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Peri-Menopause / Menopause

The Beginning

We are born with a set amount of eggs. Egg production in a female begins before she is even born. As a female fetus develops in her mother’s womb, her eggs (also called oocytes) are produced by the ovaries and stored in follicles within the ovary. Each woman is born with between 500,000 and 2 million eggs in her ovaries, but the number declines steadily from that point forward. For the average woman, only 300,000 eggs will remain by the time she reaches puberty.(43)

Though eggs are in large supply early in a female’s life, they are immature, and most will not reach full maturity because of a process called follicular atresia. Follicular atresia is a natural process wherein roughly 1,000 eggs are absorbed back into the body on a monthly basis. This process ensures that only the healthiest follicles with the best potential for successful fertilization are prepared for growth and maturation. From puberty to the onset of menopause, only about 300 to 500 eggs will reach full maturity.(43)

Then What Happens?

As a woman reaches puberty her menstrual cycle starts, her estrogen levels rise for the first two weeks or so, peak around day 12 and then begin to decline around day 13. Then ovulation occurs, and her progesterone level begins to rise and peaks about day 21. If the woman becomes pregnant, her progesterone continues to climb throughout the pregnancy. If no pregnancy occurs after about three to five days, then progesterone levels begin to decrease, and the next menses begins around day 28 or so. This cycle goes on–with estrogen being dominant the first two weeks of the cycle and progesterone dominant the second two weeks–for three to four decades of a woman’s life.

What Is Perimenopause?

This is the stage in reproductive life commonly defined as commencing with the onset of menstrual irregularity and symptoms When the perimenopause shift occurs, the pituitary gland begins to say, “Enough of this!” and slowly starts to turn down the volume of these hormones. It can happen in any number of ways, all perfectly natural, until the hormonal levels drop to the point that the cycle no longer produces menstruation. The cycle is still happening; the hormone levels are just not high enough to create a lining of the uterus that needs to be shed each month.

This phase of a woman’s life is often unrecognized until hormonal changes become more and more obvious. You may start experiencing symptoms that seem not hormone related at all.

Maybe you start forgetting where you placed your keys, or forget why you walked into that room. Or maybe you notice your hair and skin are not as vibrant as usual. Maybe sleep is becoming more disruptive and moodiness is happening a little more frequent than usual. These are just a few of the tell tale signs that your body is in the perimenopause phase.

In the early follicular phase (days 1-12 of the menstrual cycle) Follicle Stimulating Hormone (FSH) levels in women who report menstrual irregularity fluctuate markedly. Anovulatory cycles occur at increased frequency in the last 30 months before the final menses (or menopause).

There is no specific endocrine marker of the early or late transition, making measurements of FSH or estradiol (E2) unreliable in attempting to stage an individual with regard to where they are in approaching menopause.(1-4) This is the time when females begin to have anovulatory cycles. This means that although a period is still occurring, this does not mean that we are ovulating every cycle. When we do not ovulate we do not produce the follicular changes needed to make the corpus luteum and produce progesterone. These hormonal changes are starting to occur earlier and earlier starting even as young as 35 with the average occurring between 40-50.(12)

Symptoms can start even before irregular cycles begin. At this stage of life the symptoms can be mild to severe. They can include changes in sleep, heart palpitations, brain fog, forgetfulness, feeling tired all the time, no motivation, low libido, dyspareunia, urinary incontinence, vaginal dryness including pain and itching, weight gain, metabolic changes, hair loss, dry eyes, joint aches, body aches, hot flashes, night sweats, migraine headaches, depression, anxiety, increased allergies and sinus infections, just to name a few.(4)(13-42)

What is Menopause?

Menopause is the cessation of a period and no viable eggs in the ovaries. Genetic factors may affect the age at which menopause is established.(2) Vasomotor symptoms are among the most common symptoms and their frequency, duration, and intensity vary. The data suggests that women who experience vasomotor symptoms are more likely to develop depressive disorders, mood and sleep disturbances, neuroticism, anxiety, decreased cognitive function and stress. The median age of menopause is 51.25 years.(1) Menopause may occur even earlier in females who have never been pregnant, in smokers, surgical oopherectomy, chemotherapy, or radiation to the pelvic area.(3)

What is the Risk of Menopause?

Adverse health outcomes and diseases like cardiovascular disease and osteoporosis may affect women later after the establishment of menopause. CVD is the main cause of death globally in both sexes. Ischemic strokes seem to cause more severe disabilities to women after menopause than men. The risk for vascular cerebral disease is almost doubled within the first decade since menopause. Post menopausal osteoporosis is estimated to affect 22 million women in Europe and has led to 3.5 million osteoporotic fractures. Fractures are correlated with increased morbidity and mortality and osteoporosis affects more than 10 million people in the United States. (8)

Physiologic Restoration™

Hormone therapy therefore has been considered as the most effective treatment for these symptoms (14). If a woman experiences symptoms of hormone deficiency, the reason to start hormone therapy may be not only to manage symptoms but also to maintain bone density and reduce the cardiovascular and neurocognitive effects of estrogen deficiency. The aim of hormone therapy is the protection against the negative effects of hormone deficiency. Physiological Restoration is replacing hormones to normal physiologic levels to avoid these declines. Mimicking the ovulatory cycle of a young female by using bioidentical transdermal estradiol and progesterone cream in doses that replace hormone levels to what is physiologically normal, like when they were young, not only is effective in relieving the symptoms of menopause, but may also be effective in preventing the health outcomes and diseases that occur after menopause.

Women have been known to report they feel like their “best selves” again.


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