The Ups and Downs of
Perimenopause: Tips for a Healthier Transition
By Veena Verma-Dzik, ND, FIAMA
nxious, depressed, angry. Bloated, can’t sleep, can’t remember, no period, then full-blown red storm. Anxious, depressed, angry…again! Why don’t more women talk about this? I’m talking about that midlife experience of perimenopause. We are being thrown into this alternate universe where our emo- tions, menstruation, and hormones are all over the place—and let’s not forget the appearance of male-like hairs. As much as it absolutely stinks, it is normal.
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We hear more about menopause than we do about perimenopause, the time of transition into menopause. There are defi nitely speed bumps during this time of our lives; our female hormones are up and down, causing us to experience issues such as mood swings, sleep disruption, breast tenderness, change in menstruation, incon- tinence, and vaginal dryness. This period of transition most often occurs in our forties, but for some can begin in their thirties, and it can last anywhere from a few months to 10 years. There are actually two stages of perimenopause: during the early part, the
menstrual cycle is more regular and still fairly predictable; during the second and fi nal stage, the time in which we no longer have a period—that is, amenorrhea—be- comes more prolonged, lasting for at least 60 days, until the fi nal menstrual period. Perimenopause is not only a time when estrogen is fl uctuating, but there are other hormones involved as well.
Inhibin
Inhibin is one of the fi rst hormones to change during perimenopase and is re- sponsible for telling the ovaries to produce less FSH. According to STRAW criteria (Stages of Reproductive Aging in Women), inhibin is at its peak during reproductive years. As the perimenopausal years go on, inhibin decreases until it is no longer detectable during postmenopause.
Anti-Mullerian Hormone
Anti-Mullerian hormone (AMH) is com- monly used to assess ovarian reserve when diagnosing infertility, premature ovarian fail- ure, and hypogonadotropic hypogonadism. It is also an indicator in perimenopause/
menopause, when during the transition years AMH continues to decrease until blood levels drop after menopause.
Follicle-Stimulating Hormone
One of the hormones commonly tested when we are experiencing symptoms directed toward our hormones is FSH, or follicle-stimulating hormone. FSH is made by the pituitary gland and stimulates the ovarian follicles to produce estrogen. Dur- ing reproductive years, FSH stays pretty consistent but once we hit the perimeno- pausal years, FSH levels begin to fl uctuate. When it is high, our ovaries are stimulated to produce more estrogen; when it is low, we produce less.
Estradiol
Our estrogen levels are taken on a roller coaster ride throughout our transition into menopause. There are days when there is both hyperestrogenemia and hypoestro- genemia until menopause actually hits and ovarian follicles are no longer responsive. The low levels of estradiol are responsible for the increase in hot fl ashes and night
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