By Dr Anita Sturnham, GP
An internationally renowned doctor specialising in dermatology and anti-ageing medicine.
What is happening to women’s bodies during the menopausal period? Our ambassador Dr. Anita explains it here.
There are no blood tests to accurately tell if you are perimenopausal, as the hormone levels can fluctuate so much on a daily basis. There are some functional tests that look at urine analysis to map hormone pathways in more detail and these can be helpful. Most clinicians will diagnose perimenopause based on a patient’s age and a presentation of signs of hormone deficiency. It is sensible to have some baseline tests to ensure that your signs are not related to other underlying medical conditions. There are lots of measures to support women during this menopausal journey and these include diet, supplements and lifestyle factors, alongside hormone replacement therapy.
The most accurate way to tell if you are approaching menopause itself is to monitor your menstrual cycles. Menopause has happened when you have not had a period for 12 months.
It is not just declining Oestrogen levels that impact our well-being. In the time leading up to menopause there is often chaotic production of other hormones too. Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) are part of the hormone control system and re made in an area of the brain called the pituitary gland. They travel to the ovaries to switch on hormone production. In Perimenopause our brain makes a last ditch attempt to boost sex hormone levels and we often see surges in FSH and LH in an attempt to make more Oestrogen and Testosterone. This can lead to signs of Oestrogen dominance and also raise androgens levels which can cause mood swings, breakouts and hair thinning. Eventually levels of FSH become permanently high as women reach menopause. This is the result of Oestrogen levels being too low to signal back to the brain to switch FSH production off. For this reason, menopausal blood tests generally check for high FSH levels.
Progesterone is a steroid hormone which is made by the ovaries and its levels increase after ovulation. As a woman ovulates less often in perimenopause, progesterone levels can drop significantly at this time and signs of Progesterone deficiency can appear. Progesterone is often given the nickname ‘the hormonal hug’ as it is responsible for helping us to feel calm. It also aids our sleep. Allopregnanolone, a progesterone metabolite, is a GABA receptor agonist, which means that it binds to specific receptors in the brain and spinal cord and enhances GABA production. GABA works by blocking specific signals in your central nervous system and this action produces a calming effect. It's thought to play a major role in controlling nerve cell hyperactivity. Signs of progesterone deficiency also include fatigue, cramps, bloating and breast tenderness.
Testosterone is another important sex hormone that women produce in various locations around the body. One quarter of a woman’s Testosterone is produced in the ovaries, a quarter is produced in the adrenal glands, and one half is produced in the peripheral fatty tissues. Levels of testosterone gradually decline in the perimenopausal journey but early in the perimenopause it can become the more dominant hormone and women may report symptoms of androgen excess. These tend to be short lived and eventually women are prone to showing signs of androgen insufficiency, which include low mood, loss of libido, loss of lean muscle, unexplained fatigue, and changes in memory and cognition. Androgen deficiency can also increase the rate of bone thinning.DHEA is another hormone impacted by menopause. This is primarily produced in the adrenal glands but we also make some in the ovaries. It is a paracrine hormone, meaning it can convert itself into other things. DHEA can help to boost intracellular oestrogen levels as well as converting itself into Testosterone. DHEA is also helpful for the production of a neurotransmitter called acetylcholine, which is needed for learning and memory.