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.

There are several supplements and adaptogenic herbs that can help the body lower the internal stress and shift the production back to healthy female hormones. If the testosterone is low, that can be boosted as well. These supplements should be individualized so as not to take a “shotgun” approach and take 10 supplements when just a few will work.

We rarely jump to hormone replacement in perimenopause.

The natural solution should be attempted first to retain your own healthy hormone production. If this is not successful after 2-3 months (it takes 60-90 days to reach hormone stability) then the subject of hormone replacement (bioidentical or otherwise) should begin.

As with everything, the lowest dose possible to get the best result is the goal of treatment.

Also, we must remember that this kind of treatment is a marathon, not a sprint. Patience by the treating doctor (and the patient) with titration of supplements and addition and subtraction of necessary medicines is essential. This is never an emergency treatment no matter how emotionally urgent this feels to a woman.

The decision making with perimenopause can be a complicated and frustrating matter at times, but with time and with an experienced physician I believe we get good results at least 75% of the time.

Again, the scope of perimenopause treatment is well beyond the scope of a blog so if you have questions please feel free to message me. I’ll do my best to respond to your questions as soon as possible.

Most importantly, don’t despair and don’t give up. There is treatment available.

To schedule an appointment at one of our Bangkok BAAC Clinics or speak to a specialist about the benefits of Safe Hormone Replacement therapy, please contact us.

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