Peri menopause

Peri menopause is a time when progesterone is vital for well being. Levels start dropping from the age of thirty five, whereas oestrogen remains at normal levels until menopause, when they drop sharply.

The reason for the drop in level is anovulation. From thirty five onwards ovarian function declines, ovulation does not occur every month, and progesterone levels in those months will be very low.

For ovulation to occur an egg needs to reach maturity, the following explains what happens in the cycle.

The first half of the monthly cycle is known as the follicular phase, and it can range from seven days to twenty-one days. Progesterone is present in extremely small amounts, oestrogen and follicle stimulating hormone (FSH) being the dominant hormones.

When the egg has reached maturity, another hormone called lutenising hormone (LH) is released by the pituitary. Approximately twenty four hours later this causes the Graafian follicle to rupture releasing an egg, commonly known as ovulation. The follicle, which is now called the corpus luteum due to its yellow colour, starts producing progesterone, which it does for the next fourteen days, progesterone is now the dominant hormone. This part of the cycle is known as the luteal phase.

During peri menopause cycles become very erratic, bleeding can be very light to flooding, 2 weeks apart to 3 months apart, clots, spotting, sometimes pain.

Although progesterone can normally be used to regulate the cycle, unfortunately no amount is going to regulate it once peri menopause has started.

It's the imbalanced ratio of the two that causes the symptoms. Both serum and saliva tests can be done to check levels of hormones, saliva being the more accurate of the two. This is difficult in peri menopause when cycles can be so erratic, nevertheless the following is an example of what the ratios mean.

The reference used below is the UK standard. Only the luteal phase level has been shown to save confusion.

It is most important to have the test done on the correct day, as cycles can vary from twenty one days to thirty six days. So in a thirty six day cycle the test should be done on day twenty nine, a twenty one day cycle on day fourteen.

The reason for this is the luteal phase is always, no matter how long or short the cycle, the last 14 days before bleeding. The peak would always be ±7 days before bleeding.

The second and most important issue during peri menopause is the ratio between the two hormones.

Take the figures below. If a woman has an oestradiol level of 13.2pmol/L and a progesterone level of 259pmol/L she would feel awful, and yet they are both in the 'normal' range.

On the other hand if she had an oestradiol level of 5.5pmol/L and a progesterone level of 979pmol/L she would feel wonderful, and yet these are also in the 'normal' range.

The following reference ranges are given in SI units

.	17ß-oestradiol	Progesterone
Luteal	5.5 - 13.2 pmol/L	259 - 979 pmol/L

References for peri menopause luteal phase levels

All the successful studies done on progesterone use between 100mg to 200mg per day. This equates to 3ml to 6ml of Natpro per day. Some go as high as 400-600mg/day, one as high as 1200mg/day as it was the oral variety.

For information on how to use progesterone cream and progesterone application methods in general click these links.

In some women symptoms can start ten years before menopause, the average age of which is fifty one, sometimes they can persist from 5 to 10 years after.

Below is a comprehensive list of the symptoms that can occur during peri menopause...

abdominal bloating
agoraphobia
aggression, anger, rage, resentment
alcoholism, particularly pre-menstrually
allergies
anxiety, nervousness, irrational fear
arthritis, joint and muscle pains
blood clots
breast tenderness
bruising and capillary breakage
chronic fatigue - muscular weakness, procrastination, exhaustion, tiredness, mental confusion, difficulty in getting up after enough sleep, lethargy
clumsiness
cold hands and feet
constipation
cracked heels
cravings, eating disorders, binges, inability to tolerate long intervals without food
cysts - breast and ovarian
dizziness
depression - loneliness, uselessness, endless crying, irrational behaviour
fibroids
guilt
hair loss and excessive facial hair
headache
hot flushes and night sweats
hypoglycaemia (low blood sugar)
hypothyroidism
incontinence
insomnia
irregular menstrual flow, heavy or light flow
irritability
lack of self confidence and esteem
libido loss
memory loss
mood swings and irritability
nails - flaking, brittle and weak
osteoporosis
palpitations
panic attacks
personality changes
skin problems-dry skin and early ageing of the skin
sleep disturbances
tension
urinary tract infections, cystitis
vaginal thinning, dryness and itching
violence-verbal and physical
violent dreams
weight gain
water retention