Surviving Perimenopause Hell

February 7, 2020

how to survive perimenopause hell

25%

That's a big number.

It's the estimate for the number of women that will experience a "debilitating" perimenopause transition.

We're not talking hot flashes here.

That belongs to the 50% of women that will have severe symptoms.

Somewhere between severe and debilitating is a big gap.

Roughly 1 million women are entering perimenopause each year (most with absolutely no knowledge that it's even a thing).

Thanks mom for letting me know!!

So...25% of 1 million means that roughly 250,000 women are going to have a perimenopause hell. Each year.

You're not alone or losing your mind. It's just that no one talks about it.

After I came out of the ether, I started to ask around and everyone had stories. Terrible stories (divorce, panic attacks, etc).

My story is here (lucky member of the 25%).

It almost broke me but it could have been so much easier and more manageable if I could go back in time (to my mid 40's actually) and let my younger self know what to do.

Much of the suffering was just fear of what I was feeling without an explanation or warning.

No one told me to expect this so I immediately went to catastrophic thinking (already in a state of 24/7 anxiety so why not).

Women will report from the frontline with descriptions like:

I felt like I died inside
I felt like my body was no longer my body
I felt like I was losing my mind

Again...we're not talking hot flashes.

Below is a condensed list of what to expect and how to address it...based on hard-earned experience.

Blood and tears really.

We'll cover these topics:

Why is perimenopause so hard for some women
Symptoms from perimenopause hell
When does perimenopause hell start
What do the doctors do during perimenopause
How to survive perimenopause
Do perimenopause symptoms get worse right before menopause

Let's get into it.

Why is perimenopause so hard for some women

With 250,000 women about to spiral physically and mentally, you would think medical research would be all over this.

Don't ask your doctor…..they'll likely have no idea.

The whole focus of our healthcare system for women is on reproduction.

My 2nd (of many) doctors told me that my estrogen level was just fine for a woman in menopause.

First, I still had a period (strike 1) and second, if you read up on what estradiol does across the body, there's no reason to let it drop.

We'll get to that later but why do some women get hit so hard?

In roughly 25% of women, there's a communication error between estrogen (in the ovaries) and upstream managers of it.

Primarily two hormones called LH and FSH.

FSH tells the ovaries to produce estrogen to get ready for an egg. LH then spikes to stop the process and release the egg.

In some women, this communication link gets broken.

Contrary to a gentle glide into oblivion for estradiol (our primary estrogen), it can spike to levels not seen since pregnancy.

And plummet back down.

Check out the full explanation at our perimenopause versus menopause guide.

It's a roller coaster ride.

Picture the heavy swing around the period (and driver of PMS) but magnified and extended over the years.

We can't blame mother nature (she's about to lose her gender with this one) since we were never designed to live past 50.

Go back to the year 1900 and the average life span??:

Male 47
Female 49

Perimenopause is a modern problem! The last 40,000 years never got there (or rarely).

Back to our lucky 25%.

In the background, progesterone has been dropping since your mid-30's. It's at about 50% by age 40.

It really takes a nosedive when you stop producing eggs since the egg release is the trigger for progesterone.

You can actually have periods going into perimenopause where no egg is released (called anovulatory periods).

Estradiol though is the real star of this horror show.

If there's one take away from this article, it's this.

Estradiol (the main driver of estrogen train) is critical to almost every system in your body.

There are two main facets of estradiol:

Pro-growth - helps to repair and replenish tissue across the body and brain
Housekeeping - master regulator of key hormones and neurotransmitters (at a minimum)

The big one we come across in research is serotonin.

You know...the "feel good" neurotransmitter.

That's not doing it justice.

It's tied to EVERY behavior that humans have.

What does this have to do with estradiol throwing a fit and leaving the party?

