There is no exact definition for perimenopause. It means something like the time around menopause. We usually refer to it as the time before the onset of menopause. If you didn't have a period for 12 consecutive months, you are in menopause.
In the years leading up to that point, women may experience changes in their monthly cycles, hot flashes, or other symptoms. This period is also called the perimenopausal transition or perimenopause.
It is unusual for a woman to enter menopause from one moment to the other. Many women will develop changes, such as irregular menstrual cycles or heavy bleeding. Even “menopausal” symptoms are common, such as hot flashes, vaginal dryness, mood disorders, bad sleep, etc.
So, what is happening?
You know you are born with a certain amount of egg cells in the ovaries, and you will not produce any more eggs in your lifetime. The eggs in the ovaries are located in ovarian follicles. Think of follicles as little bags with an egg in them.
Now you will need some knowledge about the menstrual cycle.
The cycle begins on the first day of a woman's period, when she is menstruating. Every month a cluster of about 10–15 follicles (bags) starts to grow and mature, and only one egg cell is set free from the ovary at the time of ovulation around the middle of the cycle. Note that it is the bag (follicle) growing to about 23 mm, not the egg! Ovulation means that the bag ruptures. No, not a plop. It's more like a volcano outbreak. The surface will rupture, a jellylike liquid will escape from the bag, and the egg will be set free to enter the fallopian tube. This process sometimes produces some discomfort or pain.
The wall of the bag produces hormones. In the first half of the cycle, this predominantly will be oestrogen. After releasing the egg (ovulation), the bag collapses and will now secrete abundant progesterone and oestrogen (we call these remains of the bag a corpus luteum).
If not pregnant, the hormones oestrogen and progesterone levels decline, causing the endometrium (the lining of the uterine cavity) to break down and shed during the menstruation bleeding.
The complete cycle typically lasts about 28 days.
Because there is only a limited number of eggs, logically, there is only a limited number of cycles. Eventually, the ovaries will run out of eggs. This is the time when menopause begins.
Before menstruation stops entirely, in perimenopause, there are often cycle disturbances. The following three have varying significance:
· Shorter menstrual cycles: are caused by insufficient growth of the follicle (bag), resulting in a drop in oestrogen. It is a problem in the first half of the cycle.
· Shorter and longer cycles: can be caused by less progesterone production, a problem of the second half of the cycle.
· Very long cycles, like every 3–6 months. When almost all eggs have gone, the disappearance of follicles and incomplete follicle maturation is linked to less production of oestrogen and progesterone.
Perimenopause is a natural phenomenon, so it has to be fine? Short answer: NO
Here are a few facts to consider:
Time of menopause:
Late menopause (having had many cycles or menstruations) will higher the risk of
Breast cancer
Endometrium cancer
Ovarian cancer
Ovarian cysts
Benign Breast Disease
But on the other hand, it will have certain benefits (because your body is producing a certain amount of hormones like oestradiol and progesterone for a longer time):
Longer life span
Lower risk of stroke and Cardiovascular Disease
Less risk for osteoporosis
Perimenopause:
Evidence is emerging that the transition, considered a state of imbalanced hormones, can increase abdominal obesity (midlife belly fat), triglycerides, total cholesterol and LDL cholesterol, fasting glucose, insulin resistance, anaemia and blood pressure. These changes to body fat composition are closely associated with an increased risk of Cardiovascular Diseases.
Women's brain is genetically more prone to suffer during life, and perimenopause is a "critical period" in neuro-ageing when the degenerative processes (like Cognitive Decline, Dementia and Alzheimer's Disease) begin. Perimenopause is pro-inflammatory and disrupts oestrogen and progesterone-regulated neurological protective systems.
What can we do?
Root Causal Therapy:
The decline of initially progesterone and, later, oestrogen is the root cause of perimenopausal problems. It makes sense to balance these hormones to the levels you experienced earlier in life. By substituting progesterone from day 12 to 26 of your cycle, we will usually be able to restore a "natural 28-day cycle". If cycles become very short, we would substitute with a combination of 17-beta-oestradiol and progesterone. Vaginal dryness will commonly go with a local Oestriol treatment.
Preventive Functional Medicine:
We aim to minimize perimenopause's inconveniences and provide you with a better quality of life. We are reducing the risk of breast-, endometrium- and ovarian cancer, as well as the appearance of ovarian cysts and benign breast disease, without reducing the benefits of going into menopause late, like having a longer life span, a lower risk of stroke and Cardiovascular Disease, and less risk for osteoporosis.
Primarily based on the latest insight on the origins of neuro-ageing and degenerative processes such as Cognitive Decline, Dementia and Alzheimer's Disease, it makes sense to start HRT (Hormone Replacement Therapy) before damage to nerve cells has begun.
The oestrogen and progesterone decline promotes different pathophysiological mechanisms involved in brain ageing, memory impairment, and neurodegenerative Disease.
Also, other hormones like Testosterone, Dehydroepiandrosterone (DHEA), Pregnenolone and Cortisol play an essential role in brain function and Disease.
In Preventive Functional Medicine, we do not only look at your hormones. We look at you as a unique human being. And that is why we need time to find exactly what you need...
Dr. Paul Raas
15.01.2023
- Progesterone Recommended for Perimenopause - Vincent Richeux; Medscape - Oct 28, 2022.
- Neuroprotection in Perimenopausal Women - Manuela Cristina Russu and Alexandra Cristina Antonescu;
Feb 21, 2018; DOI: 10.5772/intechopen.74330
- Dehydroepiandrosterone (DHEA) and DHEA Sulfate: Roles in Brain Function and Disease - Tracey A. Quinn, Stephen R. Robinson and David Walker; 2018; http://dx.doi.org/10.5772/intechopen.71141
- Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review - Varna Kodoth, Samantha Scaccia and Brooke Aggarwal; Women’s Health Report, Volume 3.1, 2022