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Four Common Types of Hormonal Imbalance – Perimenopause/PMS

by | Dec 18, 2020

Both PMS and perimenopause can cause debilitating symptoms which can be managed with Bioidentical Hormone Replacement Therapy (BHRT).

Here we’ll discuss the use of progesterone to help patients manage hormone-related perimenopause and PMS symptoms.

Estrogen Levels in Perimenopause

During perimenopause, estrogen production can go one of two directions, according to UBC’s Center for Menstrual Cycle and Ovulation Research (CeMCOR):

  1. It will steadily decline
  2. It can fluctuate wildly, and can even be much higher than normal levels at times

So in perimenopause ovaries may not be “shriveling,” (as is often assumed) but instead “hyperstimulated.”

Menstruating perimenopausal women may experience either a small peak in estrogen mid-cycle or a longer swell of estrogen around that time, the key symptoms being breast tenderness and slippery mucus.

Perimenopausal can also have an estrogen peak mid-cycle but not ovulate, where estrogen levels peak about a week after mid-cycle.

Higher estrogen production levels are likely correlated with stress hormones cortisol and norepinephrine.

Hot flashes/night sweats do not necessarily mean that estrogen is consistently low, but could be a result of a fast change (eg: from high to normal).

In the low estrogen type of perimenopause, there are no heavy periods or PMS-type symptoms, and periods become lighter.

Low-estrogen in perimenopause can lead to sleep disturbances, vaginal dryness, and low mood along with any other estrogen deficiency symptoms.

Progesterone Deficiency

Even though estrogen levels can be erratic through perimenopause, women can expect progesterone to decline in their 30s.

Progesterone is primarily made in appreciable amounts when women ovulate, approximately 20-25 milligrams daily. (Smaller amounts are also made by the adrenals and CNS.)

Progesterone receptor sites are all over the body, which means that this type of hormonal imbalance can affect many different functions, including:

  • Cognition
  • Mood
  • Inflammation
  • Mitochondrial function
  • Nerve cell development
  • Myelination
  • Adrenal hormones

Symptoms of a progesterone deficiency will affect women on a physical, gynecological, and emotional level.

Physical symptoms or related conditions: Gynecological symptoms or related conditions: Emotional symptoms or related conditions:
  • Weight gain
  • Low body temp
  • Headaches
  • Poor thyroid function
  • Hair loss
  • Fluid retention
  • Allergies/sinusitis
  • Bone loss
  • Increased risk CAD
  • Acne
  • Facial hair
  • Foggy thinking
  • Heart palpitations
  • Night sweats
  • Sleep disturbances
  • Breast pain/cysts
  • Increased risk of breast cancer        
  • PMS
  • Fibroids
  • Heavy cycles
  • Irregular cycles
  • Cycles too frequent
  • Endometriosis
  • Cramps
  • Anxiety
  • Depression
  • Irritability
  • Tendency to be stressed   easily
  • Mood swings

Progesterone deficiency is common during perimenopause and menopause when ovulation ceases or sputters. It can also result from oophorectomy, birth control pills, stress, thyroid problems, or nutrient deficiencies.

Progesterone Administration for PMS/Perimenopause

Progesterone deficiency as identified by symptoms and lab results can often be simply alleviated by replacing progesterone with bioidentical progesterone cream or capsules by prescription to a compounding pharmacy.

Comprehensive lab testing that distinguishes between hormones bound to carrier proteins and unbound “free” or “available” hormone levels is the best choice when it comes to testing hormones.

This is important because these types of tests correlate with tissue levels of hormones. This includes capillary blood spot, saliva, or dried urine test.

Because perimenopause has traditionally been associated with a drop in estrogen, HRT treatments in the past may have pointed to an estrogen-progesterone combination.

But given that we now know estrogen can actually become elevated or fluctuate between high and low, progesterone can greatly benefit these patients. It helps offset estrogen dominance as well as helps estrogen receptor sensitivity.

Progesterone is usually effective if women have a very heavy flow, PMS symptoms related to higher estrogen levels, or overly-frequent periods.

For perimenopausal women, common starting doses utilized by BHRT providers is 20mg for a topical cream or 100-200mg sustained-release capsules used days 5-26 (or 7-28) of the cycle.

For younger patients, some providers prefer to add progesterone in days 12-26 (or 14 -28).

Learn More About the Benefits of BHRT Progesterone

I have used progesterone cream for 27 years, and it’s definitely helped my sleeping patterns, mood swings, and much more.

When prescribed effectively, progesterone BHRT solutions help to balance estrogen fluctuation and can ease other symptoms common with perimenopause and PMS.

Health practitioners should learn about comprehensive testing and to test and administer progesterone for individualized treatment to help their patients not just cope with symptoms, but improve their overall outlook, mood, and well-being.

This simple and accessible treatment could make a huge difference in their lives.

Considering adding BHRT to your list of services? Schedule a free strategy call.

Enjoyed this article? Here are three more to help you:

5 Reasons You Should Learn to Prescribe Bioidentical Hormones
Bioidentical Hormone Replacement Therapy: Frequently Asked Questions
Pros and Cons of Different Dosing Forms of Bioidentical Hormones

This article was originally published in 2019, and has been updated for 2020!

Get the quick read ebook,

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Key Insights to Prescribing and Implementing BHRT. 

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