Estradiol is especially nurturing towards serotonin – it stimulates TRPH expression to ensure that enough serotonin is made and suppresses MAO A levels to prolong the longevity of the neurotransmitter.

https://www.zrtlab.com/blog/archive/impact-hormones-serotonin-depression/

That's just one pathway albeit, a very powerful one.

Many doctors will prescribe SSRIs as a result but there are downsides there as I found out the hard way.

Lexapro sent me into a psychotic break after 3 nights of no sleep.

See CBD versus SSRI for serotonin to understand what's going on there.

You can't underestimate the power of estradiol on how you feel. For our bodies, it's like oxygen! we did a huge review on estrogen and mental health here.

If you read through the detailed reviews we did for many symptoms of perimenopause, estradiol fluctuation was front and center and followed up by progesterone.

Let's look at some of those now just so you don't think you've contracted some alien disease.

Symptoms from perimenopause hell

Again, the biggest issue is when one of these symptoms hit you and you're not prepared for it.

My first taste was a panic attack during a PTO meeting.

I didn't really think about it but that was way back at age 45!

Another one followed at 46. They did the full heart scan as it felt like a heart attack.

Everything was fine there. I would later get 30-day heart monitors, ultrasounds, and a slew of blood pressure and heart meds that made me feel horrible.

The full-blown rolling anxiety (day and especially night) was crushing.

Of course, the doctors then put me on benzos which were equally brutal to come off of (see how I used CBD to get off benzos here).

Progesterone drives GABA (target for benzos). They just try to mask the symptoms of loss hormones!

Here's just a sampling of the perimenopause symptoms with deep dives into how hormones are driving them:

Goodness. It's pretty much everything and that's not the end of the list...just the most prominent issues we've researched to date.

Anxiety is a major one and it's the most common one we hear about from people.

The next set of popular symptoms from perimenopause in order of occurrence:

Sleep
Depression
Pain
Racing heart
Brain fog

I had all of these and that's not terribly surprising once you see the shared pathway.

The anxiety was really the lead role in this horror show.

I'm talking about a constant blast right into the night. I almost gave up.

Progesterone (bio-identical, oral) was the first thing to really start to bring that down.

The doctors are scared about estradiol due to a bogus report in 2002 that literally sent millions of women into the abyss. Read all about it at our Estradiol supplementation review.

We'll talk about the doctors below.

Just know that your symptoms can be incredibly varied (again, every system in the body) and incredibly bad.

You may also be in a heightened state where you immediately go to catastrophic thoughts (see CBD and negative thoughts or CBD and health anxiety).

I can't tell you the number of times I asked my husband:

Is this cancer?
Is this a brain tumor?
Am I having a heart attack?

Everything is through an anxiety filter!

And meanwhile, systems are going haywire in the far reaches of your body and brain.

I suddenly had heal pain so bad that I couldn't walk on my feet!

Email us or use chat box bottom right and we'll send over research we can find for a given symptom or let us know your story below for others to speak out.

Let's look at the timing of all this which is another source of confusion.

When does perimenopause hell start, end, and for how long

Every woman is different and we even see on Reddit boards where women will start in their late 30's or early 40's.

Usually, the early phase might begin around age 45-47.

There is some evidence that the symptoms are worse at the beginning and end of the perimenopause phase.

The average "active" phase may be the last 2-4 years.

The big signal (aside from your body and brain going sideways) is that your period will start to get irregular.

That's an indication that you're really in the thick of it and the symptoms might reflect this.

Perimenopause is officially over when you've had no period for 12 months.

Now, this assumes everyone is average and that couldn't be further from the case.

It can go longer, shorter, earlier, later, etc.

Generally, 47-52 is the average range for perimenopause.

Again, check out the perimenopause versus menopause comparison here for more guidance.

When the blocks start to fall...you're likely to see your GP and/or OBGyn. Let's go there now so you can be ready and informed.

What do the doctors do during perimenopause

I thought I was just unlucky with my experience across multiple doctors.

Then I read all the Reddit boards on women and their experiences.

