Dealing Proactively with Menopause – What Happens During Menopause? (Part 1)

Isabel Lüdi-Roth, Copywriter, qualified nurse

Menopause? A brief introduction and explanation of the term

Menopause describes the transition from a woman’s fertile years to her infertile years and is a phase of hormonal changes. This transition spans several years. The years leading up to menopause are referred to as premenopause (pre = before); this begins as early as the mid-to-late 30s, when few women even think about menopause. Yet the first changes in the female body begin during this phase. Some women notice these changes, but usually do not associate them with menopause. The medical term for menopause is climacteric. The term “menopause” (men = month) is often used incorrectly; however, it refers only to the last menstrual period. The average age for menopause is around 52; it can only be determined retrospectively, namely when no menstruation has occurred for at least one year. The subsequent phase of life is referred to as postmenopause (post = after) and lasts until the end of life. The last menstrual period does not simply occur overnight; it is preceded by perimenopause (peri = around, approximately, beyond), the actual transitional phase. Perimenopause is thus the period during which the end of a woman’s reproductive life cycle is slowly and often dramatically “heralded.” During this time, numerous hormonal changes take place in the female body. About two-thirds of women experience these changes, which range from mild to very distressing and unpleasant symptoms. The duration of perimenopause varies from woman to woman and lasts about four to ten years. In early perimenopause, the sex hormone progesterone initially decreases more and more, while estrogen levels remain unchanged. Since sex hormones must always be considered in relation to one another, the decline in progesterone often leads to relative estrogen dominance. In the later stages of perimenopause, estrogen production also decreases until the final menstrual period occurs. Afterward, both progesterone and estrogen levels remain at a low level.

• Menopause – Technical term for the transition to this phase of life
• Premenopause – initial hormonal changes
• Perimenopause – the actual menopause
• Menopause – final menstrual period
• Postmenopause – one year after the last menstrual period (and until the end of life)

The female cycle – a brief overview

During puberty, our ovaries begin to release sex hormones, progestogens, and estrogens. Estrogens and progestogens are regulated by luteinizing hormone and follicle-stimulating hormone. The best-known and most important estrogen is estradiol (also known as estradiol), while the most important progestogen is progesterone. This marks the beginning of the monthly cycle, which accompanies us for about 35–40 years. The first menstrual cycle begins about two weeks before the first menstruation (menarche) with the preparation for the very first ovulation, and the last cycle ends with the final menstruation (menopause). Menopause begins when hormone levels slowly change. Hormones, particularly progesterone and estradiol, are no longer produced in a monthly balance. The eggs and the female body are nearing the end of their reproductive phase. Just like puberty, menopause can really throw us off balance.

When hormones go on a roller coaster ride – progesterone and estrogens

Progesterone and estrogens (especially estradiol) are opposites—or rather, teammates; they work closely together, complementing each other, and when they become unbalanced, we feel it!

Progesterone

Progesterone plays a crucial role in women’s health and well-being. When discussing menopause, the focus is often exclusively on estrogen deficiency. Yet in early perimenopause, a progesterone deficiency—and the resulting relative estrogen dominance—is usually the primary issue. Alongside estrogens, progesterone—also known as the corpus luteum hormone or pregnancy hormone—is one of the most important female sex hormones. It is called the corpus luteum hormone because it is produced in the ovaries within the so-called corpus luteum, which forms from the ruptured follicle after ovulation. That’s what I call recycling at its finest! In the first half of the cycle, estradiol ensures, among other things, that the uterine lining builds up to provide a perfect “nest” for a fertilized egg. In the second half of the cycle, progesterone ensures that the lining does not thicken further but remains perfectly structured; in other words: It helps maintain pregnancy. That is why another common name for it is the “pregnancy hormone.” Progesterone has many other important functions in the body. It promotes strong bones; while estrogens inhibit the breakdown of bone tissue, progesterone actually promotes the formation of new bone tissue. We also owe healthy and beautiful skin and hair to progesterone. Progesterone boosts metabolism and supports thyroid function. It has a positive effect on mental health and the nervous system; specifically, it alleviates anxiety, promotes sleep, and has a relaxing and calming effect. Finally, progesterone protects uterine and breast tissue from cancer. From this, we can conclude that a progesterone deficiency can have far-reaching consequences. As we age, fewer and fewer mature eggs are available to the body; it becomes increasingly common for ovulation not to occur and, consequently, for no progesterone to be produced (as a reminder: progesterone is formed in the corpus luteum after ovulation). This process begins as early as one’s thirties and becomes more common starting in early perimenopause. Progesterone and estrogen work closely together; when progesterone levels begin to drop in early perimenopause, the delicate balance is disrupted, leading to relative estrogen dominance.

Possible symptoms of progesterone deficiency or estrogen dominance:

• shorter cycles, breakthrough bleeding, including extremely heavy and/or prolonged bleeding
• mood swings, irritability
• Difficulty concentrating
• Anxiety
• Sleep disturbances
• Fluid retention in the tissues
• Breast tenderness, breast swelling
• Severe premenstrual syndrome (PMS)
• Weight gain (especially in the abdominal area)
• Predisposition to fibroids or cysts
• Reduced thyroid function

Estrogens

People usually refer to “estrogen,” but technically one should say “estrogens,” since there are three different types. Estradiol is the most common and most potent form of estrogen. Estrone is the second most potent estrogen; its levels decline more slowly during menopause than those of estradiol. Estriol plays a crucial role in the health of mucous membranes (vagina, bladder, joints, etc.). It is not until later in perimenopause that estrogen levels also begin to decline. However, this does not happen uniformly but is subject to sometimes massive fluctuations, which can cause considerable distress. Estrogens play a crucial role in a woman’s sexual and reproductive development. During puberty, they drive the physical changes that transform a girl into a woman. Estrogens influence sexual desire, bone and skin health, as well as fat metabolism and brain function. There are well over 400 estrogen receptors distributed throughout the female body; contrary to common belief, however, they are not found only in the uterus, ovaries, vagina, and breasts, but also in the brain, muscles, intestines, eyes, heart, lungs, and blood vessels. Estrogens could be described as “growth-promoting,” particularly in areas where these receptors are located. When levels rise during the menstrual cycle, they cause “growth” of the uterine lining and breast tissue. In addition, they ensure optimal moisture levels in the skin and mucous membranes, for example in the urogenital tract and in the joints, etc.

For many women, the decline in estrogen levels is accompanied by typical menopausal symptoms:

• (nighttime) sweating, hot flashes, flushing
• vaginal dryness, pain during intercourse
• Increased vaginal and urinary tract infections
• loss of libido
• Joint and muscle pain
• Brain fog; forgetfulness, difficulty concentrating, memory problems, etc.
• Heart palpitations
• Nervousness, restlessness
• Fatigue, exhaustion, sleep disturbances
• Dry skin, wrinkles
• Hair loss, thinner, dry hair

This is just a selection of possible new companions. Since we are all so different, symptoms can vary greatly. As mentioned earlier, there are also women who don’t notice the hormonal changes at all. Fortunately, however, the rest of us don’t have to simply suffer through menopausal symptoms in silence—we can take steps to successfully navigate this time!

This is the first of four parts on the topic of menopause.

Part 2: Stress Is Toxic and Exercise Works Wonders

Part 3: The Most Important Nutrients During Menopause

Part 4: Phytotherapy and bioidentical hormones