Perimenopausem: A Time of Transition

Perimenopause is that time in a woman's life which usually occurs between age 35 and menopause which begins around 48-52. Many changes occur in a woman’s body during perimenopause.

Because the menstrual cycle affects all aspects of a woman’s physical, mental and emotional functions; the perimenopausal period can create instability in a woman’s body.

During perimenopause, the menstrual cycle is erratic because ovulation, (egg release) is erratic. Ovulation is the timekeeper and helps to regulate the menstrual cycle. Women are more likely to have cycles in which they do not ovulate (anovulation). This disrupts the menstrual cycle and subsequently disrupts women physically and emotionally. The symptoms of abnormal menstrual cycles can be very frustrating to a perimenopausal woman. Between the ages of 18-35 the menstrual cycle is usually very predictable and manageable. This is because a woman is in her peak reproductive years and ovulation usually takes place without interruption.

As a woman ages the cells that are to mature into eggs have aged also. The body does not produce new eggs after birth. These aged eggs have more difficulty maturing to a developmental stage where they can ovulate properly. This causes a wide range of effects. Pregnancy is more difficult, birth defects are more frequent, menstrual cycles are irregular, fibroids appear and grow, risk of breast cancer increases, bone loss begins, weight increases and it becomes increasingly difficult to cope with the normal demands of life.

Perimenopause is often misdiagnosed and improperly treated. This causes women to suffer unnecessarily. Incorrect treatment can actually make the symptoms worse leading to surgery that could have been avoided or increase a woman’s risk to serious illnesses.

However, perimenopausal women can make lifestyle changes to decrease their risk of breast cancer and osteoporosis, minimize the effects of menopause and decrease the risk of heart disease. So pay close attention as you read, perimenopause doesn‘t have to be an unpredictable time of life.

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Estrogen and Progesterone: Knowledge is Understanding

A woman’s life can be explained by the fluctuations of two hormones, estrogen and progesterone. When these hormones are in their normal balance a woman’s life is wonderful. When they are out of balance problems follow. In order to understand the consequences of estrogen and progesterone imbalance, we must first discuss the normal functions of estrogen and progesterone.

Estrogen is a hormone. Hormones carry messages to different organs. These messages are different for each organ. The message to the uterus is to grow. The uterine lining is instructed to grow and replace the lining that was shed during the previous menses.

Estrogen’s message to the breast is grow. Breast cells increase in number of cells and rate of multiplication under the influence of estrogen.

Bone resorption is decreased by estrogen. Bone is constantly being broken down and replaced. Estrogen is needed to maintain a proper rate of bone breakdown.

The vagina and female bladder‘s proper function are maintained under the influence of estrogen. Estrogen keeps the vagina moist and prevents the bladder from leaking urine.

In adolescence estrogen is responsible for developing female sex characteristics. Estrogen causes breast to grow and the development of female sexual organs.

Estrogen decreases the function of thyroid hormone. Estrogen increases the production of a protein called thyroid binding globulin. This protein binds thyroid hormone making it inactive. Thereby, decreasing metabolism and increasing fat deposits. The body stores fat in order to have enough energy for a fetus if a pregnancy develops.

Estrogen also effects the brain. Estrogen’s effect on the brain is very tenuous. At normal levels estrogen prevents depression , increases concentration, maintains normal sex drive and prevents insomnia. If estrogen is to high or low, depression, anxiety, insomnia, decreased sex drive and decreased concentration is the result.

Progesterone is a hormone. It also carries messages to other organs. The messages are directed to the same organs as estrogen but the messages are different.

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Progesterone

Progesterone is produced by the ovary after ovulation and it instructs the uterine lining to stop growing and start developing and maturing to prepare for a possible pregnancy. Progesterone is produced for fourteen days after ovulation. If there is no pregnancy, progesterone decreases and signals the beginning of menses.

Progesterone decreases the target organs response to estrogen by decreasing the number of receptors the organ has for the hormone estrogen. Receptors are molecules on the cells that recognize specific hormones and allows them to carry their message to the cell.