Let's just say that our health care field is sorely lacking in understanding about perimenopause.

My suffering was probably doubled by the recommendation of doctors.

First, the GP's.

You'll likely go in with anxiety, racing heart, or sleep issues.

Keep in mind that your age 47 so their first thought should be hormones.

They may even run a simple hormone panel (not the Dutch test, the best of breed) and tell you what they told me.

"You're levels are fine for a menopausal woman".

Here's the next scene from this horror movie.

They'll likely prescribe benzos (see CBD versus Benzos) or jump right to SSRI's (see CBD versus SSRI's here).

The benzos (Ativan, Xanax, Valium, Klonopin, etc) are highly addictive and pump the GABA system.

Even the FDA frowns on their use now and they're only meant for a few weeks at best.

Read up on what progesterone does for the GABA pathway at our CBD versus Alcohol for perimenopause.

Alcohol is a major booster of the GABA pathway after progesterone leaves.

No wonder so many women are self-medicating with wine to get through perimenopause.

Most of our emails are from women trying to get off of benzos in their 50's and 60's.

Goodness, what has our medical field done?

When the benzos have to stop, they may put you an SSRI' (Lexapro, Celexa, Zoloft, Effexor).

This is to boost serotonin even though they can't test for serotonin levels in the brain.

You'll usually get a benzo for the first two weeks to "help till the SSRI kicks in".

That's dishonest or ignorant.

The SSRI can actually increase anxiety and depression during the first two weeks and we'll go through exactly why here at our CBD and Coritotrophin Releasing Hormone for anxiety article.

Here's the issue.

Serotonin is involved in so many systems and has very different effects depending on the brain (or gut) area.

Boosting it everywhere is like taking a sledgehammer to a Phillips screw.

The side effect profile sounds like a horror show or weirdness.

We even did a deep dive into SSRIs and suicidal or homicidal thoughts.

The bigger issue is this...whenever you try to boost a level in the brain of a key component, the brain pushes the other way.

It will actually drop its naturally occurring production of that chemical.

This the basis behind normalization (takes more and more to get the same effect).

That's why dosages have to be increased or SSRI's have to be switched out.

They have strict warnings about coming off of SSRI's on the back end since it can brutal.

I can attest to that. It almost broke me.

See How do SSRI's actually work here.

It turns out any benefit is via BDNF, our brain's fertilizer. Check out CBD and BDNF to understand why.

I also went through how I used CBD to get off of SSRI's.

In addition to benzos and SSRI's, you'll likely get thrown on a slew of other medications:

Blood pressure meds (see CBD and perimenopause racing heart and blood pressure)
Heart meds (same article above)
Sleeping aids (see CBD for perimenopause sleep issues). Just a head's up...most of them rip choline which is turning out to be a linchpin for dementia risk.

Basically, if you look at the list of symptoms, there's some medication out there.

At one point, I was on 5-6 meds which made me feel even worse.

Interestingly, getting off the bp and heart meds were brutal. My entire system had to reset.

Okay...so when you're done with that rodeo, let's look at what we found that actually helped.

How to survive perimenopause

We'll cover these areas:

Hormones for perimenopause hell
CBD for perimenopause hell
Siberian Rhubarb for perimenopause hell
Pregnenolone for perimenopause hell
Key nutrients for perimenopause hell
Other helpful tools

Hormones for perimenopause hell

First, there's no getting around hormones.

You shouldn't want to!

Look...estrogen is literally the vital force in a woman's body.

You essentially have two sets of symptoms that come with perimenopause (and continue into menopause in some fashion).

Loss of growth symptoms
Loss of regulation symptoms

We correspond pretty nicely with the two estrogen receptors in the body

You can see the loss of growth from atrophy or withering of various tissues.

Hair and skin are obvious
Urinary and vaginal tract are partially obvious in their results (incontinence, dryness, etc)
What about nerves, heart, bones, muscles, etc!!

You see those in the diseases that suddenly push women into first place for various diseases.

