Mastering the Hormone Maze: Your Essential Guide to Navigating Perimenopause

 by Megha Gokals Sanghi, ND

Naturopathic Doctor at New England Integrative Medicine

Hormones are chemical messengers secreted into the blood by different organs, all of which have different functions. All hormones have one ultimate goal – to maintain homeostasis in the body. Hormones control various processes of the body ranging from blood pressure management to the menstrual cycle in females. There are over 50 hormones that have been researched thus far, and continued research shows the discovery of many more. 

Female reproductive hormones control the development specific sex characteristics, stimulate the different phases of the menstrual cycle, fertility and maintaining pregnancy. Throughout the course of a female’s life, these hormones change significantly. The first hormones to change are hormones from the brain signaling to the ovaries to produce estrogen and progesterone, which begins the process of puberty between the ages of 8 and 13. Once the cyclical nature of estrogen and progesterone has been established is when the young female will begin to menstruate. 

The menstrual cycle is split into four phases: Menstruation, the follicular phase, ovulation, and the luteal phase. 

Menstruation

• Typically, Day 1 through 5 of the menstrual cycle 
• Progesterone and estrogen levels decline, causing the uterine spiral arteries to constrict, the uterus’ inner lining called the endometrium to shrink and shed in the form of menstrual blood

The Follicular Phase

• During this phase, one follicle matures and prepares for ovulation
• A gradual increase in estrogen proliferates the growth of supportive ovarian cells and the uterine lining to prepare for implantation post-ovulation 
• Progesterone continues to remain low

Ovulation

• This occurs 14 days prior to menses and lasts approximately 36 hours 
• There is an estrogen surge then drop, which results in a surge of luteinizing hormone causing the follicle to ovulate
• Pregnancy is achieved if there is a presence of sperm that is able to bind with the “egg” 

The Luteal Phase 

• During this phase, progesterone rises significantly with the goal preparing the lining of the uterus for implantation of an embryo
• Estrogen increases the thickness of the uterine lining while simultaneously increasing the blood flow to the lining
• Towards the end of this phase, if implantation has not occurred, there is an abrupt decrease in estrogen and progesterone, which stimulates menstruation

As females transition from the menstruating years through perimenopause and into menopause, these hormone levels begin to change.  

Monitoring Hormones through Perimenopause2

Each of these hormones have numerous roles in maintaining homeostasis in the body. As these hormone levels change over time, the body must adapt to these new levels, which certainly is no easy feat.  Many people need support as they go through these changes. Symptoms may vary from person to person, and the level of support necessary as well. 

Estradiol1

Estradiol is a the most active form of estrogen that is used to maintain the menstrual cycle. Estradiol is one of the significant hormones that begins to decrease during perimenopause. Ovarian failure triggers a decrease in estrogen secretion, which then sends a message back up the pathway to the pituitary gland in the brain, subsequently altering other hormone levels. This reduction in estradiol reduces in irregularities with the menstrual cycle, mood swings, vaginal dryness, hot flashes, and night sweats. Estradiol is also extremely important for maintaining bone density, which is why low estradiol levels in menopause can lead to osteoporosis. 

As estradiol begins to reduce during perimenopause, many females tend to develop menopausal symptoms. It can begin as changes with their menstrual cycles, either shortened or lengthened, heavier menstrual bleeding, and progress to what is seen as more “typical” menopausal symptoms such as hot flashes and night sweats. Evaluating estradiol levels early on and tracking these changes can support tracking this transitory phase. 

Estrone

This form of estrogen is the weakest form and tends to be the highest during menopause. Estrone tends to have the least amount of function during puberty and years of having a menstrual cycle due to the other forms of estrogen being much more active. Estrone however plays an important role during menopause. Low levels of estrone during menopause has been correlated with increased menopausal symptoms such as hot flashes, night sweats, fatigue, low libido, and depression. On the other hand, if estrone levels are too high, there is an increased risk for breast cancer and endometrial cancer. Evaluating estrone levels can give us key insight into lingering menopausal symptoms. 