Progesterone also decreases breast cell growth. Progesterone is involved in the maturation of breast cells and decreases the rate of multiplication. Progesterone also promotes normal cell death in the breast which is important in the prevention of cancer.

While estrogen decreases the rate of bone breakdown, progesterone stimulates bone osteoblasts. Osteoblasts are responsible for making new bone to replace old bone.

By decreasing thyroid binding globulin, progesterone increases the activity of thyroid hormone. Thyroid hormone increases metabolism, and utilizes the fat stored under estrogen influence for energy.

Progesterone stimulates normal sex drive because it can be converted to testosterone which is involved in male and female sex drive.

Progesterone blocks aldosterone receptors. Aldosterone promotes water retention and swelling. Progesterone blocks aldosterone causing normal fluid loss and decreasing swelling.

Progesterone decreases uterine muscle contractions which cause menstrual cramps by promoting uterine muscle relaxation.

In the brain progesterone binds GABA receptors. These receptors decrease anxiety and depression . Anti-depressants and barbituates bind these same receptors. Progesterone is a natural antidepressant and prevents anxiety.

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Perimenopause: A Time of Estrogen Excess and Progesterone Deficiency

The balance of estrogen and progesterone is crucial to normal female body function. The amount of each hormone individually is not as important as their ratio to each other. A disturbance in the ratio of estrogen to progesterone results in many of the symptoms of perimenopause

After ovulation the ratio of estrogen to progesterone should be 20:1 Progesterone should be 20 times as high as estrogen. An imbalance may involve either to much estrogen or to little progesterone.

The symptoms of excess estrogen and decreased progesterone are exactly the same.

• Breast tenderness
• Depression, fatigue, poor concentration
• PMS
• Fibrocystic breast
• Decreased sex drive
• Fibroid growth
• Endometriosis
• Thinning hair
• Water retention and bloating
• Fat gain in hips and thighs
• Breast and uterine cancer

Estrogen levels are increased by annovulation, external estrogen found in animal fat, pesticides, and pollutants. Obesity leads to elevated estrogen levels because body fat produces estrogen. A low fiber, high fat, high sugar and carbohydrate diet increase estrogen levels.

Progesterone is decreased by the lack of ovulation which occurs more frequently during perimenopause and permanently after menopause.

Recently several articles in conventional medical publications have shown that progesterone deficiency and estrogen excess define perimenopause. Urine measurements and salivary measurements show low progesterone levels accompanied by high estrogen levels. There is little doubt that this is the origin of this phenomenon .

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The Misdiagnosis  and Mistreatment of Perimenopause>

Estrogen and progesterone affects many systems in the body. The symptoms of progesterone/estrogen imbalance are often misdiagnosed if a physician focuses on only a few symptoms in isolation.

The irregular bleeding of perimenopause is often treated with birth control pills. The synthetic progesterone (progestins) controls the bleeding but usually the other symptoms become worse because the synthetic progesterone binds to progesterone receptors and blocks the progesterone your body makes. Some doctors prescribe estrogen which almost always makes the symptoms worse. This can lead to a D&C or hysterectomy.

The increased breast tissue growth of perimenopause can lead to multiple biopsies and constant fear of breast cancer in women. This fear is not totally unfounded because women are more likely to die from breast cancer when it develops during perimenopause. Suggestions of lifestyle changes, which include exercising, dietary changes and the use of soy and natural progesterone supplementation are many times not offered even though these changes may prevent breast cancer.

Many doctors prescribe estrogen during this period to women at high risk for osteoporosis. Bone loss begins at age 35 when estrogen levels are normal or elevated. This usually causes symptoms of estrogen over load. Progesterone is responsible for new bone formation and estrogen helps prevent bone loss. The bone loss seen in perimenopausal women is due to a decline in new bone formation because of decreased levels of progesterone.

Progesterone/estrogen imbalance has a profound affect on the GABA receptors in the brain. Women are often misdiagnosed with depression, anxiety and other mood disorders. Millions of women have been placed on Prozac and other antidepressants unnecessarily. Many women have become addicted to valium and other anti-anxiety medications while masking hormonal imbalances, specifically excess estrogen and decreased progesterone.

