Perimenopause and Menopause are two parts of a transition a woman goes through when their body comes to the end of its reproductive ability.

It usually occurs sometime in a woman’s 40’s or 50s, but can occur earlier.

Perimenopause is the start of this transition, when her menstrual cycle starts to fluctuate as the amount of eggs she has in her ovaries starts coming to an end.

Then, when she has not had a menstrual cycle in 12 months, we say menopause has begun.

This whole transition is a period of somewhat intense hormonal fluctuations, somewhat different for everyone, that ends with very low production of key hormones, and generally lasts around 7 years. Though it can be as long as 14 years.

During this transition a woman can experience extreme hot flashes and sweats as hormone levels fluctuate erratically, poor sleep, poor mood, brain fog or inability to make decisions, weight gain to one degree or another, headaches, bone loss and muscle loss, reduced libido, low energy and much more.

So understanding exactly what is occurring here, what causes it, what can make it worse and what we can do about it is quite important.

Let’s dive in.

We’ll start with the reproductive cycle so you can see what is happening there hormonally, and then get into menopause and perimenopause so you understand what has changed and why.

The Circadian Rhythm, Reproductive Cycle & Hormones

Every woman is born with a fixed number eggs, generally about 1-2 million, though it can be more. But only some of these eggs mature to the point that they could become fertilized.

There is something called the Circadian Rhythm or Circadian Cycle. It’s a natural process in our bodies that regulates our sleep/wake cycle, hormone release, body temperature, metabolism, digestion and even our mood.

We’ll come back to this, but I want you to remember it, as when perimenopause starts, every aspect above of a woman’s circadian rhythm is affected.

Now, when a woman hits puberty, their circadian cycle has their ovary put out an egg every month. This alternates between ovaries, with an egg releasing from each every other month.

With this there is an alignment of her hormonal systems with her ovaries and uterus to both create conditions necessary for a fertilized egg and pregnancy, and also for if there is no fertilization.

As you know, the entire menstrual cycle is roughly 28 days, though it can range between 21 and 35 days for some.

During this a lining is built up inside of the uterus to prepare for the fertilization of an egg and nurturing of it and, if fertilization does not occur, this lining is released over the course of about 1-7 days, which we call the period.

While day one of this cycle normally starts with the period, for our purposes we’ll start at “day 6” and then come back to the period.

At about day 6 a hormone is released that signals the ovary to start to “grow an egg” or get an egg ready.

During this same time estrogen levels start to rise telling the uterus to build up its lining in preparation for the egg. And, with this rise in estrogen some women notice more energy and clearer skin.

When estrogen levels have reached a certain point, generally around day 14, this triggers a surge in another hormone that causes the egg to be released into the fallopian tube that connects the ovaries to the uterus.

Then, during days 15-28 (approximately) progesterone starts being released in quantity, along with some estrogen, to nurture the lining in the uterus in case there is a fertilized egg and pregnancy occurs.

During this time some women might notice breast tenderness, mild bloating or mood changes.

If fertilization occurs, the fertilized egg continues down into the uterus and pregnancy begins along with a whole cycle of its own.

But if fertilization doesn’t occur, the egg breaks down, these hormones start ramping down over days 24-26, hormones levels finally drop and we start our period.

Our period is then day 1-7 (different for different women) when this built up lining is released.

During this time estrogen and progesterone each drop to their lowest levels.

Then, once the period completes, this whole cycle starts again.

But you see how this affects hormones significantly, with their levels changing throughout the cycle.

It should also be mentioned that both testosterone and thyroid play a role in this.

Testosterone rises around the time of ovulation, increasing not only libido, but mood, energy levels and mental sharpness. It also helps with lubrication and arousal, as well as muscle tone and bone strength.

This then comes down to lower levels during the second half of the cycle and as it dips we can see mood fluctuations and lower energy levels.

This is important to mention as testosterone isn’t often spoken about with the menstrual cycle, but is in fact key to it, and affects menopause later on.

Thyroid also plays a role in this, rising and falling during the menstrual cycle.

It regulates not just metabolism, but mood to a large degree, as well as body temperature, and is key to hot flashes and sweats during menopause.

Also, when thyroid levels are too high or too low, this can disrupt the normal 28 day cycle, causing irregular or skipped periods.

Now, thinking with all of this, lets take a look at what happens when perimenopause and then menopause arrive.

Perimenopause & Hormonal Fluctuations

We saw in the above how key hormones rise and fall during the menstrual cycle.

But these hormones affect much more than just procreation. Remember our Circadian Rhythm.

They affect a woman’s body temperature, mood, ability to gain or lose body fat, muscle growth and loss, sleep ability, digestion, bone strength, the immune system, energy levels and much more.

So when things start changing, the effects are quite far reaching.

When the ovaries start running low on eggs, perimenopause, or pre-menopause, starts.

During this time the hormonal signals normally given during the reproductive cycle above start to become erratic.

Now, every cell in our body has receptors for estrogen, progesterone, testosterone, thyroid and every other hormone.

These hormones tell our cells what to do: grow bone, don’t grow bone, grow muscle, don’t grow muscle, build body fat, lose body fat, sleep, wake up, etc.

They affect our brain, our heart and our whole cardiovascular system. They affect our mood and energy levels.

They affect everything.

If the brain is the executive deciding what needs to be done, hormones are the messengers passing on its instructions.

And each hormone has a role and is necessary.

So, during perimenopause, the release of these hormones starts becoming erratic. And the releasing of eggs becomes erratic. Some months they’re released and some they’re not.

So we get these fluctuations in hormone levels, and they can be large fluctuations, because when the cells aren’t hit by these hormones when they’re used to it, those cells start to behave erratically or themselves.

This could cause bloating or depression or aggression or joint pain.

