About (Peri) Menopause
Wondering why no one ever told you about peri-menopause and menopause can be frustrating and perplexing. With so much mis-information and unanswered questions 'out there', it can be hard to know what to believe and what to do when you suddenly find yourself in this phase of life.
Here you can discover what happens in the different phases of the 'menopausal transition' and what it means for your health throughout the second half of life.
What phase are you in?
Technically, menopause occurs after menstruation stops. But things get interesting in the body before that happens.
Pre-menopause is the phase from the first period until they become irregular in peri-menopause. This phase includes puberty and much of our reproductive life.
Peri-menopause is when sex hormone production fluctuates and starts to diminish, causing irregular periods and PMS-like and other symptoms. This phase tends to start sometime in the 40’s, and can last anywhere between two and eight years.
Menopause starts 12 months after your last period. This tends to happen around 50 years of age, but can happen earlier or later.
Sex hormones
Estrogen is the ‘female hormone’ that helps us to develop our womanly characteristics in puberty. Other roles of estrogen include thickening the lining of the womb for pregnancy, lubricating the vagina and thickening the vaginal lining, formation of bone, regulation of mood and cholesterol balance.
Progesterone's main role in pre-menopausal women is regulation of menstruation and preparation of the uterus for pregnancy. Aside from reproductive functions, progesterone is responsible for regulation of functions in the brain, heart, nerves, skin and bone.
The image below shows what happens to our sex hormones throughout our lifespans, with dramatic changes from peri-menopause:
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Estrogen (in the form of estradiol) fluctuates wildly in peri-menopause.
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We start to lose the protective effects of estrogen and progesterone in peri-menopause.
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From menopause, estrogen remains low and progesterone almost nonexistent - similar to our childhood.
(Image from JC Prior, 2006, Perimenopause Lost - Reframing the End of Menstruation - and adapted by L Briden)
Estradiol is the most potent form of estrogen, produced by the ovaries until menopause.
Our physiological needs and symptoms can be radically different during our reproductive years to peri-menopause to menopause and after.
The image below shows some of the symptoms and risks a woman can experience both before and after the menopausal transition.
Peri-menopause
In both teenage years and peri-menopause - our first and second puberties - estrogen (estradiol) is higher than progesterone. This can cause heavy periods and other symptoms associated with both puberties.
How will you experience peri-menopause? Every woman is different.
The experience of peri-menopause varies widely among women and is determined by a variety of factors, including:
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Genetics - While you're born with your genes, note that these can be influenced by diet and lifestyle factors (a field of science called 'epigenetics').
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General health - Issues experienced before can become worse in peri-menopause - for example, poor sleep can become insomnia, or low mood can lead to depression.
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Your periods before peri-menopause - How were they? Easy periods are a good indicator that things worked well before peri-menopause. Difficult periods may suggest issues which can become worse in peri-menopause - such as estrogen metabolism and the brain's sensitivity to hormone fluctuations.
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Early and surgically-induced menopause - Will put a woman straight past peri-menopause and into menopause. Symptoms may be more severe and hormone therapy (both estrogen and progesterone) will most likely be needed.
Peri-menopause seems to sneak up on women - we often don't even know what it is until we start experiencing symptoms. There's actually a lot happening physiologically during peri-menopause, driven by sex hormone levels. I'll describe below what is happening towards the beginning and end of peri-menopause and what kind of symptoms one might experience.
Early peri-menopause:
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Periods are irregular. Cycles vary in length by seven or more days.
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Estrogen is high and fluctuating, while progesterone is decreasing.
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Symptoms can include mood swings, irritability, insomnia and breast pain.
Late peri-menopause:
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Skipped periods occur. This phase is often marked by 60 days without flow.
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Estrogen is still fluctuating, while declining, and progesterone bottoms-out.
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Symptoms can resemble both that of early peri-menopause (high, fluctuating estrogen - see above) and menopause (low estrogen and progesterone - see below).
While these hormonal fluctuations of peri-menopause can last for years, they won't last forever. Hormone levels fluctuate during peri-menopause and then stabilise, with reduced production from menopause onwards.
Menopause
Symptoms associated with menopause relate to the loss of the protective benefits of estrogen and progesterone. These include: hot flushes, night sweats, abdominal weight gain, decreased libido, dryness (hair, skin, vaginal), body aches and pains, fatigue and impaired memory.
Health risks associated with these low levels of sex hormones include: osteoporosis, insulin resistance, heart disease, breast cancer and urinary tract infections.
How can nutrition help a woman's health before and after menopause?
The transition into menopause presents a 'Critical Window' for our health.
Peri-menopause in particular is a moment when small problems can become worse without adequate care and attention. Examples include insulin resistance, histamine tolerance, autoimmune disease (e.g., Hashimoto's thyroid disease), muscle loss and impairment in sleep, mood and cognition.
This critical window provides a vulnerability as well as an opportunity. It can be the time to implement healthy habits that can help to sustain healthy ageing and wellbeing.
Hormonal changes don’t need to be the end of the road for our health and vitality. Nutrition and lifestyle recommendations can help to address the specific causes of hormonal imbalances, balance hormone levels and safely eliminate excess levels.
To learn more about my approach around the menopausal transition, please see my pages on:
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What to expect from Nutritional Therapy, and
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How Personalised Nutrition can address the individual needs and experience of each woman both before and after menopause.