Women are often diagnosed with low thyroid function if their main complaint is decreased energy, fatigue and sudden weight gain. These are all symptoms of low thyroid. However, in many cases, thyroid levels are usually found to be normal. These women are placed on thyroid medication. Estrogen blocks the action of thyroid hormone. Progesterone allows thyroid hormone to work more effectively. While the symptoms are similar to low thyroid levels the problem is excess estrogen.

Women who complain of bloating and weight gain prior to menses are often given diuretics to decrease water retention caused by low progesterone levels. The effect of a hormone aldosterone is to cause water retention. Progesterone decreases its effects when produced after ovulation. Without appropriate amounts of progesterone aldosterone causes water retention.

As you can see treating symptoms without an understanding of the cause can lead to more problems than solutions.

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Testing For Hormones

Estrogen and progesterone are hormones that are fat soluble. Because fat or oil soluble hormones are not dissolvable in water they are attached to a protein when in the blood stream so they can be transported to the appropriate organ. More than 99% of the hormone is attached to this protein and is inactive or has no effect on the body. The free or active portion of the hormone is not found in the blood but in fat tissue, the uterus, the brain and saliva. Measuring blood levels do not reflect the amount of free hormone effecting your body.

Saliva is able to absorb fat soluble hormones. Saliva reflects how much estrogen, progesterone, testosterone, DHEA and other fat soluble hormones are actually available to carry messages to other organs. Saliva testing is not new, it has been used for years by the World Health Organization because it is much easier to collect than blood. It is beginning to be accepted by conventional medicine and a limited number of insurance companies pay for the test.

Women experiencing perimenopausal symptoms will almost always have salivary hormone levels that reflect a progesterone deficiency, estrogen excess or both.

Also, studies looking for metabolites or breakdown products of estrogen and progesterone in urine have shown high levels of progesterone in perimenopausal women.

The amount of information that can be gained from test s enormous. The other advantage is you can monitor the level of natural hormones used to treat deficiencies.

In other words, doctors can customize the amount of hormone replacement that is correct for each patient. This allows the doctor to only treat women that are actually deficient and avoid potential overdosing.

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Growth Hormone Stimulators

Growth hormone is the hormone that is involved in body cell rejuvenation. There is a lot of interest in this hormone because studies show that its production is decreased beginning at age 30. It is thought that replenishing this hormone may slow down or reverse some physical changes that have been considered inevitable with aging.

While replacing growth hormone is very expensive and painful. (it has to be given by injection each day @ more than $100.00 per injection. There are specific amino acids powders that can be dissolved in water and taken one to two times per day. These amino acids stimulate the pituitary gland in your body to secrete growth hormone at a level equal to the before 30 year old level. This is safer because your body controls the amount of growth hormone it makes

The benefits of growth hormone are:

• 8.8% Increase in muscle mass in 6 months
• 14.4% loss in fat on avg. after 6 months without dieting.
• Increased energy
• Enhanced sexual performance
• Regrowth of heart, liver, spleen, kidneys, and other organs that shrink with age.
• Greater cardiac output
• Superior immune function
• Increased exercise performance
• Lower blood pressure
• Improved cholesterol profile
• Stronger bones
• Younger, tighter, thicker skin
• Hair Regrowth
• Wrinkle removal
• Elimination of cellulite
• Sharper vision
• Mood elevation
• Increased memory retention
• Improved sleep

These benefits are very exciting. For years we thought that the changes associated with aging were inevitable. Growth hormone seems to benefit the cosmetic changes of aging such as wrinkles and fat gain. What is more important is that it plays a role in cardiovascular, liver, kidney and bone function, rejuvenating these organs and enhancing their performance.

As you can see it may potentially benefit perimenopausal women by enhancing bone mass, increasing energy, elevating mood, increasing memory, improving sleep, increasing muscle mass and decreasing fat, and decreasing cellulite.

For more information on growth hormone, Visit our book club on our website to order Grow Young with HGH by Dr. Klatz. He is an authority on humans growth hormone.

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