Estrogen and progesterone are hormones that play a significant role in women’s health. These two hormones are most commonly understood as they relate to menstrual cycles, but they affect so many other areas of wellbeing, especially as women age.
Both estrogen and progesterone are primarily produced by the ovaries. From adolescence until perimenopause, estrogen and progesterone levels rise and fall related to a woman’s menstrual cycle.
Progesterone and Estrogen Changes During Perimenopause and Menopause
As a woman ages and enters perimenopause, both estrogen and progesterone levels change. In the early stages of perimenopause, progesterone production declines, resulting in estrogen dominance. During this time, many women feel they are in a constant state of pre-menstrual syndrome, experiencing:
- Mood swings
- Tender breasts
Estrogen production declines in the second phase of perimenopause. This drop in estrogen levels often results in symptoms such as:
- Hot flashes
- Night sweats
- Memory problems
- Heart palpitations
- Sleep disturbances
- Vaginal dryness
Eventually, both estrogen and progesterone decline to very low levels and most symptoms are relieved, although some women continue to experience discomfort through menopause.
As estrogen and progesterone production decline, symptoms can range from easily manageable to negatively life-altering. Additional changes that result from the varying levels of estrogen and progesterone include:
- Reduction in skin thickness and elasticity
- Increased risk of heart attack due to increased rigidity of the blood vessels in the heart
- Reduced calcium absorption leading to decreased bone density
- Increased bladder infections
Although these lists of symptoms may sound daunting, having a sound relationship with your physician can make all the difference!
Healthy Aging IS Possible
Confusion and stress often accompany the wide variety of symptoms related to estrogen and progesterone imbalance. The inevitability of aging combined with limited information and treatment options add to a sense of frustration and helplessness. However, healthy aging is possible and women should not only survive this time of transition, but can actually thrive.
General recommendations regarding a healthy diet and adequate exercise are more important than ever as estrogen and progesterone production declines. Fresh, leafy greens, colorful fruits and vegetables, healthy fats and lean protein support the body as it adjusts to new hormone levels. Additionally, regular weight-bearing exercise builds muscle to support aging bones, while cardiovascular workouts strengthen the heart and lungs and improve circulation.
Hormone replacement therapy (HRT) and bioidentical hormone therapy are common treatments for the side effects of estrogen and progesterone decline. HRT is not without risks, however. A thorough health history review is necessary before beginning treatment and continual monitoring is required during treatment.
Vitamin and mineral supplements, topical estrogen, focused nutritional therapy and prescription medications have all been shown to support healthy aging and offer relief of symptoms related to estrogen and progesterone imbalances. The correct combination for each woman is best determined over time in collaboration with her doctor.
The concept of hormonal pathways, including thyroid and adrenals, has to be understood to seamlessly get through this transition phase. While the scope of menopause is much more extensive than this article allows for discussion, Dr.Raman teaches, counsels, and treats once each women has understood why she is experiencing the symptoms she is.
Dr. Raman is focused on holistic care and good health maintenance. Patients at her Concierge Medical Practice may benefit from bioidentical hormone therapy and a medically supervised weight management program to help ease the symptoms associated with progesterone and estrogen changes.
For women, the transition through perimenopause to menopause is a time of major hormonal fluctuation. The phases are often confused with each other, but true menopause is when a woman has not menstruated for a full year. Perimenopause is the phase leading to menopause and lasts an average of four years, although it can range from a few months to 10 years. A woman’s body typically begins to start the perimenopause process at age 35.
Perimenopause usually begins between the age of 35 and 50 when the ovaries begin to produce less estrogen. The imbalance of estrogen and progesterone often results in missed periods as well as side effects like hot flashes (the most common side effect of perimenopause), fatigue or low energy, difficulty sleeping, decreased libido and what some women call “PMS plus” —instances when pre-menstrual side effects worsen.
Like many transitions, perimenopause can be physically and emotionally challenging. There is no quick fix for troublesome side effects but many women find relief in lifestyle changes that improve overall health, including:
- Adding moderate exercise to your daily schedule
- Improving nutrition
- Avoiding smoking and alcohol
- Reducing stress
- Increasing water intake
- Practicing good sleep hygiene
Hormone replacement therapy (HRT) and bioidentical hormone therapy (BHT) provide side effect relief for some women. These therapies help balance hormone levels that vary throughout perimenopause. However, using hormones to control symptoms are NOT mandatory. The first question to ask is, “how much do my symptoms affect my daily life?” And if the answer is not at all, then no hormones are needed at that time. The fluctuations of the hormones are like the waves of the oceans. Symptoms are variable depending on lifestyle habits, stress during that particular period in your life, weight loss or weight gain, climate and weather changes and Mother Nature.
Even though menopause is the official ending of your menstrual periods, the hormone fluctuations that created side effects during perimenopause are still occurring, meaning that some perimenopause symptoms may remain (or return) and new side effects could appear during menopause.
Once women reach menopause they are at greater risk for developing osteoporosis, a disease that weakens bones. The post-menopausal drop in estrogen is directly related to loss of bone mass. Because there are no symptoms of bone loss, it’s often only after a bone-related injury that the presence of osteoporosis is discovered. Bone mineral density tests (BMD) are x-rays that measure bone density. Screening should begin if you have any of the following risk factors or at the cessation of the menstrual cycle. The following puts you at a higher risk of developing osteopenia or osteoporosis:
- Advanced age
- Your race – Caucasians and Asians have a higher prevalence of osteoporosis
- Family history of osteoporosis
- Body frame – people with petite frames can have a higher risk because they often have less bone mass to begin with.
Likewise, your doctor can offer osteoporosis treatment and prevention suggestions which may include:
- Eating foods high in calcium
- Calcium and vitamin D supplements
- Bone density medications
- Estrogen therapy
- Exercise, especially weight bearing exercise
- Medically Supervised Weight Management
- Avoiding smoking and alcohol
Health Care Options for Perimenopause and Menopause
Perhaps one of the most important things to know about perimenopause and menopause is that you aren’t alone. Approximately three million women transition to menopause every year and there are abundant health care options for both phases. Each woman will enter this phase in her life. During these transition years, remember that these symptoms are not forever. Your doctor can help get you through the storm, by teaching you to dance in the rain.
Certainly the scope of this topic is much more in depth and much more individualized than can be covered here. Knowing that the greatest years of your life don’t have to be the darkest days, lends hope for every woman to reclaim her body.
Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.