For example, we trail men for heart disease until….perimenopause/menopause.

Just one pathway...BDNF (builds and repairs nerves and brain cells).

Our results indicated that estradiol increased BDNF mRNA and protein levels in the presence of ethanol.

https://www.ncbi.nlm.nih.gov/pubmed/24650733

That was a study to look at how estradiol protects the brain from the effects of alcohol (see CBD versus alcohol for perimenopause).

Check out the various symptom pages but just the effects on the brain are reason enough.

Then there are the housekeeping symptoms (mood, sleep, heart function, etc).

We this clearly with our full review on Siberian Rhubarb which operates on the ERb receptor.

It does really well on symptoms like hot flashes, anxiety, etc.

Not so much for the atrophy symptoms.

The net-net is this...you need estradiol and when your doctor tells you that your levels are just fine….find another doctor.

They're not keeping up with the research and you can check out the estradiol review for that full history.

You want bioidentical (not synthetic).

Then there's Progesterone.

The two (estradiol and progesterone) are designed to have a yin/yang relationship going back to their function in reproduction.

One is pro-growth (make the place for baby to grow) and the other is anti-inflammatory (protect baby from the immune system).

That's why they turn off and on during the cycle.

There's a reason women are hit disproportionately with autoimmune diseases (almost a "female" disease).

And the likely time of diagnosis??? The 40's and beyond.

That's when progesterone, our immune calming master hormone, is dropping.

That's just one example (although powerful since every commercial is for an auto-immune disease these days).

Bioidentical progesterone...oral is fine there.

You need a good test to establish where you are and how your body is breaking these down.

The Dutch test is the gold standard although expensive.

Work with your doctor or naturopath but it's important to monitor levels as everybody is different.

CBD for perimenopause hell

We stumbled on CBD to help with the transition and there are powerful pathways directly affected by CBD.

It was a game-changer which is why we created this entire site and did 1000's of hours of research.

Learn all about CBD and perimenopause symptoms here but some quick takeaways.

Usually, the really debilitating symptoms revolve around:

Anxiety
Sleep
Panic Attacks
Depression
Heart racing

Of course, a general sense of being "off" is unsettling but that's "likely" serotonin!

In fact, most of these symptoms rest on serotonin imbalance and that's not surprising since estrogen directly controls its level.

Let's just look at CBD's effect on serotonin pathways to shed light on why it's so attractive during perimenopause.

Remember, we don't want to just jack up serotonin levels as that feels just as bad (maybe worse) as too little and then the brain goes the other way.

What does CBD do for serotonin?:

Overall, repeated treatment with low-dose CBD induces analgesia predominantly through TRPV1 activation, reduces anxiety through 5-HT1A receptor activation, and rescues impaired 5-HT neurotransmission under neuropathic pain conditions.

https://www.ncbi.nlm.nih.gov/pubmed/30157131

Let's break that down because it's too cool.

Basically, they caused nerve damage in rats, some of which were given CBD.

In the CBD rates, there was a reduction in pain sensitivity and anxiety via the serotonin pathway (5HT1A).

Here's the important piece for us.

The nerve damage essentially exhausted serotonin function which became impaired after the injury.
CBD "rescued" this pathway and reduced pain and anxiety as a result!

"Rescue" maybe our 2nd favorite word around serotonin because we don't want to hit it with a hammer.

Remember that during perimenopause, estradiol (and therefore serotonin) can spike and drop. By the hour even.

We want to support it when it's low and not when it's high.

If CBD only worked in one direction, we would see symptoms akin to serotonin syndrome (when it's too high) which is a very dangerous reaction from SSRIs primarily.

Go to the ER dangerous.

We don't see that with very high doses of CBD. It's used as needed substance in the very system (endocannabinoid system) that's tasked with balancing neurotransmitters.

