Am I in Peri-Menopause?
Q: My doctor says I am in menopause because my FSH level is high. I’m still having periods, sometimes very heavy ones, and I thought menopause was the point at which your periods stop?
A: Menopause is defined as the point in time when a woman has gone 12 consecutive months without a menstrual period. The average age in the US is 50-51. It used to be thought that a high FSH level was an indicator of menopause, and it is true that menopausal and postmenopausal women have high FSH levels. However, we know from research studies that the FSH level begins to rise at age 30 and increases through the 30s and 40s. Because of this information, the FSH level is now considered to be an unreliable marker of menopause, yet many doctors continue to use this test. You may be in perimenopause, the years during the late 30s and 40s leading up to menopause. Changes in menstrual flow, including heavier periods, are common in women during the perimenopausal years.
What is Perimenopause?
Perimenopause is the transition time between a woman’s reproductive years and menopause. Typically, perimenopause occurs between the ages 40 to 51(average age is 47), but hormonal changes may start as early as the 30s. As women age, the supply of eggs in the ovaries is depleted. In the 40s, the supply is very low, and menstrual cycles without ovulation (anovulatory cycles) become more frequent. Due to the increase in anovulatory cycles, perimenopausal women often have low levels of progesterone, with high or fluctuating levels of estrogen. High estrogen, low progesterone or an imbalance of estrogen to progesterone may be associated with many of the symptoms that perimenopausal women experience including hot flashes, night sweats, anxiety, depression, irritability, insomnia, headaches, palpitations and irregular, prolonged or heavy menses. These symptoms are often worse before the menstrual period, so many women may think they are having PMS, when it may be the beginning of perimenopause. If you are experiencing symptoms of Perimenopause, you are not alone.
Q: I’m 46 and still having regular menstrual periods, how would I know if I’m in perimenopause?
A: The hormonal changes of perimenopause often begin in the late 30s and early 40s. The menstrual periods may not be affected by hormonal changes until we get close to menopause, although some women notice changes in the frequency or amount of bleeding during their 40s. More commonly women start to experience other symptoms first, such as anxiety, insomnia, hot flashes, night sweats, mood swings, depression and heart palpitations. Even if you are not experiencing any symptoms, it is likely that your hormones are changing.
Q: Sometimes I wake up at night soaking wet and cold. My friend told me it is probably night sweats (nighttime hot flashes), but I’m only 40. Does this mean I will have an early menopause?
A: Night sweats, or hot flashes that occur at night, are quite common in early perimenopause, and are often one of the first symptoms that women experience. It is normal for hormones to begin to change around age 40, and for women to begin to experience some symptoms of hormonal change such as night sweats or hot flashes. Most women who have early perimenopausal symptoms experience menopause at the average age of 50-51. Night sweats and hot flashes are due to a variety of hormonal changes, not just to low estrogen.
Q: I am having my periods every 2 weeks and they are very heavy. Sometimes it is difficult for me to go out because the bleeding is so heavy. Is this normal? I’m only 48.
Changes in the frequency and amount of menstrual bleeding are common in peri-menopausal women. It is often due to excess stimulation of the endometrium (uterine lining) by estrogen, and a lack of progesterone to balance this effect of estrogen. While this is a common symptom, it is important to have your doctor check for overgrowth of the endometrium. Many doctors will prescribe a synthetic progestin to decrease the bleeding due to estrogen. Holistic physicians use natural progesterone to balance estrogen in peri-menopause.
Q: Almost every night I wake up around 2-3 AM. It is hard to get back to sleep, and sometimes I feel so anxious. I’ve never had problems with sleeping until recently. Any ideas on what is causing this? I’m only 42, and I thought that insomnia was a problem for older people.
A: Many women experience this problem beginning in their early 40s. It is associated with the hormonal changes of perimenopause when there is often excess estrogen produced, or too much estrogen relative to progesterone in the body. Estrogen acts as a central nervous system stimulant, while progesterone has a relaxing effect on the brain. With excess estrogen, symptoms such as insomnia, anxiety and irritability are common. The use of supplemental progesterone can balance estrogen and may help to promote sleep and calm mood.
Q: Since I turned 37, I am noticing that in the week before my period I experience a lot of bloating, as well as feeling irritable. I’ve never had PMS before, why I am I starting to have it now?
Many women in their late 30s and early 40s begin to have premenstrual symptoms due to the changes in hormones experienced at this time. Studies have shown that estrogen levels may rise and progesterone levels fall as women enter perimenopause, and this is more pronounced in the premenstrual time. Estrogen may increase fluid retention in the body, as well as having a stimulant effect on the brain causing irritability. Other symptoms of "estrogen excess" include breast tenderness, insomnia, anxiety, and changes in the frequency and amount of the menstrual period.
Q: I’m 43 and having hot flashes several times a day. Even though I’m still having periods, my doctor wants to give me estrogen. I’d rather not use estrogen if I don’t have to.
