How do you know you are in Perimenopause or Menopause?

Every system in the body is controlled by hormones. As we get older, hormone levels change…and so do we. Manipulating levels of certain hormones can provide a significant change to the quality of life.

Perimenopause

Many doctors shy away from trying to balance hormones during the perimenopause phase because of your irregularity of this transition. It’s no secret that this phase has its ups and downs.

However, by implementing an HRT regime, you are getting a jump of approximately 10 years of prevention by developing debilitating diseases caused by eventual ovarian failure.

The possible diseases you can help prevent by starting BHRT, include but not limited to cardiovascular disease, osteoporosis, endometriosis, and cancers caused by estrogen dominance, such as breast and ovarian cancers. 

Perimenopause, the transitional phase leading to menopause, typically begins in a woman's 40s but can start earlier or later. During this time, hormone levels fluctuate, leading to various symptoms, including:

Irregular periods: Menstrual cycles may become shorter or longer, and periods may become lighter or heavier.

Hot flashes: Sudden feelings of warmth, often accompanied by sweating and flushing of the face and neck.

Night sweats: Hot flashes that occur during sleep, leading to night sweats and disrupted sleep patterns.

Mood swings: Fluctuations in hormone levels can lead to mood changes, including irritability, anxiety, and depression.

Vaginal dryness: Decreased estrogen levels can cause vaginal tissues to become thinner and drier, leading to discomfort during intercourse.

Sleep disturbances: Changes in hormone levels and night sweats can disrupt sleep patterns, leading to insomnia or restless sleep.

Changes in libido: Fluctuating hormone levels can affect sexual desire and arousal.

Fatigue: Hormonal changes, sleep disturbances, and other symptoms can contribute to feelings of fatigue and low energy.

Memory problems: Some women may experience difficulties with memory and concentration during perimenopause.

Changes in weight distribution: Hormonal changes can affect metabolism and lead to changes in weight distribution, often resulting in increased abdominal fat.

The benefit of bioidentical creams is that you can easily titrate up or down based on your feeling of resilience.

In addition, bioidentical creams attach to your receptor sites and start acting within minutes.

Menopause

Menopause for women or andropause for men has more consequences for patients than the inconvenience of putting up with symptoms; it has literally put their health at risk for serious diseases and higher death rates, predominantly from Estrogen Dominance. This is particularly the case in two areas where information is deficient: how natural hormones can prevent many of the diseases of aging, and how the incorrect use of hormones can cause unnecessary deaths due to cancer, heart disease, and strokes. 

Perhaps the most commonly known application of hormone therapy is the treatment of women going through menopause. The term “menopause” means the absence of periods, whether the absence occurs naturally or is surgically induced (e.g., due to a hysterectomy).

As women approach the time of menopause, that is, during perimenopause, there is a drop in levels of the hormones produced by the ovaries. This causes a number of symptoms, the most common of which is the onset of irregular periods, which may start occurring sporadically and be of shorter than usual duration. This reflects a drop in estrogen levels. At the same time, a drop in progesterone levels may cause women to experience an increase in PMS (premenstrual syndrome) or cramps, a drop in libido, an increase in weight, and more difficulty in thinking.

Eventually, estrogen and progesterone levels will fall to a level where they can no longer prepare the uterus for bleeding— menopause has begun. Typically clocked after one year after your period.

Some women go through this phase of their lives with few or no symptoms. Other women develop hot flashes, night sweats, and other symptoms and become very uncomfortable.

But no matter how you look at it, menopause is a very natural condition that all women eventually go through. The problem is that the medical system has taken this natural condition and turned it into a disease that has to be treated. The major approach to treatment is to prescribe estradiol, the strongest estrogen. This is done with pills, patches, creams, or pellets inserted under the skin.

Women should be aware that estradiol is the cause of six different cancers. This is why progesterone is often given at the same time to protect them. However, if a woman has had a hysterectomy many doctors feel that progesterone is not needed. I guess they are not aware that the woman still has breasts and are at risk of breast cancer.

Another problem is that doctors prescribing estradiol very often prescribe an oral form of progesterone such as Prometrium. The oral form goes straight to the liver and converts into a different hormone that will not protect them from estrogen-induced cancer. This is a situation found with pellet doctors. Women should also be aware that if they are put on a high dose of estradiol, there is a strong possibility that stopping this hormone may cause severe hot flashes. A safer form of estrogen is estriol, the weakest estrogen. It is the only estrogen that does not cause cancer, and the only estrogen effective for vaginal dryness.

When it comes to treatment, it is always better to treat symptoms rather than lab tests. This is because hormone levels vary inconsistently on a daily, weekly, and monthly basis. I never recommend saliva tests. As women go from the perimenopause to the menopause, there is a significant drop in all four ovarian hormones: estradiol, progesterone, testosterone, and DHEA.  Again, testing is not necessary except in the case of testosterone because it is a controlled drug.

In the actual menopause, both FSH and LH levels increase. It is felt that LH (luteinizing hormone) is the actual cause of hot flashes. However, excess adrenaline can also be the cause especially if the hot flashes occur around 2:30 am when adrenaline peaks, or during the day when feeling stressed. The hormone that blocks adrenaline is a 5% progesterone cream.

Our colleague Carol Peterson, Rph, CNP, described in her recent substack article suggests urine testing is the most accurate and every drop needs to be collected over 24 hours. 

"However, no test can predict the actual clinical outcome. For instance, what progesterone level in the serum, urine or saliva do you need to achieve to ensure that the uterus is “protected?  Only a vaginal ultrasound or a biopsy can verify that – not a lab test. Women are being told that they won’t feel well unless their serum level reaches a certain number. But this number only verifies that absorption has taken place and the longer the time lapse from the dose and the blood drawer means the number will be smaller. So what does that mean? 99% of monitoring hormone therapies is clinical. It is important to learn which hormone is responsible for what and adjust accordingly."  Her full article on testing read here. 

We must ask ourselves...do you really need to test our hormones?  

The most important hormone to replace in the perimenopause, or menopause, is a natural 5% progesterone cream. It is never necessary to check progesterone levels except if a woman is trying to conceive. I would suggest a combination of estriol cream and progesterone cream to deal with hot flashes. The next step is to add DHEA - 10-25 mg per day. When in the menopause, another important hormone to replace is testosterone in the form of a cream obtained with a prescription at a compounding pharmacy.

A woman needs two hormones in order to have a libido: testosterone and progesterone. Both of these hormones are beneficial for bone growth, and testosterone is good for the heart. Women with the highest DHEA levels have the greatest longevity.

The bottom line:

It is more important to address symptoms with regard to the perimenopause rather than blood tests. Progesterone cream in a 5% strength is the most important hormone to replace. Estriol, DHEA, and testosterone can be added as needed.