- Perimenopause (age 35-50)
Perimenopause (age 35-50)
Pre-menopause or perimenopause usually occurs from ages 30 to 50. You are usually in your mid-30s and you heard the word menopause, but you can't see how it applies to you. You're still young. You haven't even had kids, or your kids are still in grade school. But something isn't quite right. Your exercise and your eating habits haven't changed, but you're gaining weight. Your breasts are sore and lumpy and bloating, especially right before your period. And now, your periods are also irregular. Your sex drive, just isn’t what used to be. Your skin is dry and isn't smooth. You used to be even tempered, but now you're irritable just before your period. You can't seem to get out of bed now in the morning. Your friends, your age are dealing with infertility, fibrocystic breast disease, PMS, and fibroids.
Perimenopause means right around menopause. Pre-menopause refers to the age between 30 and 50. Tender breasts, endometriosis, PMS, difficulty conceiving or carrying a pregnancy to term, fatigue, irritability and depression, foggy thinking, memory loss, migraine headaches, weight gain, or cold hands and cold feet characterize this age group. The reason why is that your body is making less progesterone for most cycles but not all cycles. However, your body still makes the same amount of estradiol. Also, you have a large intake of xenoestrogens. Your estradiol in synergy with the xenoestrogens unbalanced by the small amount of progesterone, your body is producing is responsible for these changes. In other words, the intake of xenoestrogens and estradiol is unchanged. However, your production of progesterone for most of the cycles goes to less than 1% of normal.
Often, women call me up in this age group claiming to have taken a hormone test and say that their progesterone level is very low. This is a typical scenario. I usually answer them, "Yes, for your age, your progesterone level is low for most cycles but not all cycles. This is normal for person of your age." Why is this occurring? The answer is that women of this age group is undergoing an anovulatory cycle.
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An anovulatory cycle is a menstrual cycle in which you do have a period, but do not ovulate. Anovulation means "no ovulation".
During a normal cycle for a woman before the age of 35, the follicle comes up on the ovary like a pimple. The follicle produces estradiol. The follicle pops out an egg. The used follicle becomes the corpus luteum. The corpus luteum then begins to produce progesterone. This is a normal cycle for women aged 25.
During an anovulatory cycle after the age of 35, the follicle comes up on the ovary. The follicle produces estradiol. The follicle does not produce an egg. There is no corpus luteum. There is no progesterone. There is a period. For this particular cycle, no conception is possible since there is no ovulation. This occurs for most the cycles after the age of 35, but not all cycles. The entire menstrual cycle produces estradiol, but little or no progesterone. However, some cycles may occur in which the woman does produce progesterone, and also produce an egg. Thus, a level of little or no progesterone after the age of 35 is normal. Or it may be possible that you do have a cycle with ovulation, after the age of 35. You measure the progesterone, and it is normal. Thus, I do not find that a progesterone hormone test is helpful. After the age of 35, because the progesterone hormone level may be normal or close to zero depending on whether the woman has ovulated or not.
Most cycles after the age of 35 are dominated by the synergistic action of estradiol and xenoestrogens. For most cycles, there is little or no progesterone. It is this unopposed synergistic action of estradiol and xenoestrogens that cause estrogen dominance and all the associated problems with this.
The usual mainstream approach is to give drugs or surgery. The prescribing physician will usually give a synthetic brand-name prescription estrogen. The women will usually get worse. She may feel better for two weeks, then her depression may get worse, and her weight gain may get worse. The woman, of course, notices this,and calls her doctor. The doctor calls the pharmacy to give a stronger prescription of estrogen. The woman dutifully takes the stronger prescription and now becomes constantly weepy. In addition to that she finds and she is immediately gained 6 pounds. And now she take some time off from work because her headaches have become much worse. After six months of these symptoms, her doctor gives her a Pap smear and finds cervical dysplasia. Her doctor foreshadows a hysterectomy, and promises that all her symptoms will go away and she will be a much happier woman. For her depression, he recommends a serotonin reuptake inhibitor antidepressant. Her quality of life has now gotten much worse.
The solution is usually to avoid estrogen dominance. I usually recommend to my patients to avoid all xenoestrogens. Xenoestrogens are chemicals and herbs that act like estrogen. Xenoestrogens do NOT appear on the hormone test. Anything on the skin is 10 times the dose of what is taken orally, because whatever is on the skin is absorbed directly into the body and bypasses the liver. So, I usually recommend only that the patient use certain products. Usually, the patient that come to me are very health conscious and believe that they are taking safe products. The products that they are taking are usually from the health food store and are expensive, natural, and organic. However, these expensive health food store products usually have herbs in them that are estrogenic. The herbs in the product that there are taking mimic estrogen and make my patients worse. I tell them that their products are making them worse and explain that the herbs in them act like estrogen. However, these patients insist that their products are fine because they are natural and organic. I counter that the mushrooms that grow in their yard may be natural, and organic, but you don't eat them. I looked through 500 shampoos and only found three that were safe to use. If you buy any of our products from our website, you will get all of recommended list of safe products to use that do not contain any xenoestrogens. Xenoestrogens are stored in the fat, and it usually takes one to three months for them to wash out of the body. Usually, patients begin to feel better after about 2 to 3 weeks. It is important to realize that xenoestrogens are active in very small amounts. If you are taking 20 xenoestrogens on your skin and eliminate 19 of them, that last one that you did not eliminate could be causing all your grief. Some xenoestrogens are weak. Some xenoestrogens are strong. The weak xenoestrogens may go into the estrogen receptor and block the strong xenoestrogens. So, the weak xenoestrogens can be beneficial. However, taking one strong xenoestrogen completely torpedos all your efforts.
I also recommend patients to take some progesterone topically. Natural progesterone taken topically can balance out weak xenoestrogens. However, natural progesterone taken with one strong xenoestrogen can make you worse. This is because chronic xenoestrogens exposure causes down regulation of the estrogen receptor. You now become less sensitive to estrogen. Progesterone wakes up the estrogen receptors. After progesterone wakes up the estrogen receptor, the estrogen receptor reacts more strongly to the one strong xenoestrogen. You become more sensitive to estrogen. You regain your original true sensitivity to estrogen. Therefore, progesterone used with one strong xenoestrogens can make you more miserable. This is why is important to eliminate all strong xenoestrogens in your environment before taking progesterone, if you are very sick.
In summary, as you reach 30 you are undergoing anovulatory cycles for most cycles but not all, and do not produce progesterone during those cycles. Unopposed estradiol and xenoestrogens give you estrogen dominance. The solution is to eliminate xenoestrogens and take some progesterone.
1. John Lee, MD, Jesse Hanley, MD, “What Your Doctor May Not Tell You About Premenopause Balance Your Hormones and Your Life from Thirty to Fifty”, Warner Book, Inc., New York, New York, 1999 pg 3-5.