Perimenopause is characterized by a declining production of the ovarian hormones estrogen and progesterone.
Estrogen levels tend to rise and fall dramatically throughout a woman’s remaining cycles, while progesterone levels tend to stay low.
The result of these changes are symptoms like hot flashes, night sweats, brain fog, fatigue, and depression when estrogen levels suddenly tank, and increased stress and anxiety when estrogen levels abruptly spike.
During this time, cycles may become irregular. Some of my patients comment that their periods are incredibly light one month and the heaviest of their lives another.
Some get periods every few months and some notice increased frequency, even spotting between cycles, or have a full-blown period every two weeks in more extreme cases.
Weight gain tends to drift from the thighs and buttocks to the abdomen. Once pear and hourglass-shaped figures begin to resemble apples.
Fatigue is a common symptom. Women may experience poor sleep due to night sweats from estrogen deficiency, and anxiety from insufficient progesterone.
What a joy, right?
Many of these perimenopausal symptoms are a relatively modern phenomenon, stemming from a dysregulated HPA axis.
After cessation of periods, it’s the job of the adrenal glands to take over sex hormone production. However, if the HPA system is preoccupied with organizing a stress response, this can affect the production of other hormones.
If you’re in perimenopause (or think you may be in perimenopause), there’s a good chance you have more than one hormonal imbalance at play.
It’s a good idea to step back and look at hormonal imbalances overall, as there are several that may especially impact you over the next few years…
1. Cortisol Imbalance
Some combination of fatigue, a low sex drive, restless sleep, depression, anxiety, poor sleep, and brain fog might indicate cortisol imbalance.
When stress hormones levels are too high we experience a “tired and wired” feeling. During this time we might feel we thrive better under stress: workouts boost our energy, we have a hard time quieting down and we rarely feel hungry.
We might still struggle with weight gain, however, especially the abdomen and face, where cortisol tends to encourage fat deposition. We might feel tension—tight muscles and shoulders, and body pain, as muscles clench up, preparing to fight or flee.
Chronic stress is associated with high levels of cortisol. We work long hours, late into the night. We go, go, go. This may give us a “high” or it may feel exhausting and depleting.
2. Estrogen and Progesterone Imbalance
PMS (premenstrual syndrome), PMDD (premenstrual dysphoric disorder), infertility, fatigue and low libido, missed and irregular periods may be related to imbalances in the hormones estrogen and progesterone.
When estrogen and progesterone levels surge and drop suddenly, drastic fluctuations in mood can occur.
Cravings for sweets, crying, lack of motivation, or severe anxiety can all occur when hormones drop right before a period is due.
However, elevated levels of estrogen can also be problematic. Estrogen stimulates other hormones that make us feel good, give us energy, and help to motivate us. In genetically vulnerable women, elevated levels of these other hormones can cause excess irritability, low stress tolerance, and even mania or psychosis.
Estrogen also slows the recycling of the stress hormones epinephrine and norepinephrine, which can lead to symptoms of acute stress and anxiety, when dysregulated.
This means that dramatic rises and falls in estrogen throughout a woman’s cycle can cause her to feel irritable and anxious one week and unmotivated and depressed the other.
3. Estrogen Dominance
Some combination of stubborn weight gain, typically around the hips and thighs, heavy and painful periods, tender and painful breasts, fibrocystic breasts, endometriosis, uterine fibroids, acne, cyclical mood swings, especially premenstrual anxiety and panic attacks, and irregular menstrual cycles can indicate estrogen dominance, in which estrogen is either high or normal while progesterone is low.
Estrogen is normally cleared through the digestive system: the liver and intestines.
A sluggish and congested liver causing a slower rate of hormonal clearance (think of it like a clogged drain), an increase in environmental toxin exposure, or an overconsumption of alcohol, can slow the liver’s ability to regulate estrogen levels in the body. Constipation and a gut with unhealthy bacteria can also impair estrogen clearance.
You May Be Thinking…
Geez, this is a lot.
At least that’s what I thought when I started working with my team of Naturopathic Doctors to put it together.
What we ended up doing is creating a (free) series of lessons with some simple steps you can follow to balance your hormones naturally and treat perimenopause and menopause naturally.
You can get those lessons along with a handy checklist by entering your email below (I will never, ever sell or share your email address).
4. Testosterone Imbalance
High levels of testosterone can cause missed or irregular periods, weight gain, acne, and hair loss.
Taken together, these may also indicate a health condition called PCOS.
PCOS is a collection of many symptoms can be quite complex. You may also see male-pattern facial hair growth, especially on the upper lip, chin, breasts and abdomen, and the presence of cysts on the ovaries.
It’s often associated with hair loss, infertility, and cystic acne on the jawline. So there’s a lot to look out for!
5. Thyroid Imbalance
Some combination of fatigue, brain fog, difficulty losing weight, puffiness, constipation, dry skin and hair, irregular periods, and low body temperature can be signs of a hypothyroidism, which basically means low thyroid hormones.
To assess thyroid function, conventional doctors will test a hormone called Thyroid Stimulating Hormone, or TSH.
TSH is not a thyroid hormone, but a hormone made in the brain that urges the thyroid to pump out the thyroid hormones (called T3 and T4). It gives doctors an indirect measure of thyroid regulation.
When TSH levels are high, this suggests that thyroid function is sluggish; the brain needs to send a louder signal to get an unresponsive thyroid to work. And the reverse is also true.
The most common cause of low thyroid function is actually an autoimmune condition but there are many possible causes of low thyroid function and that’s why it can sometimes be tricky to figure out.
Unfortunately, many people are not taken seriously by their doctor because lab tests seem fine or are medicated but still feel unwell. This situation is sometimes known as subclinical hypothyroidism. And if you’re not feeling well, something definitely needs to change!
The Challenge Is…
Many women have imbalances with more than one hormone.
That’s why, as you can probably tell, it’s a lot to make sense of all at once.
I’ve been working with my team of Naturopathic Doctors to put together a checklist of steps you can take to balance your hormones naturally.
You can get that for free below…
(I will never, ever sell or share your email address.)
P.S. If you would prefer to speak with a naturopathic doctor online, you can check that out here: How It Works