Navigating the Hormonal Shifts of Menopause

Women are cyclical beings on a monthly basis, so we are no stranger to hormonal changes. However, the arrival of menopause is a game changer. In this post, we will:

• Help define perimenopause, menopause, and postmenopause
• Decipher what is actually happening in the body on a hormonal level
• Discuss why hormone replacement therapy (HRT) is important for women, and most importantly what we can do to help through this huge hormonal shift

Perimenopause

Perimenopause can be defined as the time about 5 years prior to menopause when you are experiencing highly variable symptoms of hormonal changes that will eventually be defined as menopause. Unfortunately, the length of time that we experience perimenopausal symptoms can vary significantly on a person to person basis, sometimes lasting 8+ years and sometimes starting as early as our 30’s and 40’s. 

On a hormonal level, your brain and ovaries are miscommunicating due to the transition to anovulation (lack of releasing an egg from the ovary, or ovulating, monthly). Without ovulation, progesterone, testosterone, and estrogen are not being produced by the ovaries and as a result we experience irregular menstrual periods and the symptom rollercoaster that comes with it. Symptoms of perimenopause may include:

• Bloating or weight gain
• Headaches or migraines
• Fatigue
• Irregular menses (longer or shorter cycles)
• Change in menstrual quality (heavier bleeding or lighter bleeding)
• Hot flashes and night sweats
• Decreased libido
• Anxiety or depression symptoms
• Insomnia
• Brain fog
• Genitourinary symptoms (frequent urinary tract infections or vaginal infections)

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If any of these resonate, I recommend a review of your lab studies in conjunction with your symptoms to help define perimenopause and management of it. Management will vary considerably person to person; however, estrogen and progesterone therapy can be beneficial with symptom management as you navigate to menopause. 

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Menopause

Menopause is diagnosed when a woman has not had their period in 12 months in a normally cycling female (arguably, one day of your life). You are considered postmenopausal once you have had cessation of menses for one year. Menopause can be difficult to define for women who have had gynecologic procedures such as uterine ablation or hysterectomy. In these cases it can be diagnosed in conjunction with interpretation of labs and your symptoms. Menopause may allow for some relief in perimenopausal symptoms mentioned above; however, this is not the case for all patients. With menopause, you may experience lingering symptoms that can last for 7-10+ years.

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A note on testosterone and progesterone

Both males and females have testosterone! Women who have decreased levels of testosterone (due to menopausal changes) may experience symptoms of decreased libido, or sex drive, decreased bone density, and decreased muscle mass with increased fat mass. Testosterone is also important in production of red blood cells, lowering triglyceride and cholesterol levels, improving urogenital health, impacting overall wellbeing and mood, and helping with metabolism. Discussion with your provider can help you to further decide if testosterone replacement is for you.

Progesterone decreases steadily during perimenopause as estrogen wildly changes (like a rollercoaster). This steady decline can contribute to symptoms of brain fog, mood swings, anxiety/depression, weight changes, lack of motivation, and sleep difficulties. Mentioned above, progesterone is always mandatory when taking estrogen therapy but is not mutually exclusive and can be taken alone. Progesterone levels are generally drawn on a lab based on your menstrual cycle, but do not always have to be done to guide therapy. Discuss best options with your provider. 

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The Bottom Line

The changes occurring in your body during perimenopause and the subsequent lead to significant health conditions and symptoms that affect health optimization. With the help of HRT, we can optimize your health and prevent or help manage symptoms that affect your well being. It is important not only to have an open communication with your provider about your symptoms, but to be gentle with yourself as you journey through. During this time, avoid extremes in dieting, overexercising, and stress. Prioritize things like sleep, stress management, balancing your blood sugar, and eating nourishing foods.

Colleen McElroy, NP