Progesterone

Progesterone is typically secreted during the luteal phase of the menstrual cycle and is used to prepare the inner most layer of the uterus by thickening to allow a fertilized egg to implant. If a fertilized eggs implants successfully, progesterone continues to rise to support the progression of a healthy pregnancy. Progesterone suppresses the maturation of other eggs during pregnancy, and support milk production by preparing the breasts. In the case that fertilization does not occur, progesterone levels begin to decrease, which triggers menstruation to begin. Along with estrogen levels, progesterone levels steadily decrease throughout the years leading up to menopause. Synthetic progesterone has been shown to treat menopausal symptoms very effectively and reduces the risk of certain cancers when used in conjunction to estrogen as hormone replacement therapy. 

Luteinizing Hormone

Luteinizing Hormone (LH) is a hormone secreted by the pituitary gland in the brain. A feedback mechanism from lowering estrogen and progesterone levels due to failing ovarian reserves results in luteinizing hormone increasing. High levels of luteinizing hormone are common during perimenopause as estrogen and progesterone decreases, prompting the negative feedback mechanism to continue. LH can gradually increase over time, staying within the typical lab ranges but are functionally high for the person. 

Follicle Stimulating Hormone

Follicle Stimulating Hormone (FSH) is another hormone secreted by the pituitary gland in the brain. The same feedback mechanism from lowering estrogen and progesterone levels that cause increased LH, also increase FSH. Similar to LH, FSH increases gradually during perimenopause leading up to menopause. 

Cortisol3 

Cortisol is another hormone that can change during perimenopause. Due to the ongoing stress from physical symptoms, and mental health symptoms arising, females tend to have an increased stress response. Increased cortisol levels during perimenopause tend to increase the severity of hot flashes. This is why it is best to monitor cortisol levels in addition to other hormones during this transition.

Thyroid Hormones4 

Given that fatigue is one of the most common symptoms that arises during perimenopause, it is important to evaluate thyroid health at the onset of these symptoms. This can either rule in a comorbidity or rule out hypothyroidism as a potential cause of the fatigue. Lab ranges for thyroid health tend to be rather widespread, which is why it is best to work with a provider who can support getting your levels into an optimal range. 

Hormony’s Goals

As highlighted in our first article, our goals are to get a whole-body picture of a female’s health as they begin this transition into perimenopause, so we are able to get the appropriate support necessary. By evaluating not only the typical reproductive hormones, but other hormones such as thyroid hormones and cortisol levels, providers will be able to determine the best way to support a person’s health at this time. 

Many a times, we are told to find a “balance” of all our hormones. What does this even mean? Particularly during this phase of a female’s life, a new normal of hormone levels are being sought. Therefore, a perfect balance is not exactly achievable. The best way to support hormones is to get a proper understanding of what they are attempting to achieve, or why they are outside of the optimal ranges so that we can work together with our hormones to find that sweet spot where you are feeling your best. 

Citations

1. Cheng, C.-H., Chen, L.-R., & Chen, K.-H. (2022, January 25). Osteoporosis due to hormone imbalance: An overview of the effects of estrogen deficiency and glucocorticoid overuse on bone turnover. International journal of molecular sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836058/ 
2. Reproductive Hormones. www.endocrine.org. https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones#:~:text=Estradiol%20has%20several%20functions%20in
3. Woods, N. F., Mitchell, E. S., & Smith-Dijulio, K. (2009). Cortisol levels during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women’s Health Study. Menopause (New York, N.Y.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749064/ 
4. Yadav M, Kose V, Bhalerao A. Frequency of Thyroid Disorder in Pre- and Postmenopausal Women and Its Association With Menopausal Symptoms. Cureus. Published online June 24, 2023. doi:https://doi.org/10.7759/cureus.40900

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