The perimenopausal period is a time of huge hormonal fluctuations, and is often the period of a woman’s life that is the most tumultuous. A recent survey undertaken by Dr Linda Dear (aka the MenoDoctor) on approximately 1500 Australian women, indicated that 23% felt that life was not worth living*, and 88% reported that perimenopause had a negative impact on their relationship.
The transition period between our reproductive years, normally marked by regular menstrual cycles, and our post-menopausal years where menstrual cycles have ceased is known as perimenopause. While most women have an image of menopause in their minds - a sudden cessation of your period and the onslaught of hot flushes - it’s not quite as clear cut as that.
Perimenopause can begin up to 10 years before the last menstrual period, which means the onset of symptoms can begin in our 30s. The timing and symptoms of menopause vary from person to person, and there is no firm consensus on the duration of these symptoms; although most references quote somewhere between 5 and 15 years. In fact, symptoms can continue into post-menopause for a decade or more for some!
If you’re experiencing perimenopause right now, you might feel like you’re on a rollercoaster where you can’t see the twists and turns ahead of you, so you can’t find stability. You can blame your hormones for that!
Which hormones are impacted by menopause?
There are three main hormones that are impacted by perimenopause.
Oestrogen
It’s a common misconception that oestrogen’s only role is to regulate the menstrual cycle. However, given women have oestrogen receptors everywhere in their bodies, this hormone is actually pretty damn important. For example, it plays a huge role= in our body, including in:
-
Regulating our reproductive tract
-
Urinary tract
-
Heart and blood vessels
-
Bones
-
Breasts
-
Skin
-
Hair
-
Mucous membranes
-
Pelvic muscles
Progesterone
Progesterone is part of several roles within the female body, including in:
-
Menstrual cycle regulation
-
Maintaining the uterine lining
-
Bone health
-
Mood regulation
-
Regulating fluid balance
-
Immune system
Testosterone
Women have testosterone too! We have a significant natural production of testosterone from the ovaries, which also declines as the ovaries retire, meaning it is impacted by perimenopause. Testosterone is important for:
-
Libido and sex drive
-
General bone strength
-
Overall health
-
Mood and wellbeing
The Perimenopause Rollercoaster
One of the most challenging things in perimenopause is that it is not stable. Just when you feel you have a handle on managing one set of symptoms, a new wave of challenges may arise.
This cycle of change and adjustment can persist throughout the perimenopausal years, making it a dynamic and sometimes frustrating time for many women.
However, there is hope on the horizon! Most women find that as they transition into post-menopause, symptoms tend to settle down. Postmenopausal women often reflect on their menopausal years with a more positive outlook, highlighting the contrast between the instability of perimenopause and the relative stability of post-menopause.
It's important to note that experiences vary widely—while some women may experience a multitude of symptoms, others may go through this transition with minimal disruption.
What are my hormones doing in perimenopause?
While most of us focus on the reproductive system when we think about perimenopause, the brain is actually at the centre of all of the action. How the brain changes and adapts is known as neuroplasticity, and it plays a big part in the hormonal shifts during perimenopause. The neuroplasticity of the brain is mediated by oestrogen and progesterone (particularly oestrogen), which are our two main hormones as females.
Across our lifetime, we have an increase of oestrogen and progesterone as we hit puberty, and the hormones are at their highest during the fertile reproductive years. These hormones start to decline as we enter perimenopause, into menopause.
But it’s not a smooth transition!
As we enter perimenopause and fertility is declining, the hormones are declining overall but progesterone and oestrogen are going up and down, over and over.
Menopause Hormone Therapy - Is It Safe?
Menopause Hormone Therapy (MHT) stands as the gold standard for managing menopausal symptoms.
It involves using transdermal estradiol and micronized progesterone, which are synthesized to mirror the exact chemical and molecular structure of the hormones naturally produced by the body. Transdermal estradiol, derived from soybeans and yams, is a natural option for hormone supplementation.
In Australia, Sandrena gel or a gel patch are common forms of transdermal estradiol, administered directly through the skin into the bloodstream. This supplementation helps top up declining estrogen levels, maintaining homeostasis in the brain and body for overall health.
Micronized progesterone, taken orally or vaginally, protects the uterus from cancer and restores progesterone balance during perimenopause. It's important to note that women without a uterus do not need to take progesterone.
Menopause Hormone Therapy has undergone rigorous testing and studies, being deemed safe by regulatory bodies like the FDA (Food and Drug Administration) and the TGA (Therapeutic Goods Administration). These newer forms of MHT, transdermal estradiol, and micronized progesterone, are associated with fewer health risks compared to earlier hormone replacement therapies.
While the hormonal fluctuations of perimenopause can be challenging, understanding what’s going on in your body can empower you to make choices about how to manage your symptoms. Whether you’re debating whether MHT is right for you or you just need a bit more support from a professional who deeply understands what you’re going through, All About Her is here to help.
Find the right person to support you by browsing our experienced menopause health practitioners, or check out our resources.
*Statistics are from The Australian Menopause Survey by Dr Linda Dear in 2023
Comments