The conventional view of what happens at perimenopause is that estrogen levels plummet. This is a gross oversimplification and too often leads to treatment that can make mildly uncomfortable symptoms worse. In natural menopause, the first hormonal change that occurs is a gradual decline in levels of progesterone, while estrogen levels remain within the normal range or even increase. Because progesterone and estrogen are meant to counterbalance each other throughout the menstrual cycle, with one falling while the other rises and vice versa, an overall decline in progesterone allows estrogen levels to go unopposed—that is, without the usual counterbalance. The result is a relative excess of estrogen, a condition that is often called estrogen dominance—which is precisely the opposite of the conventional view.
Symptoms of Decreased Progesterone And Estrogen Dominance
- Decreased sex drive
- Irregular or otherwise abnormal periods (most often, excessive vaginal bleeding)
- Bloating (water retention)
- Breast swelling and tenderness
- Mood swings (most often irritability and depression)
- Weight gain (particularly around the abdomen and hips)
- Cold hands and feet
- Headaches, especially premenstrually
If a woman begins to experience uncomfortable symptoms at this stage, it’s because her body can sense—and attempts to adjust to—that relative estrogen excess. Estrogen excess is also exacerbated by high insulin and stress hormones. Unfortunately, however, there’s a great deal of overlap in the symptoms of various hormone imbalances, and it’s not uncommon for a woman experiencing symptoms of estrogen or stress hormone excess to be given a prescription for more estrogen or even antidepressants. Not surprisingly, her mild symptoms can worsen as a result.
As the transition goes on, progesterone continues to decline, and eventually estrogen levels may begin to swing widely. The estrogen highs occur because the ovaries have begun to allow entire groups of follicles to grow and mature during successive menstrual cycles, instead of only one at a time, as though attempting to hurriedly “spend” those remaining eggs. (This is the reason why the incidence of twin pregnancies increases with age.) The progesterone decline occurs because fewer and fewer of those maturing eggs actually complete the entire ovulation process.
The ovaries are the organs that we focus on most commonly at menopause, but the physical foundation of a woman’s menopausal experience actually rests on the health of all her endocrine (hormone-producing) organs. Thyroid problems are very common during the perimenopausal and postmenopausal years. While many women with these problems are completely asymptomatic, others may have a wide variety of symptoms. Among the most common symptoms are mood disturbances (most often seen in the form of depression and irritability), low energy level, weight gain, mental confusion, and sleep disturbances. (See chart above for similarities.)
Thyroid problems are intimately intertwined with menopause. According to the late John R. Lee, M.D., a noted clinician and author, there appears to be a cause-and-effect relationship between hypothyroidism, in which there are inadequate levels of thyroid hormone, and estrogen dominance. When estrogen is not properly counterbalanced with progesterone, it can block the action of the thyroid hormone, so even when the thyroid is producing normal levels of the hormone, the hormone is rendered ineffective and the symptoms of hypothyroidism appear. In this case, laboratory tests may show normal thyroid hormone levels in a woman’s system, because the thyroid gland itself is not malfunctioning.
It is no surprise, then, that this problem is compounded when a woman is prescribed supplemental estrogen, leading to an even greater imbalance. In that circumstance, a prescription for supplemental thyroid hormone will fail to correct the underlying problem: estrogen dominance.
To better understand this balancing act, and to learn the many options for addressing estrogen dominance, including hormone testing and more, check out Chapter 5 “Hormone Therapy: An Individual Choice” in The Wisdom of Menopause paperback or ebook edition.
© Christiane Northrup, Inc. All rights reserved. Excerpted with permission from The Wisdom of Menopause eBook, by Christiane Northrup, M.D. Reproduction in whole or in part without permission is prohibited.