But this isn’t a point of these hormones going down, it’s that they go out of whack.

There may be some months when they’re okay and months when they’re at 50% or so. But it’s not a smooth rise and fall. It might a spike or a drop or be late. The whole system gets discombobulated.

With some women this hits hard and with others not so hard.

This is perimenopause. (And don't worry, there are many things you can do to help with this.)

Then, when a woman hasn’t had a period in 12 months, we call this stage menopause.

Menopause, Lowering Of Hormones & Health Issues

Whereas in perimenopause the hormones fluctuate wildly, in menopause the hormones go very nearly to zero.

The ovaries stop making the hormones.

If you measure someone’s hormone levels at 60, they’re almost non-existent in comparison to before perimenopause.

And this affects everything.

The first thing most notice are the hot flashes and sweats that occur out of nowhere. This can be quite intense heat or sweats during the day or during the night, waking one up.

This is mainly a lack of estrogen.

It affects the whole circulatory system and even the “fight or flight” half of our nervous system.

There will suddenly be too much blood flow to the skin, too much stimulation of the sweat glands.

This comes on in a second and can last anywhere from 5 minutes to 30 minutes.

This is the body adjusting to not having this normal cycle of hormones being released and the hormones being released in a dis-coordinated manner.

After menopause the hot flashes tend to go away as the estrogen drops lower and lower. But then other issues arise.

Largely estrogen, but the other hormones as well, help to protect the heart muscle and nurture and protect the blood vessels. When estrogen goes down, risk of heart trouble rises and the blood vessels are more susceptible to building up plaque.

We also get loss of bone mass and muscle.

Breaking a hip, being in a hospital, getting an operation and not being mobile is a very serious thing. And without estrogen and testosterone we get bones that are hollowed out or don’t heal well, and if there is some kind of traumatic event, they're more likely to break.

Muscle mass lowers. We can feed ourselves all the right nutrition and amino acids and exercise (which does need to be done), but without these hormones present to tell our cells to use these nutrients to build and maintain muscle and bone, they won’t.

Memory trouble can start, “brain fog” and indecision. It can even affect reaction time and balance as these hormones also affect our nervous system.

All of our cells and tissues are hormonally supported. If the hormones aren’t there, the tissues start to atrophy.

So what do we do?

Addressing Hormones In Perimenopause, Menopause and Later Life

From perimenopause, to menopause, to later life we have first a large fluctuating of hormones and then a gradual drop toward near zero.

While diet, exercise, gut health and even toxins will be mentioned, the first thing that must be addressed are these hormones, and they can be addressed and provide significant help in each phase above.

This helps improve muscle and bone mass, sleep ability, mood, energy levels, cardiovascular health and even skin. And it can address the hot flashes and sweats.

There is something called bio-identical hormones. They are hormones that are made that have the same chemical structure as naturally produced hormones.

During perimenopause and menopause, and more after, they can significantly help in about 90% of cases.

These must be given by a doctor, and it must be a practitioner who understands hormones and bio-identical hormones and who practices in whole body health.

The doctor can give one a female hormone panel, and it must cover not only estrogen, but progesterone, testosterone and thyroid as well. If they’re very low, the body needs help.

But one point to think with is that there is not a way to determine the exact amounts needed, and fluctuations will still occur.

So you must keep in tight communication with your doctor on this and tell them what is happening.

For example, if there is breast pain, you may be taking too much, or if there are still hot flashes, it’s not enough.

You take these for 6 weeks, then see what’s happening, and communicate with your doctor who will adjust as needed.

And there may not be a right amount that then works from that point forward, because remember, these things are in flux during perimenopause, and start to lower to near zero during menopause and after. The amounts in your body are changing the entire time.

So you need to stay in tight contact with your doctor and continue adjusting as needed for best results.

Also, sometimes topical estrogen will be needed vaginally, as the tissue there, not receiving the needed estrogen, has begun to atrophy and the membrane becomes thick and dry.

UTIs can more easily occur due to this, or there can be pain during intercourse.

With topical hormones here we then get mucous production again and the unpleasant sensitivity goes away.

In addition to this, there are key lifestyle actions that must be taken.

Carbohydrates should be lowered as the body is not as able to process these during menopause and later on as it was when it was younger, and high levels of carbohydrates can further throw hormones off when we’re trying to get them under control.

Essential fatty acids are very important here as well to our hormones. While we need both omega 6 and omega 3, and each to be in balance with the other, most of our processed foods raise our omega 6 levels to 20 times or more that of our omega 3 levels.

So cutting out processed foods and taking omega 3, as well as ensuring we eat our fatty fishes and 100% grass fed meats, is important to balance these.

Essential amino acids are also key. If we raise hormone levels telling our cells to build and repair muscle and bone tissue, but don’t give them what they need to do so, we’re in the same boat as before.

So essential amino acids become even more key during and after menopause.

Next is exercise. This is also more important than before menopause. It is the stress we put on our muscles and bones that causes them to build in strength. So if we don’t exercise, they don’t have a cause to grow or repair themselves, even with us addressing hormones and providing amino acids.

Vitamins and minerals are also key here, such as zinc, selenium and iodine, along with antioxidants. Also magnesium.

And then there is the gut and prevention of toxins entering the system, which we’ll get to.

But key is addressing hormones.

If we only give an estrogen patch and say that’s fine, that’s not enough.

But when we get accurate monitoring of hormones and use bio-identical hormones under the care of a doctor, along with diet, nutrition and exercise as above, it goes a long way.

We get higher energy levels, better sleep, more strength, stronger bones, better mood, softer skin, more energy and much higher levels of overall health.

I hope this helps.

In the next article we’ll cover what can and is making menopause and perimenopause worse today for many, and what we can do about it.