A: Hot flashes are due to hormonal changes, not just to low estrogen levels. Other hormone changes that can contribute to hot flashes include high or fluctuating estrogen, as well as low progesterone, low beta-endorphin levels, and increased FSH, LH or cortisol. Research has shown that most peri-menopausal age women (age 40-51) have normal or high estrogen and low progesterone levels, and the researchers recommend progesterone replacement rather than estrogen replacement for peri-menopause.
Perimenopause and Hormonal Balance from 30 to 50, information from Dr. John Lee
Has your doctor prescribed estrogen or progestin (Provera, contraceptives, ect.) pills or patches to treat your GYN problems? If he has and you are finding that things are getting worse instead of better, Dr. John R. Lee's latest book, "What Your Doctor May Not Tell You About PREmenopause," may be for you. Dr. Lee together with Dr. Jesse Hanley and Virginia Hopkins discusses what Dr. Lee calls "estrogen dominance" and the effects it may have on your body. Estrogen dominance may be the true culprit when symptoms or conditions such as weight gain (despite exercise and dieting), breast tenderness or lumpiness, irregular or abnormal menstruation, thyroid dysfunction, fibroid tumors, PMS, fatigue, insomnia, loss of sexual desire, some cases of infertility and/or inability to maintain pregnancy, migraine headaches, and cold hands and feet occur.
Why do these symptoms occur?
Most physicians typically prescribe pharmaceutical synthetic estrogens to treat many of these conditions. But it's quite possible that your body already has more estrogen than it needs and what you really need is another hormone, progesterone (not to be confused with pharmaceutical progestins which can make symptoms such as abnormal bleeding worse). According to Dr. Lee, natural progesterone (available over-the-counter in the form of creams or by prescription at compounding pharmacies) can effectively reduce the symptoms of hormonal imbalances and the conditions that it causes by restoring the body's natural hormone balance. Dr. Lee's view on natural progesterone is based on extensive medical research, as well as his over twenty years of promoting this method in his patients. According to the retired California family practice physician, the millions of women who are showing signs of estrogen dominance can solve their problems by rubbing natural progesterone cream into their skin for three weeks of each month.
If natural progesterone is so great, then why don't more physicians routinely recommend it to their patients?
Progesterone is a natural substance and natural substances cannot be patented for sale at profit which makes pharmaceutical companies uninterested in marketing and promoting natural products such as progesterone. And if pharmaceutical reps don't market a product to physicians, many physicians will simply be unaware of its existence. Most prescription estrogens such as Premarin, are chemically altered so they can be patented and sold as a drug. Dr. Lee does not totally discount the use of estrogen replacement, but he stresses that caution should be used when using estrogen urging that only estrogens that are chemically equal to the the estrogen produced naturally by the body be used in the smallest effective dose. Even women who have had hysterectomies, who experience surgical menopause, need to use progesterone to balance the estrogen in their body. Dr. Lee recommends natural estrogens which are available as pills, creams, and patches. Dr. Lee began recommending progesterone to women for menopausal symptoms in 1979. After ten years of prescribing natural progesterone he realized that many of his patients who were using natural progesterone were not experiencing fibrocystic breasts, fibroid tumors, thyroid deficiencies, osteoporosis, or difficulty maintaining pregnancies to term.
Natural progesterone affects almost every organ in the body and the main function of progesterone is to help balance estrogen in the body.
According to studies by Dr. Lee and other researchers, natural progesterone aids the body in producing its own estrogens and other hormones, and helps build bone (rebuilds bone lost to osteoporosis), burns fat, prevents endometrial and breast cancers, and helps embryos survive pregnancy. And natural progesterone has all these benefits without the side effects such as anxiety, fluid retention, depression, headaches, and weight gain, often experienced by women using synthetic hormones. Estrogen dominance is only one factor that explains many of the symptoms experienced by women 10 to 20 years before menopause. Dr. Lee cites several other factors such as poor nutrition, stress, and environmental factors that can play a significant role in many women. Dr. Lee's thought-provoking book, "What Your Doctor May Not Tell You About PREmenopause," provides tips for finding a physician who will treat you naturally, as well as advice for educating your physician about natural progesterone and other natural treatments. He cautions the importance of reading labels when purchasing natural progesterone cream and stresses that because a product says it contains "wild yam extract" is no guarantee that it contains real natural progesterone. His book includes a list of recommended resources for obtaining the cream. He also suggests that saliva tests are a more accurate method of obtaining hormone levels than the traditional blood tests and offers information about getting saliva tests when your physician is uneducated about this type of test. Dr. Lee is also the author of a monthly medical newsletter where he keeps you informed about the latest medical research about natural progesterone and other important topics. In this month's newsletter he discusses the danger of fluoride in our water supplies and the surprising truth about its benefits to your dental health. Each newsletter includes articles by Dr. Lee, as well as a question and answer section, and resources for further information. Dr. Lee is not alone in his efforts to promote natural progesterone; Dr. Susan Love in her book, "Dr. Susan Love's Hormone Book," Christine Conrad in her book "Natural Woman, Natural Menopause," and Raquel Martin in her book, "The Estrogen Alternative," also discuss the importance of hormonal balance with natural progesterone.