Early Peri-menopause

Peri-menopause is the transitional phase before menopause. It can start as early as 10 years before menopause. Women in as early as their mid-thirties can start to feel the change in their hormonal status. These symptoms can get incrementally worse the closer to menopause they get. Word of warning ladies is to not try to wait it out. 10 years of peri-menopause, then the year waiting to see if your periods have actually stopped to be diagnosed as menopausal and then it generally takes 2 more years before the symptoms resolve post menopausally if you haven't treated them yet. 13 years is too long to wait it out. The quicker you take action, the easier your transition becomes.

In the early stages of peri-menopause, your ovaries reduce the frequency of ovulation. You may menstruate but the frequency, duration, and flow of blood can change. Nothing about your cycle is predictable anymore and midcycle spotting is common. Some women start to experience very heavy bleeds, others very light flow. Some cycles are short and others are very long. If you didn't ovulate this month, your progesterone level in the second half of your cycle would be negligible. Your estrogen levels might not have changed but your ratio between the amount of estrogen you have compared to the amount of progesterone you have is imbalances. This is often referred to as having a relative estrogen dominance. 

Symptoms of estrogen dominance in peri-menopause includes:

• low libido
• swollen breasts
• bloating
• headaches
• nausea
• mood swings
• fatigue
• depression
• anxiety
• weight gain
• brain fog
• insomnia
• reproductive growths eg endometriosis, cyst, polyps, fibroids, cancer.

It is estimated 60% of all women in peri-menopause have fibroids. The good news is that they usually self resolve but for a handful of women, they become so problematic that they require surgical removal.

Anemia with heavy periods is common and iron supplementation or infusion may be advisable. They are many herbal medicines that act as uterine astringents that can reduce blood flow. These herbal medicines include yarrow, ladies mantle, shepherd's purse or squaw vine.

We need to consider estrogen modulating strategies for best results. These include:

• Optimising your weight. Excess fat or adipose tissue can contribute to the circulating pool of estrogens and increase estrogen dominance.
• Avoid xenoestrogens (or environmental estrogens) These endocrine disruptors are found in unfiltered water, commercial foods, in plastics, personal care products, and beauty products. You need to swap to organic chemical-free alternatives.
• Increase your consumption of sulforaphane containing foods such as broccoli, kale, brussel sprouts, bok choy, collard greens, cauliflower, and cabbage. 

Have you heard of the estrobolome? This collection of microbes are capable of metabolising estrogens. This means a healthy microbiome will remove excess estrogens but an unhealthy one will increase the amount of beta-glucuronidase which activates and increases the number of available estrogens circulating in your body. Therefore optimal digestive function with a good microbiome profile is needed. Consider whether probiotic therapy or calcium d glucarate supplements may be useful for you to get your estrobolome back on track.

Other additional estrogen modulating supplements include:

• Diindolylmethane (or DIM for short)
• Liver detoxification herbs like St Mary's and Dandelion
• Antioxidants like alpha lipoic acid
• Anti-inflammatory agents like Omega 3
• B vitamins 

This information is not provided to replace medical advice, please speak to your health care provider or book an appointment with one of our Naturopaths to help set your up for a successful menopausal transition.