Perimenopause, Menopause & Postmenopause
What is it?
Menopause is the cessation of the menstrual cycle. Postmenopause is when a woman's menstrual cycle stops for 12 consecutive months, and she is no longer fertile. Though not a technical term, the years before menopause are referred to as perimenopause, and on average can last between two to fifteen years, and ends with menopause. Estrogen levels rise and fall unevenly during perimenopause. Perimenopause usually begins in your 40s; however, some women notice changes as early as their mid 30s. [1]
Menopause and postmenopause are marked by sharp declines in the production of both estrogen and progesterone.
Causes of Perimenopause and Menopause
Ovaries are primarily responsible for the production of estrogen and progesterone, with the adrenals producing these hormones in smaller amounts.
"During the first 2 weeks of a normal menstrual cycle, estrogen is the dominant hormone. In response to ovulation around day 14 of the cycle, estrogen levels drop and progesterone levels rise and assume dominance for the final two weeks of the month. When progesterone levels drop the next menstrual cycle begins in about 48 hours." [2]
Under normal circumstances, the above cycle of estrogen and progesterone continues with most women up until their 40s, when this delicate interplay of hormones begins to change. "For some women this can mean low levels of progesterone in relation to estrogen levels. In other cases, the levels of progesterone are fine, but estrogen levels are too high". [3] Whatever the case, the hormones are now imbalanced, leading to the perimenopausal/menopausal symptoms we will list in the next section.
Perimenopause will ultimately result in menopause. Menopause is, as previously stated, confirmed one full year after your last period. During menopause, the ovaries produce less estrogen and progesterone than during the reproductive years. As a result, many problems women have with menopause relate to these low hormone levels. [4]
Important Note: Surgical menopause is the removal of both ovaries. As such, the symptoms of menopause are much more rapid and severe.
Symptoms
Perimenopause & Menopause:
- irregular menstrual cycles
- heavy bleeding
- hot flashes/night sweats
- mood swings/irritability
- headaches
- heart palpitations
- reduced libido
- weight gain
- vaginal dryness
- bloating
- extreme fatigue
- dizziness
- depression & anxiety
Important Note: "There is a direct relationship between the lack of estrogen during perimenopause and menopause and the development of osteoporosis. Early menopause (before age 40) and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass." [5]
~Web MD
Postmenopausla women are also at increased risk for:
- heart disease
- osteoporosis
- macular degeneration & glaucoma
Conventional Medical Option Treatments
Conventional medical treatment options for perimenopause and menopause may include one or any combination of the following:
- hormone replacement therapy (HRT)
- antidepressants
- vaginal estrogen
- bisphosphonates (for bone loss)
- high blood pressure medication
- gabapentin (neurontin) - approved for seizures, but can be used for hot flashes.
Vitamins, Supplements and Herbs
- bioidentical estrogen and progesterone replacement: This differs from conventional medically prescribed HRT, in that the finished product has the same molecular structure as the hormones made by our own bodies; whereas, drug companies, not being able to patent a bioidentical substance, create synthetic hormones that are patenable.
- omega-3: "Omega-3 fatty acids help reduce LDL (“bad”) cholesterol and decrease the risk of heart disease. Women who are at greater risk of heart disease after menopause may want to ask their doctor whether they should take a fish oil supplement or simply increase the amount of fish they eat. The American Heart Association recommends having at least two servings of fish per week." [6]
- DHEA: "Low-dose dehydroepiandrosterone (DHEA) administration increases adrenal hormone plasma levels in early and late menopause. Administration of DHEA significantly affects several endocrine parameters in early and late postmenopausal women independently from body mass index. Our data support the hypothesis that DHEA treatment acts similarly to estrogen-progestin replacement therapy on the GHRH-GH-IGF-1 axis. This suggests that DHEA is more than a simple “diet supplement” or “antiaging product”; rather it should be considered an effective hormonal replacement treatment." [7]
- calcium/magnesium/vitamin D3: A deficiency in calcium, magnesium and vitamin d may play a role in the developement of osteoporosis.
- black cohosh: this herb has received more attention for its potential benefits in alleviating menopausal symptoms, then any other botanical. Research results are mixed however. Women with a known liver disorder, or who note darker-then-normal urine, or abdominal pain after taking black cohosh should consult with their healthcare practitioner before starting/continuing this herb.
- soy: foods made with soy contain plant-based estrogen substances called phtoestrogens (aka-isoflavones). May be of benefit in increasing bone density, and to a lesser degree vaginal dryness and hot flashes. Unfortunately, there is as much evidence to refute the use of soy products, as there are claims purporting its benefits.
Diet
If any one single thing can claim to be a "cure-all," then a healthy diet comes closest. The old adage, "You are what you eat," says it all.
If your health is important enough to you, you will need to make the time to shop for and prepare meals using whole, NOT processed food items. Balance is the key here. Don't worry so much about the calorie count as opposed to portion size. Eat three meals a day with a plan for some healthful, nutritious snacks in between.
A well-balanced diet can go a long way in relieving many of the symptoms associated with menopause. All the vitamin, herbal and mineral supplements in the world are no match for a healthy, well-balanced diet.
Every woman is different, and her needs are unique. There are many good books available for purchase and FREE articles online dealing with diet and menopause. Do some research, and find out what works best for you. To get started, we are including the link below, which will get you going on some very basic essentials that will apply to most women, regardless of symptoms:
6 Essential Menopause Foods for Your Midlife Diet
EXERCISE: Ensure you are getting plenty of exercise. Walking is a major plus. Start slow and work up to more intensity, every day if you can manage it. Try to work out with weights once a week, to start, for muscle strength.
SLEEP!!! A good night's sleep is critical! This is when your body attempts to balance/replenish your hormone levels. For the best quality sleep, sleep in as dark an environment as you can manage.
References
[1] Mayo Clinic Perimenopause: Definition Sept. 16, 2008 Websource: http://www.mayoclinic.com/health/perimenopause/DS00554
[2] Dr. John R. Lee Estrogen is not the only hormone: The important role of progesterone. 1997 Websource: http://www.project-aware.org/Managing/Hrt/progesterone_FAQ.shtml
[3] Perimenopause — the beginning of hormonal change
by Marcelle Pick, OB/GYN NP 05/23/2002 Websource: http://www.womentowomen.com/menopause/perimenopause.aspx
[4] The Symptoms Menopause Changes Estrogen And Progesterone Levels
Progesterone Resources Websource: http://www.progesterone-resources.net/a655652-the-symptoms-menopause-changes-estrogen-and.cfm
[5] Osteoporosis and Menopause
WebMD Medical Reference Websource: http://www.webmd.com/menopause/guide/osteoporosis-menopause
[6] University of Maryland Medical Center Menopause Websource: http://www.umm.edu/altmed/articles/menopause-000107.htm
[7] Fertility and Sterility, Volume 76, Issue 2, August 2001, Pages 241-248
Alessandro D. Genazzani M.D., Ph.D., Massimo Stomati M.D., Claudia Strucchi M.D., Simone Puccetti M.D., Stefano Luisi M.D., et al. Oral dehydroepiandrosterone supplementation modulates spontaneous and growth hormone-releasing hormone-induced growth hormone and insulin-like growth factor-1 secretion in early and late postmenopausal women.
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