So your cycle has gone haywire or your period has completely disappeared, you’re over forty years old and you have night sweats. This is me, day 43 and counting.
This is pretty unusual for me and I can tell via this app that there's a lack of regularity with not only my cycle but my physical symptoms and my feeling of wellbeing. I actually thought that my cycle was pretty regular (give or take a few days) and that my feelings were primarily stress related.
But to be honest - chances are I’m peri-menopausal.
Peri-menopause is a transitional, dynamic stage in the lead up to menopause. Menopause is the point at which you have not had a period for 12months the other word for not menstruating is “amenorrhoea.”
So how do I know I'm peri-menopausal?
Diagnosis is not simply by a blood test or the absence of a period or night sweats or in fact being over forty or even feeling a bit irritable.
A diagnosis is primarily involves questions around the bigger picture. So context is important.
There could be other reasons why these symptoms are showing up, for example
- Pregnancy (amenorrhoea)
- Pituitary dysfunction
- Uterine cancer
- PCOS Polycystic Ovarian Syndrome (amenorrhoea)
- Hyperthyroidism (hot flushes, anxiety)
- Hypothyroidism (fatigue, weight gain, constipation)
- Intense (over) exercise
Any number of these or a combination of them could contribute to an irregular or absent cycle so they should also be investigated.
What’s happening with my hormones?
When the ovaries have stopped ovulating because of a depletion in eggs, there’s a bunch of stuff going on hormonally. It would be remiss of me not to mention a few. Here’s a quick summary of the main ones but I don’t want to lose you with too much detail.
Let’s start with the “female” hormones (as opposed to the neurological ones affecting mood).
OK you’ve probably heard of oestrogen.
Oestrogens are a group of hormones primarily responsible for the development of female sex organs and secondary sex characteristics. There are three main oestrogen fractions: oestrone (E1), oestradiol (E2) and oestriol (E3).
Oestrone (E1) is the major oestrogen after the menopause. It is derived from chemicals released from the adrenal gland and is also made in adipose tissue (fat).
Oestradiol (E2) is produced in women mainly in the ovary and normal levels provide for proper ovulation, conception, and pregnancy. Between ages 35-50 there is a 35% reduction of oestrogen so not only is there a reduction in ovulation, the protection afforded by E2 with regards to healthy bone structure and cholesterol levels in females can be compromised (more on this later). There is also a higher ratio of oestrogen to progesterone during peri- and post-menopause.
Progesterone is secreted by the corpus luteum (the rupture follicle that released the egg). Progesterone’s main role is to help prepare a woman for pregnancy and low levels can lead to amenorrhoea and fertility issues.
There is a 75% drop in progesterone from age 35-50 which can result in an increase in PMS symptoms such as breast pain, fluid retention, anxiety, irritability and depression. Some of the key symptoms experienced in peri-menopause.
Follicle stimulating hormone (FSH) is produced by the pituitary gland which stimulates the follicles surrounding eggs in ovaries causing them to produce oestrogen (mainly oestradiol). FSH is the diagnostic marker for ovarian failure. Levels usually surge during the menstrual cycle, however, in peri-menopause, FSH levels are higher than luteinising hormone (LH) levels and the FSH rise precedes the LH rise.
Lutenising hormone (LH) during mid-cycle triggers ovulation and also stimulates the ovaries to produce oestradiol and progesterone. At the time of menopause, the ovaries stop functioning and LH levels rise.
Inhibin B has been used as a marker of ovarian reserve and decrease during peri-menopause. Every female is born with a specific number of follicles containing oocytes, a number that steadily and naturally declines with age. The number of follicles remaining in the ovary at any time is called the ovarian reserve. The amount of inhibin B measured in serum during the early follicular phase of the menstrual cycle (day 3) directly reflects the number of follicles in the ovary.
Putting all that aside, if blood pathology is not enough of an indicator for diagnosing peri-menopause - what is? (assuming you have ruled out any of the other possibility as listed earlier)
1. Your age (are you over forty?)
2. Track your cycle (I use ClueApp but there’s others)
3. Fill in this form using a scorecard for the severity of problem based on your own experience - or use the list below to calculate your score. A score of 15 or over usually indicates oestrogen deficiency.
None =0; Mild =1; Moderate =2; Severe =3.
· Hot flushes
· Light headed feelings
· Unloved feelings
· Anxiety Mood changes
· Unusual tiredness
· Backache Joint pains
· Muscle pains
· New facial hair
· Dry skin
· Crawling feelings under the skin
· Less sexual feelings
· Dry vagina
· Uncomfortable intercourse
· Urinary frequency
In summary, if you’re over forty, here’s an opportunity to really connect with your body and understand what might be an underlying factor to your current state of wellbeing.
But please don’t limit yourself to saying you’re just being “hormonal” when it comes to your feelings. Make sure you look at the context - what else is going on?
Don’t let peri-menopause become the overarching reason for why you feel the way you do.
There’s always a combination of contributing factors – unless of course you are blissfully happy in your relationships with others, your kids are total angels, you’re sleeping 8 hours every night, exercising everyday, eating great nutritious wholefoods and you have little or no stress. If this is you, then I want to BE you!
No doubt you’ll be saying to yourself if you tick a few of these boxes, OK I’m peri-menopausal so what can I do about it? How can I not only suffer less, but actually feel better?
You guessed it, I’ll be jumping in to this in the coming weeks. But right now, start tracking your symptoms and your cycle.
See your healthcare practitioner, or see me. Because we’re on this journey together.
Sources and Resources
Butler L, Santoro N. The reproductive endocrinology of the menopausal transition. Steroids. 2011 Jun. 76(7):627-35. [Medline].
Santoro N, Randolph JF Jr. Reproductive hormones and the menopause transition. Obstet Gynecol Clin North Am. 2011 Sep. 38(3):455-66. [Medline].