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Articles on Menopause & Perimenopause

Perimenopause (Premenopause) 

The period in which a woman's hormones begin to shift is called "peri-menopause". This can happen anywhere from the mid 30's to the late 40's. (It seems to be happening at a much earlier age in our current generation). During this period, the ability of the follicles to mature an egg and release it becomes more erratic, often 10 years before the actual cessation of menstrual periods.

Also during this period, the woman’s Hormones and brain signals to the ovaries are fluctuating.Menstrual cycles in which a woman does not ovulate are called anovulataory. If you are not ovulating, your ovaries are not producing any progesterone.

You may notice symptoms such as:

  • Weight gain

  • Water retention

  • Mood swings

  • Chronic fatigue

  • Depression

  • Heavy periods or very light periods or irregular periods

  • Insomnia

  • Thinning hair

  • Anxiety attacks

  • Acne

  • Dry skin

  • Headaches

  • Inability to handle stress

  • Low metabolism

  • Craving for caffeine, sweets and carbohydrates

  • Sluggishness in the morning

  • The beginning of hot flashes or night sweats

Why am I not ovulating?

Currently anovulatory cycles are very common in women even as young as their 20’s this is a new concept as the usual age for this to occur is in the 40’s. It is believed that the high levels of xenohormones in the environment are interfering with the brains ability to send out hormone-stimulating substances that cause the manufacture of hormones. The ovaries may be losing their ability to respond. The hypothalmus gland in the brain may be influenced by the xenohormones not to send out the signal for the ovary to ovulate.

During peri-menopause, menstrual cycles can continue, even though you are not making progesterone, so most women are not aware that lack of progesterone is causing symptoms. With anovulatory cycles, estrogen production may become erratic and you may experience periods of high estrogen alternating with periods of low estrogen. This is why your periods may become erratic with some much heavier than others.

When the estrogen is high, women may notice incidences of breast tenderness, mood swings, insomnia, bloating and weight gain. These are all symptoms related to estrogen dominance, a phrase coined by John R. Lee, M.D., an expert in the field of natural progesterone. The body is not making progesterone during anovulatory cycles, therefore, estrogen is the dominant hormone. Estrogen levels may be within a “normal” range on a blood test, but progesterone levels are too low and symptoms arise.

On the other hand, if your doctor takes a blood test on a day where estrogen has fluctuated to the low side, he or she may give the patient a prescription for estrogen. This often makes things worse.

Most medical doctors are focused on estrogen at this phase of a woman’s life, and do not check progesterone levels.

When a peri-menopausal woman presents at her doctor’s office with the symptoms listed above, she is very likely to leave with a prescription for synthetic hormones, either estrogen or birth control pills.

This can lead to a state of unbalance, specifically estrogen dominance which has been found to be linked to breast and uterine cancer.

What is happening to my hormones?

During the peri-menopause phase, your body begins to “down-regulate” your hormone systems.

Estrogen levels begin to fall and progesterone levels begin to fall. However, due to the outside influence of xenoestrogens, the balance is upset and symptoms of estrogen dominance can appear and usually do.

The earlier you begin to act to balance out the symptoms of peri-menopause, the easier it will be for you to stay in hormonal balance as you go into menopause.

One of the patterns that has emerged is that the more unbalanced a woman is in the 5 or 10 years before menopause, the worse her symptoms of menopause seem to be.

Progesterone: The Balancing Hormone

Progesterone has an opposing, or balancing effect on estrogen. Estrogen and progesterone each sensitize receptor sites for each other. Thus, the presence of estrogen makes body receptor sites more sensitive to progesterone and vice versa. According to Dr. John R. Lee, the addition of natural progesterone often eliminates the unwelcome symptoms and restores a woman to hormonal balance.

How to use Progesterone Crème during Peri-Menopause

According to instructions of John R. Lee, M.D.

Use from day 12 thru day 26 of the menstrual cycle (count the first day of bleeding as day 1).

If your period starts before the last day, stop using the crème and begin counting again to day 12.

It can be normal during peri-menopause to have cycles that are shorter or longer than usual.

If this is the case try to figure out the day when you expect your period. Count backward 14 days and start the crème. This will keep the use of the progesterone more in tune with your own particular cycle.

If your period does not come within a week after you stop taking the progesterone, consider the last day you took the progesterone as day 1 of a new cycle. Then begin on day 12 again.

If your periods stop for a total of 3 months in a row, begin to use the crème for 25 days of each month.


Velde, E.R. 1993 Disappearing ovarian follicles and reproductive aging. Lancet 341:1125

McKinlay, S.M. et al, “The Normal Menopause Transition.” Maturitas 14 (1992) 103-114

Rannevik G. et al. “A Longitudinal Study of the Perimenopausal transition: Altred Profiles of Steroid and Pituitary Hormones, SHBG and Bone Mineral Density.” Maturitas 21 (1995): 103-113

Sulak, P.J. “The Perimenopause: A Critical Time in a Woman’s Life.” International Journal of Fertility 41(2) (1996): 85-89