Periods during the perimenopause … what can happen?
Perimenopause involves complex hormonal fluctuations that impact menstrual cycles. Initially, shorter cycles and heavier periods may occur due to higher FSH and oestrogen levels. As follicle numbers decline further, cycles become more irregular, with missed periods becoming more common.
Progesterone for perimenopausal symptoms
Progesterone plays a crucial role in managing perimenopausal symptoms by balancing estrogen levels and supporting overall hormonal harmony. It helps regulate menstrual cycles, alleviate mood swings, and reduce the risk of endometrial hyperplasia. Incorporating natural progesterone, such as micronized progesterone, can be an effective strategy for women seeking to manage perimenopausal symptoms without synthetic hormones. Consulting with a healthcare provider is essential to determine the most appropriate treatment plan tailored to individual needs.
Endocrine ‘disruptors’ - xenoestrogens
Xenoestrogens are synthetic chemicals that mimic estrogen in the body, potentially disrupting hormonal balance. Common sources include plastics (e.g., BPA), pesticides (e.g., DDT), and personal care products containing parabens. Exposure to these substances has been linked to various health issues, including hormone-related cancers and reproductive health problems. To minimise exposure, consider reducing plastic use, choosing organic foods, and selecting personal care products with natural ingredients. Being mindful of these factors can help protect your health from the potential effects of xenoestrogens.
Bleeding on HRT - information for women who still have a womb
Experiencing vaginal bleeding while on hormone replacement therapy (HRT) is common, especially for women who still have a uterus. The type and timing of bleeding can vary depending on the HRT regimen—continuous or sequential. While light, short-duration bleeding is often considered normal, especially with sequential HRT, unscheduled or prolonged bleeding may indicate underlying issues such as endometrial hyperplasia or cancer. It's crucial to monitor bleeding patterns and consult with a healthcare provider if irregularities occur. Early detection and appropriate adjustments to HRT can help manage symptoms and reduce risks.
Iodine deficiency
Iodine is an essential mineral which is especially important for women considering pregnancy, during pregnancy and during breastfeeding
Long term safety of HRT
Hormone Replacement Therapy (HRT) remains a cornerstone in managing menopausal symptoms, offering relief from hot flushes, night sweats, and mood changes. While HRT is generally safe for women under 60, especially when initiated close to menopause onset, long-term use carries certain risks. These include a slightly increased risk of breast and ovarian cancers, as well as potential cardiovascular concerns if started many years post-menopause. However, for many women, the benefits—such as reduced risk of osteoporosis and improved quality of life—outweigh the risks. It's crucial to have a personalised discussion with a healthcare provider to weigh the pros and cons based on individual health profiles.
Progesterones and meningiomas
Recent studies have highlighted a potential link between certain progesterone-based medications and an increased risk of meningiomas, which are typically benign brain tumors. While these tumors are more common in women and often asymptomatic, some high-dose progestogens—such as medroxyprogesterone acetate (found in Depo-Provera), cyproterone acetate (found in Dianette), and nomegestrol acetate (found in Zoely)—have been associated with a higher risk of developing meningiomas. Notably, the risk appears to be dose-dependent, with prolonged use increasing the likelihood of tumor development. It's important to note that while these associations exist, the overall risk remains low, and more research is needed to fully understand the relationship between progesterone use and meningioma development. Women using these medications should consult with their healthcare providers to discuss potential risks and consider alternative options if necessary.
Diagnosing the perimenopause
Diagnosing perimenopause can be complex due to the absence of a definitive test. According to the British Menopause Society, perimenopause is characterized by changes in menstrual cycle patterns, such as infrequent periods and cycles becoming slightly longer, e.g., 6–7 weeks apart. Common symptoms include hot flushes, night sweats, cognitive changes, mood swings, sleep disturbances, and urogenital symptoms like vaginal dryness. In some cases, a trial of hormone replacement therapy (HRT) may be used to assess symptom improvement. It's essential to consult with a healthcare provider to evaluate symptoms and consider appropriate treatment options.
