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Perimenopause is a transitional phase that occurs in a woman’s reproductive years, typically starting a few years before menopause. It typically begins sometime in a woman’s mid-40s or early 50s. While many women experience these symptoms to some degree during this period of their lives, the exact timing and degree of changes will differ from person to person.
During perimenopause, hormones like estrogen and progesterone start to fluctuate more widely, causing drastic changes in mood, energy levels, and overall health. Additionally, changes in sleep patterns and weight gain can occur as women’s bodies adjust to this new physiological state.
Perimenopause can last for several years before leading to complete cessation of menstrual periods and officially reaching menopause.
Perimenopause and menopause are two major milestones in a woman’s life, but they differ greatly in terms of their physiology and symptoms. Unlike menopause, perimenopause usually occurs over the course of several years. Menopause is defined by the absence of menstrual periods for an entire year, and it marks the end of a woman’s reproductive cycle. Compared to perimenopause, menopause is a much more abrupt change focused mainly on hormonal fluctuations. Ultimately, both perimenopause and menopause signify important developmental milestones for any woman, but they each have very different physiological implications and impact women in different ways.
Often referred to as the “menopausal transition,” perimenopause can last for several years, or even decades for some women, and is characterized by fluctuating hormone levels. During perimenopause menstrual cycles can become heavier or lighter, they can become more frequent or less frequent, or any combination of these. And this is all normal.
There is an increase in estrogen and decrease in progesterone production as well as fluctuations in other reproductive hormones like follicle stimulating hormone (FSH) and luteinizing hormone (LH).
These hormonal changes can lead to symptoms that can begin to appear as the body transitions from a reproductive to a non-reproductive state. Some of the most common symptoms include hot flashes, weight gain, depression, difficulty sleeping, and mood swings. Additionally, changes in bodily functions such as menstruation and libido can occur during this stage as well.
While these symptoms can be unpleasant, they can be managed.
To help manage the symptoms of perimenopause, Tier1 Health & Wellness does the following with our patients.
- Optimize progesterone, which enhances everything that’s good about estrogen while minimizing its negative effects (breast tenderness, bloating, pelvic cramps, migraines/headaches)
- Optimize testosterone, which will help to restore sexual function/libido
- Optimize thyroid if needed, which it usually is
Micronized Progesterone Replacement Therapy
Progesterone is a calming, mood stabilizing hormone that no woman should be without. It offers protection against breast cancer, and has been shown to be as effective in treating breast cancer as Tamoxifen, one of the preferred drugs prescribed to treat breast cancer or prevent recurrence of breast cancer. Progesterone is the drug of choice to treat PMS as it enhances all of estradiol’s positive effects and minimizes estradiol’s negative effects such as: breast tenderness, irritability, cramping, heavy menstrual periods, and migraine headaches.
Testosterone Replacement Therapy
Testosterone is a hormone that is responsible for sex drive and energy levels. When levels decline during perimenopause, it can cause decreased libido and fatigue. Testosterone replacement therapy can help alleviate these symptoms by replacing the testosterone that is no longer being produced. We generally recommend women use bioidentical testosterone cream because it is easy to adjust, easy to apply, and has positive cardiovascular effects and does not carry some of the adverse effects that other delivery methods may cause.
Thyroid Optimization Therapy
Optimized thyroid hormone can increase your energy levels, improve metabolism and make it easier to lose weight, reduce hair loss, improve your skin and nail health, give you better bowel movements, decrease anxiety and depression, give you better temperature regulation, regulate the menstrual cycle, and lower cholesterol levels.
