause is a time in a woman’s life which usually occurs between ages 35 and 48. Many changes occur in a woman’s body during perimenopause. The perimenopausal period can create instability in a woman’s life because the menstrual cycle affects all aspects of a woman’s physical, mental and emotional health.
During perimenopause, the menstrual cycle is erratic because ovulation, (egg release) is erratic. Ovulation is a timekeeper and helps to regulate the menstrual cycle. Women are more likely to have cycles in which they do not ovulate (anovulation) during perimenopause. The symptoms of abnormal menstrual cycles can be very frustrating and disruptive for women.
Between the ages of 18-35, the menstrual cycle is usually very predictable and manageable. Between these ages, women are in their peak reproductive years and ovulation usually takes place without a hitch. Women do not produce new eggs after birth. As a woman ages, so do her eggs. These aged eggs have more difficulty maturing to the developmental stage which is necessary for ovulation. This causes a wide range of effects. Pregnancy is more difficult, birth defects are more frequent, menstrual cycles are irregular, fibroids appear and grow, the risk of breast cancer increases, bone loss begins, weight increases and a woman’s ability to cope with stress decreases.
Perimenopause is often misdiagnosed and improperly treated which leads to women suffering unnecessarily. Incorrect treatment can actually make the symptoms worse, lead to unnecessary surgery and increase a woman’s risk to serious illnesses.
However, perimenopausal women can make lifestyle changes to decrease their risk of breast cancer and osteoporosis while minimizing the effects of menopause and decreasing the risk of heart disease. Perimenopause doesn’t have to be an unpredictable time in life.
Perimenopause: A Time of Estrogen Excess and Progesterone Deficiency
A disturbance in the ratio of estrogen to progesterone results in many of the symptoms of perimenopause. After ovulation, the ratio of estrogen to progesterone should be 20:1. Progesterone should be 20 times as high as estrogen. If this ratio is out of balance, symptoms will ensue.
The symptoms of excess estrogen and progesterone deficiency are exactly the same.
- Breast tenderness
- Depression, fatigue, poor concentration
- Fibrocystic breast
- Decreased sex drive
- Fibroid growth
- Thinning hair
- Water retention and bloating
- Fat gain in hips and thighs
- Breast and uterine cancer
Several articles in conventional medical publications have shown that progesterone deficiency and estrogen excess define perimenopause. Urine and salivary hormone laboratory measurements show low progesterone levels accompanied by high estrogen levels as the underpinning of peri-menopause. There is little doubt that this hormone imbalance is the origin of this phenomenon.
The Misdiagnosis and Mistreatment of Perimenopause
The symptoms of progesterone/estrogen imbalance are often misdiagnosed if a physician only focuses on a few symptoms in isolation. The irregular bleeding of peri-menopause is often treated with birth control pills. This synthetic progesterone (progestins) controls the bleeding. However, other symptoms may worsen because the synthetic progesterone binds to progesterone receptors and blocks the progesterone made by your body. Some doctors may also prescribe estrogen which may worsen the symptoms and may lead to a D&C or hysterectomy.
Increased breast tissue growth caused by excess estrogen during perimenopause can lead to multiple biopsies and constant fear of breast cancer in women. This fear, however, is not totally unfounded because perimenopausal women are more likely to die from breast cancer.
Lifestyle changes such as exercise, weight loss, and dietary changes along with bio-identical hormone replacements can greatly reduce the negative symptoms of perimenopause.
Many doctors prescribe estrogen during this period when women are at high risk for osteoporosis which can lead to estrogen overload. Bone loss begins at age 35 when estrogen levels are normal or elevated. Therefore, estrogen alone does not improve bone health. Progesterone is responsible for new bone formation and estrogen helps prevent bone loss. The bone loss seen in perimenopausal women is due to a decline in new bone formation because of decreased progesterone levels.
Progesterone/estrogen imbalance has a profound effect on the GABA receptors in the brain
Perimenopausal and menopausal women are often misdiagnosed with depression, anxiety, and other mood disorders. Millions of women have been placed on antidepressants unnecessarily. Women have needlessly placed at risk for prescription additions i.e. valium and other anti-anxiety medications when they are prescribed these medications to mask the symptoms of hormonal imbalances.
Women are often diagnosed with low thyroid function. They often complain of decreased energy, fatigue and sudden weight gain which are associated with hypothyroidism. However, in many cases, thyroid levels are normal. Progesterone allows the thyroid hormone to work more effectively while estrogen blocks the action of thyroid hormone. Therefore, the symptoms of hypothyroidism are really due to estrogen excess or progesterone deficiency and not due to low thyroid hormone levels.
Women who complain of bloating and weight gain prior to menses are often given diuretics to decrease water retention which is caused by low progesterone levels that are present at the start of a women’s menstrual flow. Aldosterone, a hormone, causes water retention. Progesterone decreases the effects of aldosterone which in turn decreases water retention. Without appropriate amounts of progesterone, aldosterone will lead to water retention.
As you can see treating symptoms without an understanding of the underlying cause can lead to more problems than solutions.
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