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In the simplest terms, what happens to a woman’s hormones during perimenopause-- Perimenopause often begins with irregularities in a woman’s cycle starting as early as 35. Most women enter perimenopause in their early to mid 40s.  Our body goes through a very delicate hormonal dance not dissimilar to puberty. Normally during ovulation,  the most mature egg leaves its follicle in the ovaries, and if the egg isn't fertilized, the lining of our uterus sheds, and we have our period. This cycle repeats over and over and over, for decades.

During perimenopause ovulation becomes disrupted and erratic resulting in  having cycles that come too quickly—like, two periods in one month—or suddenly skipping two months, and then having your period return with constant spotting. Some women experience chronic fatigue, trouble sleeping, mood swings, or depression. Often we’re dealing with major life changes and asking ourselves questions that can cause both mental and physical fatigue. During the early phase of perimenopause women experience a decrease in progesterone, the hormone that is produced normally after ovulation. Progesterone is the hormone responsible for making you feel calm, relaxed, the "feel good hormone". As a result women experience increased PMS, mood changes, severe insomnia, agitation, heavier periods and very erratic periods, similar to their teenage years. Estrogen, the hormone that makes you feel juicy, energized and sexual becomes more dominant so many women experience a heightened sexual surge during perimenopause.

Eventually, during perimenopause our body lowers the production of estrogen and we experience the next wave of symptoms- hot flashes, night sweats, dry skin, brain fog, depression, joint pain, and eventually vaginal dryness and painful sex. Unfortunately during this hormonal roller coaster women are also experiencing major life changes such as marital discord, sending our children off to college, caring for aging parents, work stressors which also affect our cortisol, adrenal gland and even our thyroid. Sluggish thyroid hormones and adrenal fatigue result in weight gain, lower metabolic rates, crippling fatigue, and the infamous muffin top waist. High cortisol or stress hormone production results in increasing fat storage, insulin resistance and anxiety. Insulin resistance is our body's inability to burn calories and use food as fuel; instead fat cells are increased and mid gut weight gain ensures. The last hormone that declines is testosterone, resulting in low libido, loss of muscle mass and tone, and worsening fatigue. 



During perimenopause hormonal shifts adversely affect skin and hair. Suddenly women in their 40s describe acne especially in the periorbital region from the decline in female hormones. As estrogen levels plummet women will also notice loss of collagen which increased the appearance of dry sagging skin and decreased vaginal lubrication. Another significant finding is hair loss associated with hormonal changes. As estrogen levels are reduced, our testosterone levels become more dominant so we get more unwanted hair, acne, oily skin and hair loss. 

Menopause is defined as no periods for one year. Women who go through menopause before 45 are defined as early menopause. Risk factors for going through early menopause include a family history. If your mother went into menopause early you have a much higher likelihood (about 20% of repeating this pattern. Smoking, certain medications, low body fat, all increase the risk of estrogen deficiency and earlier loss of ovarian hormones. Genetic disorders such as Fragile X or Turner syndrome can result in premature menopause. In addition, autoimmune conditions, especially thyroid imbalances can affect ovarian hormone balance. Unfortunately many cancer therapies, especially for breast cancer, will force women to go into a chemical menopause. 



This is when your body is forced into an abrupt cessation of ovarian function, usually from chemotherapy, surgery (removal of your ovaries ), and is far more severe than when your body goes into a natural menopause with a slow decline of hormones over years. Symptoms are far more severe and intense including debilitating vasomotor symptoms (hot flashes, night sweats), bone loss, vaginal dryness, depression and loss of libido, insomnia and memory changes, 

The habits you have in the decades prior to perimenopause are key in how women navigate through any hormone fluctuations. Accumulated dietary stressors, adrenal stressors and emotional stressors can wreak havoc on your hormone balance. Symptoms are in direct proportion to your degree of micronutrient depletion and lack of self care.High blood sugar levels and stress can adversely affect your hormones. Fiber helps with the absorption of sugar and also with the excretion of excess estrogen through our gut. Omega 3 fatty acids have been established as key essential nutrients to promote hormone balance, brain health and cardiovascular support. Sleep and exercise, especially resistance training with weights help protect bone loss and promote muscle tone.Caffeine and alcohol deplete your micronutrients and should be kept to a minimum. Finally, MEDITATE. 10 minutes a day of breath work and headspace can truly transform your health. 



The biggest thing in terms of preventing and helping yourself with skin changes really is skin protection, wearing sunblock that blocks both UVA and UVB rays, such as products with zinc and titanium oxide. Switch to heavier creams with hyaluronic acid. As soon as you leave the shower apply the cream on your face and body to lock in the moisture. For loss of collagen using lasers, retinoids and clean skin products are all healthy. Stop smoking, vaping and drinking as they all age your skin. 



There is no reason to suffer during this time. In my practice we offer individualized tailored bioidentical hormone treatment to help mitigate all of our patients symptoms. Bioidentical hormones are similar in molecular structure to what our body makes, safe to use under the guidance of an experienced medical doctor, and can truly transform your quality of life. A regimen of natural hormones, supplements, lifestyle changes and herbs can address each of the above symptoms. Not every patient needs hormone therapy but when indicated, can restore our body's hormone harmony.


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