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PERIMENOPAUSE – What Women Need to Know - Part One

From the ages of 40 to the early 50s, women may experience mental, physical and emotional symptoms for a long period of time before they reach menopause (i.e. a 12 month consecutive period of absence of the menstrual period).

This can be described as the perimenopause stage or the menopause transition.

Perimenopause can also be initiated due to chemotherapy, radiation therapy and oophorectomy (surgical removal of both or one of the ovaries) or by drugs/medications that disturb the hormone balance.

Symptoms and changes to the body and its function

In the perimenopausal stage, a majority of women experience what is called the Menopause transition in an estimated time frame and will of course vary individually.

Definitions of phases of phases of midlife

2-5 years for the Early transition whereby they experience changes of their cycle – irregular periods ( cycles may vary in length by 6 or more days), 3 years - Mid transition - skipped period ( starts with 60 days without flow)

1 year - Late transition -final menstruation and a full consecutive 12 month period of no menstrual periods


In perimenopause, a women’s hormone levels fluctuate and change considerably , it can often be described as a ‘hormone rollercoaster!’ Here, the female hormones are regulated by the brain-ovary axis also known as the Hypothalamic - Pituitary-Ovary- Axis ,which is also affected by the Hypothalamic- Pituitary- Adrenal- Axis ( our stress response both physical and mental) are secreted by the ovaries or interestingly made in the adipose (fat cells) by converting DHE-S and Testosterone.

So to understand why women undergo various disturbing symptoms of perimenopause, we need to understand what the main female hormones roles are in the body. Oestrogens Roles in the body

· Not only does oestrogen have a role in the reproductive processes i.e. build up endometrium in the uterus and stimulate graffan follicles for the development of the ovum in the follicular phase (oestrogen dominance), they affect the growth, differentiation and function of diverse tissues throughout the body.

· They are needed for bone maintenance and formation

· They have cardiac protective effects

· They influence our moods and behaviours

· As stated earlier, they are produced by the ovaries and also by the aromatization(chemical reaction) of the androgens in fat cells, skin, bones and other tissues

· They play a role in regulation of appetite, and works in the brain to increase glucose transport into cells and aid in ATP ( energy production),

Progesterone role in body

· Prepares breasts for lactation

· Decreases oestrogen receptor synthesis

· Improves oestrogen receptor synthesis

· Promotes cell differentiation

· Maintains uterus in pregnancy, suppresses uterine contraction , and allows for the implantation of a fertilised egg

· Has a calming effect and enhances mood

· Reduces symptoms of PMS and hot flushes

· Decreases risk of endometrial cancer

· Regulates fluid balance SYMPTOMS PERIMENOPAUSE

Hot flushes and night sweats are common , and are also aggravated by lifestyle changes, environment, nutrition, stress, alcohol. It is important to differentiate other medical conditions from menopause-related hot flashes, including hyperthyroidism, anxiety, and more.

Depression, anxiety and/or mood swings. The cause of these symptoms, including increased irritability and anxiety/panic disorder, may be sleep disruption associated with hot flashes, or other factors not related to the hormonal changes.

Changing lipid profiles. Decreasing estrogen levels may lead to unfavourabl changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — decreases in many women as they age.

Other symptoms associated with perimenopause can include: changes in memory and cognition, scalp hair loss, facial hair growth, acne, palpitations, nausea, and headaches.

How can I help?

I will take and in depth information gathering at your initial consult (allow 60-90minutes) - I often integrate pathology data with your physical/emotional/social environmental and genetic information to help provide individualized evaluation and to provide you with optimal therapeutic guidance.

As a naturopath I will also delve into how your body is metabolising your hormones, so questions will incorporate other body systems, for examples such digestion and liver functions.

With the use of dietary and lifestyle changes, I may incorporate herbal mix of either phytoestrogens or nonphytoestorgens , to combat your perimenopauseal symptoms.

Other herbs may be added to support your digestion, liver and or nervous system.

Nutraceutical supplements may be prescribed and mind body medicines to help with stress reductions ( A major contributor to disruption of hormonal imbalances).

My therapeutic approach is very individualised and proactive in strengthening your overall health and give preventative approach to your health in general. This may incorporate referral to other health practitioners for further testing.

I look forward to seeing you soon at the Sonia Ellery Naturopath Clinic located in Argyle Street, Camden.


[1] Roepke, T. A. (2009). “Oestrogen modulates hypothalamic control of energy homeostasis through multiple mechanisms.J Neuroendocrinol 21(2): 141-150.

[10] Karim, R., et al. (2015). “Association of endogenous sex hormones with adipokines and ghrelin in postmenopausal women.J Clin Endocrinol Metab 100(2): 508-515.

Prior, J., (2011).” Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for peri-menopause” Facts, views & vision in ObGyn Vol 3, (2): 109-120.


The Australian Institute of Health and Welfare 2016. Australia's Health 2016

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