In your 40s, you may find you don’t cope with stress as well as you did. You’re not imagining things, and you’re definitely not alone. Women are three times more likely to suffer anxiety, depression, and insomnia during the five years before menopause.
These years are called perimenopause and it’s a vulnerable time. Not just because you’re busier than ever with career and family, but also because you’ve suddenly lost the progesterone that used to calm and stabilize your stress response system (hypothalamic-pituitary-adrenal or HPA axis).
⚠️ Tip: HPA axis dysregulation is the medical term for “adrenal fatigue”.
⚠️ Tip: For more detail about how progesterone deficiency causes perimenopausal depression, please read this fascinating paper: “Ovarian Hormone Fluctuation, Neurosteroids and HPA Axis Dysregulation in Perimenopausal Depression”.
Progesterone regulates the HPA axis
Did you know that progesterone plays a huge role in regulating your HPA axis? Progesterone is not just a reproductive hormone. It’s also a brain hormone and a nervous system hormone. Progesterone promotes neurogenesis (new nerve growth) in the hippocampus, which regulates your HPA axis. It also converts to a neurosteroid called allopregnanolone (ALLO), which acts just like the soothing neurotransmitter GABA and is your “hormonal Valium”.
Progesterone ⇒ neurogenesis and GABA ⇒ healthy happy HPA axis (adrenal function)
The end of progesterone
As you approach menopause, you will find it harder and harder to ovulate. That means you’ll lose your only way to make large amounts of progesterone. It’s not all bad. Menopause transition is a natural, normal process — not a failure on your part! Eventually, you will adjust to the small amount of progesterone made by your adrenal glands, and you’ll recover your ability to cope with stress.
Here’s how I see it. Perimenopausal progesterone withdrawal is the price we pay for having enjoyed decades of wonderful progesterone and all its many benefits for brain, bones, and metabolism. The fact that progesterone has to end with menopause should just make us more grateful that we had it at all. (And more determined to not switch it off with hormonal birth control.)
⚠️ Tip: 45 is the average age for the onset of the menopause transition or perimenopause. For some women, it can start up to a decade earlier.
How to survive the great progesterone crash of perimenopause
More rest and self-care. You are in a vulnerable time but it will not last forever. You have permission to slow down and look after yourself at least until you get to the other side of menopause. Being in my late 40s finally convinced me to meditate regularly.
Magnesium is a powerful stress-reliever. It boosts GABA, blocks glutamate, reduces adrenaline, regulates cortisol, and promotes sleep. If you take one supplement during perimenopause, let it be magnesium. (See 8 Ways Magnesium Rescues Hormones.)
Taurine is an amino acid that calms the brain by boosting GABA and blocking glutamate and adrenalin. It’s obtained from animal products but it’s depleted by estrogen, so women have a higher requirement for taurine than men. I prescribe a combination of magnesium and taurine for almost every perimenopausal patient.
Ashwagandha (also called Withania somnifera) is one of my favorite herbal medicines. Like all so-called “adaptogen” herbs, it stabilizes the HPA axis by reducing neuroinflammation at the hippocampus. It also has direct anti-anxiety and sleep-promoting effects (hence the Latin name somnifera or “sleep-inducing”).
Progesterone. Your brain and adrenal system will eventually adapt to a reduced postmenopausal level of progesterone, but in the meantime, if you’re suffering, you can take natural micronised progesterone. A capsule works better than a cream for perimenopausal mood symptoms because the liver converts progesterone to allopregnanolone (ALLO). For more information about natural progesterone, please see my last perimenopause post What Estrogen Does In Your 40s (and How Progesterone Can Help).
What’s your experience with perimenopause and perimenopausal treatments? Please comment.
Yours in health,