Hot flashes, sleep problems, mood swings, and crazy heavy periods. Is this menopause already? And you’re only 42? No, menopause may still be a decade away. This is perimenopause, which is the two to ten years of hormonal change before periods stop.
Perimenopause can be a tricky time and causes more symptoms than menopause itself. Conventional medicine has surprisingly little to offer. Your doctor will say you’re too young for hormone replacement, so she will likely prescribe the pill or an antidepressant, or tell you just to ride it out.
“There has to be a better way!” you say. And fortunately, there is. It all starts with understanding what estrogen is really up to.
Estrogen goes on a roller coaster ride
Contrary to current medical belief, your estrogen is probably not on a slow, gradual decline in your forties. In fact, it would be a lot nicer if it was (see “Low-estrogen type of perimenopause” below). Instead, it’s fluctuating wildly. It’s soaring to levels that are almost twice what you had you were younger—only to crash down again to almost nothing. (And then to do it all over again the very next month.) I call this the estrogen roller coaster of perimenopause, and it’s very unpleasant.
High estrogen causes breast pain, heavy periods, fluid retention, and irritable mood. Crashes to low estrogen cause depression, hot flashes, and night sweats. (Hot flashes are not caused by low estrogen per se, but rather by a rapid rate of decline from high to low.)
Low estrogen type of perimenopause
The estrogen roller coaster is the most common type of perimenopause, but another type is a slow and steady decline in estrogen. With low-estrogen perimenopause, there are no heavy periods or intense PMS. Instead, periods become lighter and lighter and fade away. Low-estrogen perimenopause can cause mild sleep disturbance, but generally, it’s a much easier road. For treatment ideas, read How to increase estrogen.
Progesterone becomes seriously deficient
Your estrogen is crashing up and down, so some progesterone would be nice. Why? Because progesterone counterbalances estrogen. For example, progesterone calms your nervous system, while estrogen stimulates it. Progesterone boosts your thyroid, while estrogen suppresses it. Progesterone thins your uterine lining, while estrogen thickens it. And finally, progesterone prevents breast cancer, while estrogen promotes it.
And just when you need progesterone more than ever, it is quietly exiting the scene. As I say in my book Period Repair Manual, progesterone is like a beloved friend who never stays long. Progesterone was hard enough to make in your twenties and thirties. As you move into your forties, you will ovulate less frequently, and therefore make less and less progesterone. See Road map to progesterone.
Natural treatment of perimenopause
Two key strategies:
- Prevent estrogen from spiking too high by supporting its healthy detoxification. That means reducing alcohol and maintaining healthy intestinal bacteria. You can also consider supplementing iodine (see my iodine post), and calcium-d-glucarate, which promotes estrogen clearance. For more information and treatment ideas, read How to lower estrogen.
- Consider taking natural progesterone, which is almost the perfect treatment for perimenopause because it relieves symptoms of both estrogen excess and estrogen deficiency. It also stabilizes the HPA (adrenal) axis and supports thyroid function, which further benefits mood and wellness. Natural progesterone is available as a capsule (Prometrium) or a topical cream, and it’s safe as long as you stay around a dose of 20 mg in a cream, or 50-100 mg in a capsule. Natural progesterone does not promote breast cancer, and according to new research, it may even be effective for treating breast cancer.
Natural progesterone is also called body-identical progesterone or micronized progesterone, which is the term your doctor prefers. Don’t use the word “natural” when speaking with your doctor.
Natural progesterone is completely different from the progestins of birth control and conventional HRT. Read The crucial difference between progesterone and progestins.
Finally, progesterone lightens periods. For treatment for the heavy, flooding periods of perimenopause, please see my heavy period post.
The good news
If you work now to reduce estrogen spikes, then your estrogen receptors can more easily adapt to the permanent decline in estrogen that’s coming in your fifties. In other words, if you treat perimenopause now, you’ll have an easier menopause transition later.
See my upcoming book Hormone Repair Manual.