The imbalance of hormones that occur during menopause or perimenopause can have a very dramatic impact on a person's ability to manage even the smallest tasks. Hormone imbalance affects a person's ability to function normally, making them feel inadequate to handle the demands within day to day tasks and sometimes even causing depression.

Perimenopause is often not discussed enough in relation to women’s health. Perimenopause is defined as the time between a healthy menstrual cycle and menopause, wherein the menstrual cycle halts completely. It typically begins around the age of 35 and may last from six months to ten years before developing fully into menopause. During this time of transition, production of two important hormones, estrogen and progesterone, decline. Depending on the speed at which these hormone values drop, one may experience a slow, almost imperceptible change to bodily function or a sudden or dramatic shift.

The change in hormone values caused by perimenopause/menopause can induce a wide range of symptoms. The type and severity of symptoms is determined primarily by the values of progesterone and estrogen.

Symptoms associated with low progesterone: heavier and/or longer periods, periods occurring closer together, bloating, cramps, breast tenderness, irritability, rage, anxiety, and insomnia.

Symptoms associated with low estrogen: shorter and/or missed periods, increased fatigue, night sweats, hot flashes, sadness, heart palpitations, increased urination, vaginal dryness, painful intercourse, yeast infections, acne, osteoporosis, migraines, memory loss, and weight gain.

Another major component of perimenopause is the degradation of ovarian follicles. These structures in the ovaries contain eggs and are a key component of female fertility. As perimenopause progresses ovarian follicles become less sensitive to follicle-stimulating hormone (FSH) meaning that ovulation, or the release of eggs, may not occur during one’s period. In response to the reduced receptivity, the pituitary gland may increase the production of FSH to encourage egg release. This action can prolong a woman’s fertile years, but it also comes with other side effects. Increased FSH values can negatively affect various systems and contribute to symptoms of perimenopause. Menopause, much like perimenopause, is a process that doesn’t occur overnight. A woman is only considered to be menopausal if a full year has passed since their last period. This means that even if a woman hasn’t had a period for eleven months if they menstruate during the twelfth month, they are still considered premenopausal.

Menopause has many of the same symptoms that occur during perimenopause. However, because of the continuous decline in progesterone, estrogen, or other hormones, more serious problems may present themselves. Some more pronounced symptoms associated with menopause include musculoskeletal issues, achiness, thinning skin, hair loss, weight gain, cardiovascular problems, reduced cognitive ability, memory loss, poor bone health, and increased urination.

In trying to diagnose menopause or perimenopause, a patient may be asked to track your symptoms and record when they occur. Your doctor will order a complete blood workup to assess your hormone levels and may also check for any other contributing factors, such as adrenal dysfunction or thyroid issues. Bioidentical hormone replacement therapy (BHRT) has been found to be a safe and effective treatment for symptoms associated with perimenopause and menopause.

Hormones in BHRT are derived from plants and are structurally identical to the hormones produced by the human body. Long-term BHRT treatment is highly encouraged due to its exceptional results in maintaining bone density, decreasing incidences of breast or uterine cancers, lowering the incidence of heart disease (stroke), and prevention of dementia.

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