The Transition from Perimenopause to Menopause

Both perimenopause and menopause are a time where your body goes through major hormonal changes. Your period doesn’t just start and stop one day, it goes through a transition before it’s officially gone. Typically, your ovaries produce estrogen and progesterone during your fertile years. Menopause, which is defined as the absence of menstrual cycles for 12 months, happens after perimenopause. The average length of perimenopause is 4 years, but it can last for up to ten years. The most commonly reported peri-menopausal symptoms are hot flashes, insomnia, mood changes and irregular cycles. Women may notice that their cycle length will vary about 7 days from their usual cycle length during perimenopause. You may notice your cycles will be closer together at first and then they will start to spread out and become less frequent.


Scroll to the bottom under “the sciencey stuff” if you’re interested in what happens to your hormones during menopause :)

Most people are familiar with menopausal symptoms like hot flashes and night sweats, however, there are other symptoms that can happen around this time.

What might you notice during menopause?

  • Night sweats

  • Hot flashes

  • Poor sleep

  • Vaginal dryness

  • Low mood

  • Irritability

  • Anxiety

  • Changes in concentration and focus

  • Low libido

  • Bladder incontinence or changes in frequency


Over the years I have helped many people through this transition. There are many myths that I commonly hear regarding menopause and I’d love to break them down for you!


Myth busting




1. Plant estrogens are the same as estrogen

I often hear how people are trying to avoid things like soy because they believe it will negatively impact their body. Soy contains isoflavones which are phytoestrogens and phytoestrogens have a similar function to human estrogen, however, it is much weaker in action. Phytoestrogens can help symptoms like hot flashes, but note that it will take time for it to work. So how much soy is effective in reducing hot flashes? Only 25 grams of soy protein per day is needed to help support hot flashes.

2. Hormone therapy is dangerous and should be avoided at all costs

Menopausal hormone therapy (MHT) is a low risk treatment for those who are under the age of 60 and within 10 years of their final menstrual period. MHT is the gold standard to help with symptoms and quality of life in menopause. Topical estrogen is used more often than oral estrogen as it’s the safest form of estrogen therapy for MHT.

There are two main hormones that are prescribed in both perimenopause and menopause, one being estrogen and the other being progestogens (micronized progesterone or progestin). Progestogens are always prescribed if someone is taking estrogen (and has a uterus) because progestogens counteract the effects that estrogen has on the uterus. Progestins are better at opposing estrogen at the uterus and can be used to reduce bleeding, whereas progesterone can also be used to help promote sleep. Transdermal estrogen is preferred over oral medications due to it being safer and it can be helpful for hot flashes and bone health.

Risks vs. benefits are based on the individual taking the medication, how old they are, the reasons for the prescriptions, the dose and duration of the medication.





3. Menopause causes weight gain.

There are many reasons why someone may notice a change in body weight and composition around menopause. Contrary to what many people may believe, menopause isn’t the sole cause of weight gain, but people might notice a shift in how weight is distributed. Many people will notice more weight in their waist, versus their hips and thighs, since the changes in hormones can change where your body distributes weight.


Treatment

I always make sure to treat perimenopause and menopause symptoms with a holistic lens. After chatting about different evidence based botanicals, I like to incorporate lifestyle medicine along with nutrition and hormonal support based on persons goals.

Perimenopause / menopause is also a great time to consider your overall health and check in on other markers, such as cardiovascular health. Cardiovascular disease is the leading cause of death and illness in women, which is why checking in on things such as blood pressure, cholesterol and blood sugars is so important for prevention. Ultimately, everyone’s needs and health is different and I’m always happy to discuss treatment details over an appointment (booking link below)!



The sciencey stuff…

First, it’s important to understand how does a menstrual cycle work?

Your menstrual cycle has three phases. The follicular, ovulatory and luteal phase. The first day of your period marks Day 1 of your cycle and the follicular phase is Days 1 to 14. Your period will start when there is a drop in your estrogen and progesterone, which triggers the uterine lining to shed. The drop in your estrogen and progesterone will send a message to your brain to release more FSH (follicle stimulating hormone) to stimulate the growth of ovarian follicles and to increase estrogen. The rise in estrogen promotes a surge in LH, which leads to an egg being released. The rise in estrogen and the LH surge happens around Days 12 to 14 of your cycle. About 5 to 7 days after an egg is released is where you will see a peak in progesterone levels!

When someone starts to go through perimenopause it’s not as easy for the ovaries to produce hormones from an average amount of FSH (follicle stimulating hormone), so their body will start to produce more FSH. In perimenopause a person will have less viable follicles, which can prevent ovulation from happening. This in turn causes irregular periods. Periods can start to be closer together or they can start to be further apart. When someone stops ovulating there isn’t an increase in their progesterone.

 

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References

Akhlaghi, M., Ghasemi Nasab, M., Riasatian, M., & Sadeghi, F. (2020). Soy isoflavones prevent bone resorption and loss, a systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition, 60(14), 2327–2341. https://doi.org/10.1080 /10408398.2019.1635078

Allshouse, A., Pavlovic, J., & Santoro, N. (2018a). Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms. Obstetrics and Gynecology Clinics of North America, 45(4), 613–628. https://doi.org/10.1016/j.ogc.2018.07.004

Chedraui, P., & Pérez-López, F. R. (2019). Metabolic syndrome during female midlife: What are the risks? Climacteric: The Journal of the International Menopause Society, 22(2), 127–132. https://doi.org /10.1080/13697137.2018.1561666

Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang SF, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019 Mar 7;4(5):e124865. doi: 10.1172/jci.insight.124865. PMID: 30843880; PMCID: PMC6483504.

Hanachi, P., & S, G. (2008). Assessment of Soy Phytoestrogens and Exercise on Lipid Profiles and Menopause Symptoms in Menopausal Women. Journal Biological Science, 8. https://doi.org/10.3923 /jbs.2008.789.793

NAMS 2023. North american menopause society. Retrieved from: https://www.menopause.org/

NAMS 2023. Changes in Weight and Fat Distribution. Retrieved from: https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-weight-and-fat-distribution

Taku, K., Melby, M. K., Kronenberg, F., Kurzer, M. S., & Messina, M. (2012). Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: Systematic review and metaanalysis of randomized controlled trials. Menopause (New York, N.Y.), 19(7), 776–790. https://doi.org /10.1097/gme.0b013e3182410159

Krista Lowehormones, menopause