Perimenopause: What You Can Do
By Dr. Erik Fleischman –
I’ve already discussed the mechanism and physiology behind perimenopause – the often insidious, imbalanced progressive drop in estrogen, progesterone and testosterone over a period of years leading up to menopause.
So let’s talk about what can bring perimenopause on sooner than expected. There are a number of factors that are genetically pre-determined:
- The age of your mother during her menopause
- The age you started your menstrual period
- Other genetic factors
There are also some very important external factors that can promote hormonal imbalance and early fatigue of the hormone producing organs – this goes for both men and women! As you may have expected the most important cause for early hormonal failure is prolonged stress and sleep deprivation.
And once again there are clear cut biologic hormonal reasons for this. Here is the simple explanation – Even though there are over 55 different hormones in your body and many pathways for the biologic function they serve, there are 2 major pathways for the chemicals that produce sex hormones:
- Sex Hormone Production
- Stress Hormone Production
When the body is under stress, internally you go into protective mode – the body feels that it is under attack, so it produces hormones that would protect you: Cortisol, SHBG (sex hormone binding globulin) and Prolactin are 3 such hormones.
The problem is that when the body is in stress hormone production mode it lowers or even stops the production of sex hormones. Sex hormone production is considered by the body to be a function of the body in a normal, unstressed condition.
Even trickier is the fact that you may not even know that your body is under stress. In your mind you may believe you’ve countered all your stress, but a simple blood test has proven so many women wrong.
Ultimately prolonged stress will cause the ovaries to burn out more quickly and produce less estrogen and progesterone.
I see early menopause frequently in women with underlying depression, chronic insomnia and especially in women who are taking one or more anti-depressant medication.
So what is the solution?
First of all, it is essential to intervene as early as possible so as to preserve as much ovary function as possible.
I think it is a good idea for a woman to get a complete hormone panel blood test done as a baseline in their early 40’s or earlier if the woman is experiencing any of the symptoms I described above.
The important point is to get a COMPLETE panel, and that includes the stress hormones as well. You should also have an AMH (Anti-Mullarian Hormone) level checked to see if the ovaries are still retaining function.
If the stress hormones are elevated, that should be the first order of correction.