Transcript
So when explaining to women what the actual hormone journey looks like, going from the premenopausal years into perimenopause and then into menopause, I find this one picture actually so helpful.
If you’re not a graph person I apologize but bear with me and let’s go through it because once you’ve got a really good visual of the kind of spectrum of experience, it becomes so much easier for you to identify where in the journey you are today.
Right, so if we look at the picture in front of us, on the left hand side in the white block represents our hormones in the premenopausal years.
So look, lots of premenopausal women have hormonal issues like polycystic ovarian syndrome or endometriosis.
It doesn’t mean that if you’re premenopausal you’re gonna have perfectly balanced hormones, but whatever your hormones are at that time of life, the pattern of them is distinctly different from the pattern that begins to emerge in perimenopause.
So if we look at the perimenopausal block on the graph, which is the blue area, you can see two massive changes compared to the premenopausal years.
The first is that estrogen levels are really fluctuant.
They’re going quite wildly high and low and they’re on a bit of a roller coaster ride and this is very typical of perimenopause and sometimes the really confusing mixture of symptoms that goes with it.
We often feel like we are on highs and lows.
You can also see on the picture that what happens to progesterone is our progesterone levels start to drop when we hit our perimenopausal years and this is because as we get older as women, as we age, we are ovulating less and less.
We make less ripe eggs and most of the progesterone that we make as women comes from the ovaries, comes from after ovulation.
So if we think about the second half of our menstrual cycles, which is the time after ovulation, this is when we get that progesterone surge.
So in our perimenopausal years, as we ovulate less and less, we make less progesterone.
What this often means is that women who are navigating through perimenopause can find themselves in a position where they have a type of hormone patterning that we call estrogen dominance.
It doesn’t necessarily mean that your estrogen levels are going to test high on blood tests.
They might, but they might not.
It just means that the delicate estrogen progesterone balance that women need to feel in good health, in good harmonious hormonal health, is no longer there.
And we may have a whole bunch of symptoms connected to the shift in our hormone patterns.
Just the loss of progesterone has a profound impact on the female brain because progesterone is a really calming hormone for us.
It helps us release a neurochemical called GABA and this keeps us calm and focused.
So without it, we sometimes get quite scattered in our thinking or we may feel more restless or we may not sleep as well.
So that explains some of the typical mood and sleep symptoms that can accompany the perimenopause.
The wild changes in estrogen and the fluctuations can also explain why on some days you might experience things like breast tenderness and swelling and when your estrogen levels are high and then a week or two later when your estrogen levels drop, you may experience hot flushes or night sweats and it can be quite confusing to go to navigate through all these different symptoms as they change.
The perimenopausal years can last for a variable amount of time.
For some women, they begin up to 15 years before they even hit their menopausal years and this may mean for some women that already in their late 30s, they’re going through the early stages of perimenopause.
Most typically though, it really affects women in their 40s and it doesn’t necessarily last for 15 years or 10 years.
Some women have a perimenopausal period for far less than that.
So there’s a huge difference between different kinds of women and how they experience perimenopause and for how long.
We also know that perimenopause is broken up into two distinct stages.
There’s an early stage and there’s a late stage.
If you look at the picture, you can see that in the first part of the blue block, estrogen levels are much higher and that’s usually what we see in the early perimenopausal stage.
And then as a woman enters her later years of perimenopause, those estrogen levels start to drop.
So you can see in the picture that even though the estrogen line is still very fluctuant, it’s slowly and steadily going down.
And it’s in those later years of perimenopause that our estrogen pool, if you will, pool is a good term because it’s like the total pool that we have to draw from is less, but there’s still fluctuation happening in that pool of estrogen.
And then finally comes the time where our ovaries no longer work and they stop producing our estrogen and progesterone all together.
If at this stage you are still having periods and your periods stop and your periods have in fact stopped for a full year, we could then confirm that you would be in menopause.
But we don’t wait for a whole year to pass before we start treating women.
So please if your periods are becoming irregular, if you skip two or three months, or if you have symptoms like hot flushes, night sweats, mood changes, don’t wait a year to seek help.
Go for treatment sooner rather than later.
What’s a really good test to use to help to diagnose women who are in menopause is a test called an FSH level.
And you can see this on the picture in front of you.
So FSH is made in the brain and it tells us doctors how much estrogen a woman has.
And the relationship between FSH and your estrogen is inverted, meaning the lower your FSH, the more estrogen you have in your body.
And the higher your FSH, the lower amount of estrogen you have in your body.
So you can see that if we look at FSH on the graph, it’s usually low in younger premenopausal women because they’ve got an abundance of hormones.
And then as we go through the early perimenopausal years, it can still be normal as estrogen levels are still quite high, fluctuant, but high.
And then towards the later part of perimenopause, as estrogen levels start to drop, as that pool of estrogen gets smaller and smaller and smaller, we will start to see FSH levels rise.
By the time a woman is fully menopausal and she’s no longer making estrogen or progesterone, we will see high levels of FSH on blood tests, usually levels above 20.
And this, in combination with some of your symptoms, is enough for a clinician to diagnose you with menopause.
