Perimenopause: What’s Happening to Your Hormones?

 

Many women don’t think about menopause, or perimenopause, until they are struggling with hot flashes, night sweats, or other hallmark signals of this hormonal shift. Unfortunately, perimenopause is rarely discussed until women are in the midst of changes that are no longer feeling manageable. It’s often in their first appointment that many women realize some (or most) of the symptoms they’ve been struggling with for years are related to this hormonal shift! 

What Is Perimenopause Exactly?

In short it’s a period of transition as your body moves into menopause, which can start anytime around or after the age of 40. During this time your ovarian egg reserve has declined from the millions to the thousands and as a result many individuals start to have anovulatory cycles. This means having a cycle without ovulation.

For some women, the onset of perimenopause can feel a lot like puberty -  PMS symptoms like cramping, bloating, acne and breast tenderness show up while periods become more frequent and heavier. For other women, hot flashes / night sweats come on around their period, anxiety may become an issue for the first time (or worsen), while mood swings become more prominent. Other women also experience insomnia, weight gain, fatigue, and even difficulty concentrating or memory changes.

So What’s Happening To Your Hormones?

In perimenopause your hormone levels are extremely variable! It’s common to see hormone levels go up and down throughout this period of time, before you actually move into a more stable, menopausal shift. 

During perimenopause we see FSH (follicle stimulating hormone) levels start to increase. This happens faster than the increase in LH (luteinizing hormone) and can occur even when you are having regular cycles. This is why doctors most often test FSH at the beginning of a woman’s cycle.

While in menopause estrogen is low, during perimenopause estrogen may actually increase (especially in the early stages), which is a surprise to a lot of women! This estrogen dominance pattern can occur either because estrogen levels are truly elevated, or because estrogen looks high relative to a drop in progesterone. Drops in estrogen often start to happen 6-12 months before true menopause (but perimenopause can start years before this). 

As mentioned earlier, when your ovarian egg reserve goes down you’ll have more anovulatory cycles, which results in low progesterone levels through the second half of your cycle. This drop in progesterone is often responsible for a significant number of symptoms commonly seen in perimenopause. So while estrogen is the primary hormone we often think about, progesterone is often the hormone we need to support first in order to help women feel better as their bodies try to find balance through this period of time. 

What Do These Hormonal Changes Mean?

As mentioned above, during perimenopause it’s common to see estrogen dominance symptoms show up. If you’re struggling with any of the below changes, your estrogen levels may be elevated or out of balance with dropping progesterone levels, or if you’ve been in perimenopause for a few years your estrogen levels may now be starting to drop. Here are a few key symptoms that can help you figure out what might be happening.

signs of elevated estrogen

  • Worse or new PMS symptoms, especially

    • Breast tenderness

    • Heavier flow

    • Abdominal bloating

    • Acne

    • Mood changes

  • Anxiety + mood swings (especially feeling more weepy or emotional than usual)

  • Weight gain around the hips, thighs, or breasts

  • Insomnia

  • Brain fog

  • Fibroids, or worsening symptoms of preexisting fibroids

signs of low progesteron

  • Changes in cycle length (shorter or skipped cycles)

  • Insomnia

  • Breast pain / lumps

  • Cyclic headaches

  • Anxiety

  • Hot flashes

  • Weight gain

When estrogen levels start to drop, it’s common to see a few of the more classic menopause symptoms appear

These include:

  • Vaginal dryness

  • Pain with intercourse

  • Hot flashes / night sweats

  • Dry skin 

  • Memory changes / forgetfulness

  • Fatigue

  • Recurrent UTIs

Which Hormones Should You Test in Perimenopause?

Despite how much your hormones will change through perimenopause, anytime you are looking to support hormone balance we need to see exactly what your levels look like before beginning treatment. 

At the beginning of your cycle test:

  • FSH

  • LH

  • Estradiol

1 week before your period is due test: 

  • Estradiol

  • Progesterone

  • Testosterone

Other blood work that is often recommended, based on your individual symptoms and health history:

  • Thyroid panel

  • Liver function

  • Inflammatory markers

  • Iron panel

  • Cortisol 

If you think you might be experiencing signs or symptoms of perimenopause, you have options! Start with some basic blood work to see where your hormone levels are at right now and from there we can determine what type of support is best for you. 

A Final Note

Remember, we aren’t trying to reverse perimenopause or menopause! It’s a natural shift that the body goes through but that doesn’t mean you have to endure the symptoms of these hormonal changes, or that you can’t be preventative. The goal of treatment is to help your body to find balance as you move through perimenopause and menopause so you can feel energetic, comfortable in your skin, and excited about the years to come. 

Ready to make a change?

If you're searching for more guidance, in-depth testing and understanding of how you can address your perimenopausal symptoms with naturopathic medicine, you can check out our info pages on menopause and bio-identical hormones, or you can book a complimentary consult with me here.

Yours in health,

Dr. Hayhlee Clarence, ND

 
HormonesDr. Hayhlee Clarence, NDThe Orenda Clinic & Apothecary