Changing Estrogen Levels in Perimenopause and Alternative Coping Strategies

Changing Estrogen Levels in Perimenopause and Alternative Coping Strategies
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What Is Perimenopause?

Perimenopause ushers in a period of profound change in women as the function of the female productive system declines. At the end of this first menopausal stage, a women will cease menstruating. It can be physically as well as emotionally draining for women making this life transition. Fluctuating hormones are at the root of the symptoms which women may experience. Common symptoms include:

  • Hot flashes

  • Heart palpitations

  • Abdominal fat accumulation

  • Mood changes

  • Vaginal dryness

Hormonal Changes

Declining estrogen levels in perimenopause are responsible in part for these symptoms. Hormones including progesterone and androgen are also reduced. Until levels stabilize, hormone levels fluctuate. When estrogen levels are high, you may experience symptoms of PMS including fatigue and irritability. When levels drop, you may have hot flashes.

Every woman is different in how her body responds to perimenopause. Some women may find that their symptoms interfere with day-to-day life. Others may experience depression or a sense of loss from leaving their reproductive years.

Changing Health Risks

The risk of certain health conditions increases after menopause, it is believed that estrogen levels may play a role. What is known is that estrogen can have several positive effects on the cardiovascular system specifically on cholesterol. It can both raise HDL or good cholesterol and lower LDL or bad cholesterol. The decline of hormone levels coincides with the increased risk for heart disease that women experience, suggesting a link between estrogen and heart disease.

This evidence fueled the use of hormone replacement therapy (HRT) to reduce the risk of heart disease, as well as to provide relief for menopausal symptoms. However, recent evidence has refuted the benefits of HRT with estrogen alone, finding an increased risk of stroke and blood clots. It is no longer a recommended course of action to mitigate the effects of declining estrogen levels in perimenopause on heart disease risk.

Coping with Perimenopause Symptoms

While your hormones are in a state of flux, you may find alternative remedies helpful for your symptoms. You may consider taking dietary supplements such as:

  • Black cohosh

  • Evening primrose oil

  • Soy

  • Flax seed or oil

  • Vitamin E

A 2010 study by the University of Naples in Italy found black cohosh an effective alternative therapy for treating women in the early stages of menopause. The North American Menopause Society recommends that women consider a combination of lifestyle changes and nonprescription remedies as the first course of action. You can also work with your doctor to develop a medical course of action that may include low-dose birth control or progesterone to manage your symptoms.

Perimenopause is a critical time in the life of a woman when reduced estrogen levels as well as other hormone shifts cause changes in her biology and physiology. A combination of approaches can help you cope with your changing body as you make this transition.

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F. Borrelli and E. Ernst. Alternative and complementary therapies for the menopause. Maturitas, August 2010; 66(4):333-343.

Cleveland Clinic: Estrogen and Heart Disease

North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause, January-February 2004; 11(1):11-33.

Women’s Health Initiative: Questions and Answers about the WHI Postmenopausal Hormone Therapy Trials