The PeriMenopause

Many patients comment that they hope to avoid the terrible hormonal symptoms and changes that they saw their mother endure when she went through the menopause. The menopause is often preceeded by a decade or so of symptoms which include chronic fatigue, weight gain, mood swings, unstable blood sugar, and rapid deterioration of the skin.

 

These problems seem to be a feature of modern life. They did not exist in the last century and still are uncommon in rural, agrarian cultures.

 

The emotional, mental and spiritual aspects of a woman’s existence are integrated with the physical and hormonal to determine how she reacts to the changes her body will experience.

 

The hormones oestrogen and progesterone tend to produce nurturing, passive, "female" behaviour. Testosterone and DHEA tend to produce aggressive, outgoing, impatient "male" behaviour.

 

These opposing influences are normally balanced in the healthy woman but consider a woman who is trying to raise a family, manage a household and hold down employment. The demands of modern life mean that she is likely to be chronically exhausted, always on the go, never taking time for herself.

 

She must push herself beyond the limit of her endurance just to keep up. She rarely has time for quiet nurturing time with her children, let alone her husband. Her adrenal glands are pumping out hormones that are meant to be used sparingly for "fight or flight" situations. Her body thinks that survival is at stake. The adrenals become tired, sluggish and depleted.

 

Blood sugar becomes unstable. Digestion is affected. Nutrients do not absorb. The ovaries also shut down and ovarian progesterone production also fails.

 

OESTROGEN DOMINANCE

 

As a result of the reduction of both ovarian and adrenal progesterone production there is an imbalance created that tends to make the effects of oestrogen dominant. This causes the signs of fatigue, depression, lack of desire for sex, weight gain, water retention, headaches and mood swings. Fibrocystic breasts, endometriosis, fibroids can also develop.

 

Oestrogen dominance interferes with thyroid function and this causes further weight gain, feeling cold all the time and further tiredness. Thyroid tests usually prove to be normal.

 

The patient is chronically attempting to lose weight by dieting but her metabolism has shut down and it proves almost impossible. In between diets she binges on sugar, caffeine and processed foods ! As a result of the adrenal shut down the patient finds it difficult to get out of bed in the morning.

 

XENOESTROGENS

 

These are chemicals that impact on hormone balance. They are mainly petrochemical derivatives with potent "oestrogenic actions". These sources include pesticides, herbicides, auto pollution, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and nonylphenols (alkylphenol polyethoxylates or APEs) found in many detergents.

 

These chemicals can cause enlarged ovaries, possible ovarian tumours, breast cancer and premature "burnout" of ovarian follicles.

 

 

CAUSES OF PERIMENOPAUSE SYNDROME

• Stress

• Poor diet

• Anovulatory cycles

• Adrenal exhaustion

• Exposure to xenoestrogens

 

SYMPTOMS OF THE PREMENOPAUSE

• Fatigue

• Depression

• Weight gain

• Water retention

• Headaches

• Loss of sex drive

• Mood swings

• Inability to handle stress

• Irritability

• Fibrocystic breasts

• Period problems and fibroids

• Endometriosis

• Low metabolism

• Thyroid symptoms but normal T3,T4

• Unstable blood sugar

• Cravings

• Sluggishness in the mornings

 

OESTROGEN IN THE PREMENOPAUSE

 

Oestrogen levels in premenopausal women can be unstable and tend to become excessive. There is often an overall increase in oestrogen in addition to the effects of oestrogen dominance.

 

One reason for this is that falling progesterone levels will stimulate the pituitary gland to stimulate FSH secretion in an effort to restore normality. The FSH causes stimulation of the ovarian production of oestrogen but not progesterone because of follicle depletion.

 

 

THE ROLE OF THE ADRENAL GLANDS

 

Constant drainage of epinephrine from the adrenal medulla by stressful stimuli leads to adrenal exhaustion. Problems in hormone production due to progesterone deficiency lead to an increase in the activity of the DHEA pathways and a relative excess of androgens.

 

Vitamin C is critical for normal adrenal function.

 

 

MANAGEMENT OF THE PREMENOPAUSE

 

The aim of management in this condition is based on making a correct diagnosis, making sure that no associated complications or malignancy has developed and then formulating a treatment program.

 

A personalised program of hormone balance is devised in consultation with each patient. This is involves attention to the following:

Education

Dietary assessment

Vitamins and supplements

Lifestyle advice

Hormone supplementation - this could involve transdermal progesterone, phytoestrogens, dietary supplements or traditional medications. The emphasis is on formulating an individual program for each patient with a preference for minimal treatment options and natural hormone sources.

Integration with a conservative program of prevention and management of pelvic problems using interferential therapy and pelvic floor exercises.

A personalised program of cancer surveillance and prevention focusing on steps to take to monitor and prevent cervical, breast, uterine and ovarian cancer.