What is peri-menopause?
Peri-menopause is the slowing down of a woman's reproductive system in the 6-10 years prior to menopause. It is a normal and natural part of aging, in which the production of most hormones in the body slows down and becomes less predictable. Peri-menopause means that women in their mid-thirties and early forties are less fertile and find it increasingly difficult to conceive.
This lack of regular ovulation can cause low, unstable, unreliable progesterone levels. Insufficient progesterone makes the peri-menopausal years a time of anxiety, inconvenience and confusion for many women, even more distressing than the actual menopause itself.
Peri-menopausal ovaries no longer produce a regular and predictable amount of the hormones progesterone, testosterone and estrogen. Peri-menopausal symptoms are all indicators of progesterone deficiency and estrogen dominance.
Some women have no, or very mild symptoms during these years. However, for many women the last 3-6 years can be most uncomfortable if they don't take steps to control it.
Symptoms of peri-menopause
- Mood changes and swings, anxiety attacks, crying spells, forgetfulness, irritability and low tolerance, depressive thoughts or feelings of being "old and past it", low motivation and brain fog (poor concentration).
- Menstrual problems. Irregular or shorter intervals between periods, spotting, extended and heavy bleeding. About 10% of women world-wide suffer from severe menstrual bleeding; in Australia the rate is a little over 5%. Investigate other possible causes of the excessive bleeding such as uterine fibroids (benign or non-cancerous tumours), cancer, endometriosis, or a genetic bleeding disorder like Willebrand's disease. However, the most common cause of heavy bleeding is hormonal imbalance.
- Iron deficiency anaemia, caused by the above excessive bleeding.
- Hot flashes during the day, or night sweats.
- Headaches or migraines.
- Body shape changes and weight gain around waist rather than hips. Sagging breasts. Loss of muscle bulk. Slowing metabolism.
- Sub-fertility - difficulty getting pregnant, or carrying full term.
- Ovulation may be inconsistent or even cease completely.
- Insomnia or disturbed sleep, not deep and restful.
- Fatigue and low energy, worsened by heavy bleeding.
- Low libido. A dry and less resilient vagina, reduced or no orgasms. Sleep deficiency, lack of testosterone and iron deficiency (from excessive bleeding) often mean she is too tired to enjoy sex.
- Bladder infections or vaginal yeast infections (candida).
- Osteoporosis (thinning of bones) and consequent joint and backache.
- Incontinence (urine leakage) particularly when coughing, sneezing or laughing.
- Skin - thin, dry, inelastic. Formication (feeling like insects crawling on the skin).
- Risk of heart disease / atherosclerosis.
Risk Factors for peri-menopause
- Having a mother who experienced significant peri-menopausal symptoms.
- Smoking - menopause likely to occur two years earlier.
- Hysterectomy with ovaries left intact, particularly if the surgeon cut the nerves or blood vessels feeding the ovaries - menopause likely to occur four years earlier.
- Not having had any children.
- Malfunction of ovaries.
- Cancer treatment (radiation, chemotherapy).
- Diseases (some kidney, autoimmune, thyroid diseases).
- History of anorexia.
- Pharmaceuticals (antidepressants and many others) and exposure to toxic chemicals.
Onset of peri-menopause
In the western world, the average age of menopause is 51, and peri-menopause six years earlier at 45. Worldwide, the age range for menopause is from the late 30's to the early 60's. Women in the poor third world tend to have menopause significantly younger than women in rich countries.
If you are overweight, have borne more than one child, or had high IQ test results as a child, then your menopause is likely to be later.
Menopause is official when you have not had a menstrual period for 12 consecutive months, provided there are no other complications that would suppress your period, such as intense exercise, prolonged breastfeeding, starvation or anorexia nervosa. Pregnancy is still possible up until this point.
The old, conventional approach
The long-held belief was that these symptoms were caused by estrogen deficiency. However, it is now apparent that a lack of progesterone is the root cause of these premature changes. If a woman is still having her periods, then plenty of estrogen is produced by the ovaries. It is a deficiency of progesterone that causes the breakdown of the uterine lining with irregular and heavy bleeds.
The medical profession has for decades been convinced by the pharmaceutical industry to prescribe the contraceptive Pill to women facing this situation. The Pill overrides the natural production of hormones and adds estrogen. Unfortunately it fails to address the progesterone deficiency. Most women who take the Pill in this situation find their symptoms get worse rather than improve. Their estrogen-dominant symptoms are exacerbated. The Pill usually contains progestin, which is a progesterone look-alike. Unfortunately is does not do what natural progesterone would, balancing the effects of unopposed estrogen. Therefore the Pill usually aggravates these symptoms in an already estrogen-dominant woman.
Another mistake often made is to take antidepressants in this situation. This is a case of controlling the symptoms rather than treating and curing the underlying cause.
Prevention / remedies / treatment of peri-menopause
Many doctors will offer a hysterectomy to women suffering peri-menopausal symptoms, and may remove the ovaries as well. A hysterectomy will certainly stop the irregular bleeds and heavy blood loss. One in five hysterectomies is performed just for this reason. This drastic and irreversible step is often offered as the first treatment option.
The standard post-hysterectomy treatment promoted by pharmaceutical companies has been to supplement with estrogen. This particularly applies to women who have had bilateral oophorectomy (removal of both ovaries). The natural hormones progesterone and testosterone were ignored, with disastrous results.
A hysterectomy does nothing to address the symptoms caused by the progesterone deficiency. Natural progesterone is not even considered as a treatment option. If the estrogen and progesterone imbalances were addressed in the first place, it is likely that these distressing symptoms could have been avoided.
The first line of treatment for peri-menopausal symptoms should always be progesterone cream supplementation. If a woman is still getting a bleed (regular or irregular) then she is producing sufficient estrogen, so the contraceptive Pill will simply make things worse. She is deficient in progesterone and prescribing more estrogen (along with a progesterone analog) is the opposite of what she really needs.