Premenopause

What Your Doctor May Not Tell You About Menopause : The Breakthrough Book on Natural Hormone Balance
by John R. Lee, M.D., Virginia Hopkins

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A woman's hormone balance can begin to shift at anywhere from her mid-30s to her late 40s, depending on a variety of factors such as heredity, environment, how early or late she began menstruating, whether she had children and if so at what age and how many, and her lifestyle. Was she exhausted trying to juggle career and family? Was she eating junk food, caffeine, sugar, and alcohol or whole grains, fresh vegetables, and fruits? Has she taken vitamins? Has she lived in the city or country? Was she exposed to toxins in the workplace? Hormone balance is intimately connected to stress levels, nutrition, and the environmental toxins encountered daily. We will discuss all of these factors more thoroughly in the chapters to come.

The ability of the follicles to mature an egg and release it may begin “sputtering,” so to speak, a decade before actual menopause, creating menstrual cycles in which a woman does not ovulate, called anovulatory cycles. If she isn't ovulating, she isn't producing progesterone from the ovaries and she may begin experiencing menopausal symptoms such as weight gain, water retention, and mood swings.

Menstrual cycles can continue even without the progester-one, however, so most women aren't aware that the lack of progesterone is causing their symptoms. I call this phase premenopause. I will be discussing premenopause symptoms in more detail, and have also written an entire book on the subject called What Your Doctor May Not Tell You About Premenopause. The phase right around the time of menopause, when hormones and brain signals to the ovaries are fluctuating, is called perimenopause.

It used to be true that the majority of women began menopause in their mid-40s to early 50s. In the last generation, however, things appear to have changed. Women now may have anovulatory periods starting in their early 30s and yet do not experience cessation of periods (menopause) until their 50s. During this time, the ovaries continue to produce estrogen sufficient for regular or irregular shedding, creating what I term “estrogen dominance,” which will be discussed in detail throughout the book.

Some women may go for years with irregular cycles and slowly wind down, or may just suddenly stop menstruating one month and never menstruate again. They may be over-whelmed with unpleasant symptoms or hardly notice what has happened other than not having to worry about birth control or tampons every month. How menopause is experienced is as individual and unique as each human being.

During the many months of anovulatory periods, estrogen production may become erratic, with surges of inappropriately high levels alternating with irregular low levels. Periods of vaginal bleeding may become erratic, some much heavier than others. When estrogen surges, women undergoing these changes may notice breast swelling and tenderness, mood swings, sleep disturbance, water retention, and a tendency to put on weight. These may be the symptoms of estrogen dominance caused mainly by lack of ovulation and thereby lack of progesterone while their estrogen levels are still in the “normal” range. Their doctors may check their estradiol levels and their follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels, but rarely does it dawn on them that their patients' progesterone levels are too low. In taking the usual blood tests, the doctor may find the estrogen normal that day or even a bit on the low side and FSH levels a bit too high. On another day the estrogen might be elevated and FSH levels normal. If the former is found, the doctor may even prescribe some estrogen on the theory that the patient is nearing true menopause. The woman usually finds that this does not help her and often makes things worse.

More often, the doctor ascribes her complaints to emotional causes or simply some defect of Mother Nature that women must endure. In later chapters, I will discuss this phenomenon in more detail. For the present, we will merely say that a rising percentage of women are experiencing premenopausal woes that are related to their hormones. The details concerning environmental toxins, nutritional factors, stress, adrenal hormones, exercise, and weight will be found in the chapters ahead.

Revised and Updated
Copyright © 1996 by John R. Lee and Virginia Hopkins
Revised edition copyright © 2004 by John R. Lee and Virginia Hopkins

About the Author

John R. Lee, M.D., is the author of Natural Progesterone. Recently retired from private practice after thirty years, he now teaches medical professionals and lay audiences about hormone balance and health.

Virginia Hopkins, M.A., is a medical writer specializing in women's health and nutrition.