Cycle mapping - how best to monitor your menstrual cycle
Cycle mapping involves tracking key female hormones—LH, FSH, estradiol, and progesterone—throughout your menstrual cycle to assess ovulation and hormone patterns. Unlike traditional single-point blood tests, cycle mapping provides a comprehensive view, especially beneficial for those with irregular cycles, perimenopausal symptoms, or fertility concerns. Utilizing advanced tools like the Mira hormone monitor, which offers real-time, quantitative data, can enhance accuracy in tracking hormonal fluctuations. This approach aids in identifying ovulation timing, luteal phase length, and menopausal progression, facilitating informed healthcare decisions.
Berberine for PCOS
Berberine could help lower testosterone levels and the LH to FSH ratio compared to a placebo or no treatment.
Hormones and sleep during the menopause
Menopause brings about significant hormonal changes that can disrupt sleep patterns. Declining levels of estrogen and progesterone, along with reduced melatonin production, often lead to symptoms like night sweats, insomnia, and early morning awakenings. These disturbances can contribute to anxiety and depression, creating a challenging cycle. Hormone Replacement Therapy (HRT), particularly when combined with progesterone, has been shown to improve sleep quality by reducing night sweats and promoting deeper, more restorative sleep. Unlike sleeping tablets, HRT addresses the underlying hormonal causes of sleep disturbances, offering a more sustainable solution. For women in perimenopause, micronized progesterone can alleviate both sleep issues and heavy periods. Consulting with a healthcare provider can help determine the most appropriate treatment tailored to individual needs.
The role of the microbiome in phytoestrogens
The gut microbiome plays a crucial role in metabolising phytoestrogens—plant-derived compounds found in foods like soy, flaxseeds, and legumes. These compounds can mimic estrogen in the body, potentially alleviating menopausal symptoms and supporting hormonal balance. However, their effectiveness depends on the composition of an individual's gut bacteria. Certain gut microbes are better equipped to convert phytoestrogens into bioactive forms that the body can utilise. A diverse and healthy microbiome enhances this conversion, while an imbalanced microbiome may reduce efficacy. Factors such as diet, antibiotic use, and lifestyle choices can influence gut health and, consequently, the benefits derived from phytoestrogens. Maintaining a balanced microbiome through a fiber-rich diet, probiotics, and prebiotics may optimise the health benefits of phytoestrogens.
The Gut Microbiome and Cardiovascular Health
Diet plays a crucial role in cardiometabolic health, influencing both the composition of the microbiome as well as the development of related diseases. The gut microbiome, in particular, has been found to contribute to conditions such as hypertension, obesity, and diabetes through its impact on inflammation, insulin sensitivity, and blood lipid levels. A healthy gut microbiome is one that promotes long-term stability, resists infection, and helps the host maintain metabolic and immune balance.
Anastrazole for breast cancer prevention
Anastrazole has a license for the prevention in post-menopausal women with a moderate of high risk of developing breast cancer
Non-alcoholic liver disease
NAFLD is a common condition, particularly in women with PCOS. A lifestyle approach is important in preventing its progression to more serious disease and there is also some evidence for the use of complementary therapies like vitamin E.
Metformin & PCOS
Sirona Health is pleased to share the latest evidence-based recommendations for managing Polycystic Ovary Syndrome (PCOS) using Metformin.
Somatic therapy
Somatic therapy is a body-focused treatment that helps individuals process and release trauma stored in the body. Unlike traditional talk therapies, somatic therapy emphasises the connection between mind and body, recognizing that physical sensations can reflect emotional experiences. Through techniques such as body awareness, grounding, titration, sequencing, and pendulation, individuals can become more attuned to their bodily sensations, allowing for the safe release of tension and trauma-related stress. This approach can be particularly beneficial for those dealing with post-traumatic stress disorder (PTSD), chronic pain, and other stress-related conditions. By integrating bodily awareness into the healing process, somatic therapy offers a holistic path to recovery.