“It’s Just Perimenopause.” Is a Label Dismissing YOU?
By Amy Y. Nelson, ND
“I think it’s perimenopause.” Have you used this excuse lately? Were you forgetful, moody, or just tired? Sometimes it seems that anything a woman does in her mid to late 40s is labeled as perimenopause. Yes, hormones do shift at this time, but understanding how and why this happens gives you better tools to address your health.
Perimenopause is defined as hormonal changes 2-10 years before menopause. Usually implying women in their mid to late 40s, I’ve heard women in their 30s and even 20s get told by their medical providers they are in perimenopause. Applying the term to any hormonal change a woman experiences can be misleading. It’s especially heart breaking if she wants conceive. Ultimately, mislabeling is dismissive to the root cause of what a woman is feeling and avoids the path to healing and understanding.
Menopause is the point when the ovaries stop releasing eggs and a woman stops menstruating, marking the end of fertility. A woman is officially in menopause when she has gone 12 consecutive months without a menses. The average age of menopause is 52 (1). Hot flashes, night sweats, vaginal dryness, mood changes, and sleep issues are present during this time, but these are actually NOT “normal” symptoms of menopause. These symptoms are thyroid, liver, adrenal, and nervous system imbalances. There is only one true “normal” symptom of menopause: the absence of menses.
Menopause is not a disorder, but a normal transition that is smooth and symptom-free when the adrenals, thyroid, liver, and nervous system are balanced and supported. At menopause, your body does NOT completely stop making hormones. Your adrenal glands, which live above the kidneys, also make testosterone, estrogen, and progesterone. When hormonal shifts happen due to anovulation (no ovulation), the adrenal glands become the primary production site for a new hormone baseline.
Perimenopause or Adrenal Fatigue?
Stress depletes hormone production because progesterone is the biochemical template for cortisol - your main stress hormone. Progesterone also converts to estrogen and testosterone, so very established adrenal fatigue dominoes into low adrenal estrogen and testosterone output.
Adrenal fatigue is a consequence of chronic stress and/or inflammation. Cortisol will shut down its own production over time resulting in less adrenal output or a depressed HPA (Hypothalamus-Pituitary-Adrenal) axis. Salivary or urinary cortisol tests evaluating at least 4 samples throughout the day is how adrenal fatigue is assessed. Blood testing for morning cortisol, while better than nothing, is usually not enough to fully assess adrenal fatigue.
Supporting adrenal hormone production is key in alleviating hot flashes, fatigue, mood swings, and sleep issues. This is done with various herbal adaptogens such as ashwagandha, licorice root, and schisandra. A common formula I use is AdrenAll by OrthoMolecular. If fatigue is horrible, I have taken 2 caps with breakfast and 2 caps with lunch. As energy improves, you can cut this dose back to 1-2 with breakfast and 1-2 with lunch. Over time you may not need the lunch dose. Try not to dose the adrenal supplements after 4PM as this is a time your body naturally calms down with cortisol.
Perimenopause or Low Neurotransmitters?
Are you anxious, irritable and sleepless? Hormones have a very direct relationship with neurotransmitters. I tell my clients, hormones and neurotransmitters are best friends. Estrogen and serotonin are pals - estrogen supports tryptophan’s conversion into 5-HTP and serotonin, and also inhibits MAO (monoamine oxidase), the enzyme that metabolizes serotonin, thus pooling serotonin.
Serotonin’s main production site is actually the bowel. (2) If production is low due to gut inflammation, when estrogen drops, you may feel that baseline low serotonin. Ultimately, addressing gut inflammation must be considered to reestablish serotonin balance. Remember serotonin converts into melatonin, so low serotonin levels impact sleep through this mechanism.
Progesterone and GABA (gamma aminobutyric acid, a calming neurotransmitter) are best friends. Progesterone stimulates GABA production in the brain and assists it on to receptors. Studies show a proportional increase in GABA with progesterone. (3) Progesterone enhances the GABA- A receptor, leading to increased interaction with GABA and enhancing feelings of calm, relaxation and improved sleep.
Insomnia, anxiety and irritability stem from not having enough GABA. Where can you get more? Take a big deep breath. The lower part of the lungs are innervated by the vagus nerve, your main calming nerve. Meditation, mindfulness therapy, and proper sleep habits also support GABA health.
When mood and sleep issues are present during perimenopause, adding endocrine adaptogens can help. I really like using EstroVera by Metagenics or RhuBestryn by OrthoMolecular. Both are high quality extracts of rhapontic rhubarb, which contains stilbenoids which function like an estrogen receptor modulator. This can help alleviate menopausal symptoms without negatively impacting estrogen in the body. In fact, in studies show rhubarb inhibits proliferation of ER+/PR+ breast cancer cells. (4)
For potentiating progesterone, my go-to is Vitex (Chasteberry). NuMedica has a great Vitex called NuFemina. Vitex helps the pituitary gland regulate luteinizing hormone and prolactin. Doing this helps increase progesterone. (5) Oftentimes we start with vitex dosing during the luteal phase of the cycle (the last 2 weeks).
In studies, Vitex has been seen to influence dopamine receptors in the brain. Dopamine needs to be in a delicate balance for the brain. To little can mean depression, fatigue, poor focus, too much can result in anxiety, irritability, and sleep issues. Vitex compounds called diterpenes interface with dopamine D2 receptors. This dopaminergic activity is a key factor in vitex's potential benefits for mood regulation. (6)
Night Sweat - Think Liver Function
Night sweats are directly connected to functional liver health. Many times we attribute a hot flash as an adrenal-hormonal problem, as this is happening during the day. The timeframe of the night sweat implicates the liver. Your liver does most of its detoxifying while you sleep, specifically between 1-3 AM. (7)
Supporting liver detox capabilities with milk thistle, N-acetyl cysteine, Diindolylmethane, and even liposomal glutathione address the night sweat from the cause; an overworked, imbalanced liver. Ceasing alcohol, smoking, sugar, processed foods, and caffeine is appreciated by your liver. My favorite way to help night sweats is by using EstroDIM by Ortho. By taking 2 caps 1-2 x per day, you typically see a reduction of hot flashes within 30 days.
Dryness - Think Thyroid
Dryness is a common hypothyroid symptom that can can happen in the skin but also vagina, eyes, sinuses and even lack of healthy secretions in the bowel. With any vaginal dryness at any age, consider low thyroid function. Sometimes low thyroid is not the classic fatigue and lack of motivation. I have seen people simply have constipation or just hair loss. Remember, we are not linear, multiple things can contribute to any one symptom.
The mechanism of dryness with hypothyroidism is linked to lack of iodine. Iodine is the rate-limiting-step for the production of thyroid hormones. This is a chemistry term that means if you don’t have enough iodine in the thyroid, the thyroid hormones T3 and T4 are stalled. Think of it this way - if you are baking a cake and run out of flour, you can’t make any more cakes. Flour is the rate-limiting step to your baking. What’s my go-to thyroid multivitamin formula? Thyrotain by OrthoMolecular.
Let’s not be dismissive.
When we factor out age, we do see the organ-system source to hormonal problems. We need to watch for labels like “perimenopause” and even “menopause” in medicine to make sure we are not dismissive. Always look for the root cause. In women’s health especially, our symptoms mean something and various changes to our hormones are not merely disorders. This latency fails to fully give reason or proper explanation to true imbalances or pathologies for women’s hormonal health.
Let’s be careful with our labels. Don’t let medical descriptors of any kind dismiss your true imbalances and know that more can be done to help your system. You are not broken.
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