You'll see this verbiage across the research such as:

In vivo microdialysis revealed that the administration of CBD significantly enhanced serotonin and glutamate levels in vmPFCx in a different manner depending on the emotional state and the duration of the treatment.

https://www.ncbi.nlm.nih.gov/pubmed/26711860

Let's decipher that because it's equally exciting.

In this case, CBD boosted both serotonin and glutamate (our brain's gas pedal) in a specific area...the prefrontal cortex (learn more about this in our CBD and anxiety guide).

Here's the interesting part…." depending on emotional state".

Benzos pump up GABA regardless of state. SSRIs pump up serotonin regardless of state.

One direction and not the band.

CBD acts like bookends on the low and high side for major neurotransmitters (dopamine, GABA, Glutamate, etc) which is important since they're all interconnected like a spider web.

This is likely why research is showing such a powerful effect on schizophrenia, a ridiculously complicated soup of mismatched chemistry and connectivity.

See CBD and schizophrenia here.

Again, go get real deep in the weeds on any given symptom.

We could spend all day on this here.

Let's look at some other helpful tools.

Siberian Rhubarb for perimenopause hell

Siberian Rhubarb (review here, buy here) is a great option outside of hormones to hit the estrogen B symptoms (hot flashes, sleep, mood, etc).

The Germans have studied it extensively and it's an awesome tool.

Personally, I take it before bed and it feels like a benzo (without the safety concerns).

We don't get the growth side of estradiol which is important but it's a workaround.

What about progesterone?

Pregnenolone for perimenopause hell

Bioidentical progesterone (oral) feels...so….good if you've been hit hard.

I take it before bed and I'm out!

Pregnenolone is a workaround option (review here, buy here).

It's the mother of all our steroidal hormones but it really drives progesterone and more importantly, allopregnanolone...the monster trigger for GABA (where Benzos operate).

It goes down as we get older and both genders can benefit here.

Let's look at some basics which are critical.

Key nutrients for perimenopause hell

Magnesium Glycinate This may be the key nutrient to help your body and brain during the stress of perimenopause.

I take 200-400 mg 2-3 times a day! The rule is that you're fine right up till you have GI issues.

It's amazing for migraines especially if you get the visual auras.

It's the only thing I've ever taken that can stop a migraine!

I know when I'm having estradiol fluctuations because I will have the visual shimmer in the corners of my eyes (early warning for migraines).

It's also great for sleep right before bed or if you wake up in the middle of the night.

B complex for perimenopause

All these systems above require B vitamins.

Throw on top of this that a good percentage of people do not process B vitamins well (MTRR or MTHFR) and that's going to tough during perimenopause.

These are your stress vitamins!

Methylated B vitamins are my goto.

Here's a list of other helpful aids:

Vitamin D - a steroid we get from sun; get tested
Curcumin - great for inflammation - Buy here
Berberine - protects gut barrier, the key to autoimmune and longevity (review here) - Buy here
Fisetin - powerful antiinflammatory - also longevity effects (review here) - Buy here
Tryptophan - raw food for serotonin - Buy here
Glycine - an amino acid - love it before bed - Buy here
NAD - energy supply at the cellular level
Exercise - try for 30 minutes at least 4 times a week; swimming is AWESOME
Mindful meditation - see exercise and mindful meditation for neurogenesis (brain repair)
Yoga or Tai Chi - similar to meditation
Forest Bathing - Japanese pastime of being in nature - interesting research

Of course, you have to eat well and watch sleep.

Check out the alcohol for perimenopause article since so many women are trying to make up for estradiol's drop this way.

Let us know what works for you...let's help each other!

I've personally been at the very bottom and it looks dire. I can also tell you that I'm 99% there and if one woman can avoid that hell, this is all worth it.

This glimpse into perimenopause is just the beginning. 'Dre's Story' offers our complete, research-rich journey into hormones, tools to feel better, and safety. The full Perimenopause Toolkit with new additions can be found Here. Please review so other can learn. Feeling better starts with understanding what is happening.