It's estimated that 25% of women will have debilitating perimenopause.
Even without the spiral down, I felt, almost 80% of women will experience symptoms and 50% of women will deal with severe symptoms.
The net takeaway?
You're not alone ladies.
I wish I would have known what we know now back in 2017 when I really felt like I was dying.
The doctors sent me sideways by writing scripts for the symptoms but never looking at the root cause:
- Benzos for intense 24-7 anxiety
- SSRI's when those didn't work
- Blood pressure meds for spiking BP
- Heart meds for heart racing
- Pain meds and boot for sudden, excruciating heel pain
Lexapro almost broke me (see CBD versus SSRI's)
It and other SSRI's are the de facto answer for the roughly 1 million women joining the ranks of the unencumbered (goodbye period!).
That may be a problem.
When's the last time your doctor ran a full hormone panel? A Dutch test or equivalent that shows all three estrogens and how your body actually processes the hormone?
It's part of your annual ObGyn visit, right?
Good luck with that.
My first doctor in this perimenopause nightmare told me that I was in menopause based on my zero estrogens and progesterone.
I still had a period back then!!
The lack of knowledge would be funny if wasn't so scary.
- The difference between perimenopause and menopause.
- How estradiol (our main estrogen) directly drives almost every pathway in your body
- The terrible misinformation on estrogen and progesterone replacement stemming from the 2002 "Red Scare" study.
- Interesting new tools like Siberian Rhubarb Buy here (estrogen substitute) and CBD
We have now spent over 100 hours studying all the various facets and symptoms of perimenopause.
Yes, we look at CBD since research there is fascinating but we dive into the mechanics of what's going on as well and note anything else we find of use.
Here's where we'll point to all those reviews for the benefits with perimenopause symptoms (and general health, right??)
Here's a list of extensive reviews of various topics tied to perimenopause in the form of questions and answers (below):
- What's the difference between Perimenopause versus Menopause (questions on when, how, why, etc)
- Why are some women hit so hard during perimenopause
- Can CBD help with perimenopause mood
- What are CBD's benefits for perimenopause sleep
- Can CBD help with perimenopause aches and pains
- Can CBD help with perimenopause weight gain and issues
- Can CBD help with perimenopause allergies or histamine response issues
- Can CBD help with perimenopause brain fog or cognitive issues
- Can CBD help with perimenopause fatigue and exhaustion
- Can CBD help with perimenopause blood pressure or heart palpitation issues
- Can CBD help with perimenopause neuropathy, tingling, and numbness
- Can CBD help with perimenopause anger and irritability
- Can CBD help with perimenopause migraines
- Can CBD help with perimenopause nausea
- Can CBD help with perimenopause anxiety
- Can CBD help with perimenopause depression
- Can CBD help with perimenopause panic attacks
- Can you take CBD and perimenopause medications together
- CBD versus SSRI for perimenopause
- A complete guide to estradiol supplementation and function during perimenopause
- Can you take CBD with hormone replacement therapy
- Can I take CBD on my period for PMS
- Does CBD increase estrogen
- CBD versus SSRI's for perimenopause
- Can you take CBD with perimenopause medications
- Can CBD help re-open window for HRT if started late (fascinating)
- Review of Siberian Rhubarb - Buy here
- Review of pregnenolone (precursor to all our steroidal hormones) - Buy here
- Review of berberine for perimenopause and longevity - Buy here
- Fisetin and perimenopause and/or longevity - Buy here
So….just a few topics.
Each of those is in-depth.
Before you jump to any of these, let's use this article to get the lay of the land so each specific symptom will make more sense.
Welcome to perimenopause.
It can either be brutal (like mine) or a manageable period that eventually settles down.
Below, we'll hit the highlights:
- The key questions on perimenopause: when, how, why
- What is really driving perimenopause
- Why perimenopause is so different from menopause
- Estrogen's key role in our health and wellness
- Progesterone's countering force to estrogen
- The importance of supporting hormone levels going into menopause
- Why perimenopause can lead to a better you! (seriously...you'll see why)
- Tools to make a bearable perimenopause happen
From there, you can jump to the symptoms above and we'll link where appropriate below.
Also, it took me, 5-6 doctors, to find the right one but my naturopath is a partner in all this!
She listens, advises, and guides and that makes a huge difference.
Make sure to find a good advocate for you as well. Some of this still requires labs and a doctor's script or two.
Let's get into it!
The key questions on perimenopause: when, how, why
There's so much confusion on just the basics of perimenopause.
None of our mothers ever sat us down and go through what to expect.
It's a strange badge of shame women carry around.
Only when you start to put your story out there do women just start falling forward with similar stories.
- I disappeared for 2 years
- I was in rolling panic attacks 24/7
- My divorce was due to perimenopause
You think the last one is in jest but we always research how people are searching on google and one of the top searches??
Perimenopause and divorce
So...knowledge is power. Let's tackle just the basics:
- What is causing perimenopause
- When does perimenopause start
- How long does perimenopause take
- Why does perimenopause happen
- How does perimenopause affect my health going forward
Here we go.
What is causing perimenopause?
The primary drive of perimenopause is a loss of two critical hormones:
- Estradiol (E2 - our main estrogen)
These two hormones govern the ebb and flow of our monthly cycles, reproduction, and a slew of pathways across our body and brain.
During perimenopause, our ovaries (the main source of their production) is shutting down.
The body will scramble to squeeze estradiol out of fat (part of the weight gain) but a significant loss of both occurs.
The process actually starts quite a bit earlier than most women realize (but may actually start to feel).
When does perimenopause start
The general range is from 47-50 years old (49 is average) but it's not uncommon these days to see earlier starts at 45 (and even earlier than that!).
Progesterone actually starts to drop much earlier and we're at 50% of our peak by age 40.
The fluctuation in estradiol is really the kick-off to full-blown perimenopause.
This can start a few years prior to actually losing our period.
We can even have periods and not make progesterone for a period of time (since no egg is released to trigger the progesterone release).
In a perfect world where women's health was studies and valued, we would take hormone panels starting mid 30's to get a baseline so we can track it.
If you look at the symptom list above, why on Earth would you not pay attention to this?
Our medical system looks at hormones strictly in terms of reproduction. Sooo short-sighted as you'll see below.
Once it starts, then how long?
How long does perimenopause take?
The "preamble" can run for 2-3 years on average during the "flux" stage.
This is when symptoms can really be severe as estrogen may go into a roller coaster ride (peaks greater than pregnancy and sudden drops).
The perimenopause versus menopause review really goes into what's happening there.
You may still have a period during the time but it can be irregular.
Bunched up. Missing. Longer/shorter than usual. It runs the gamut.
At some point, your period will go away completely and technically, we're done with perimenopause after 12 months of no period.
Doctors can test levels of other steroidal hormones to see where we're at in the process but the women who have the most severe perimenopause periods may have imbalances between these upstream hormones (FSH, etc) and estrogen.
This leads to the cat-and-mouse effect which research is showing at the heart of the perimenopause symptom severity.
Why does perimenopause happen
How much time do you have?
Technically, this is the transition to menopause when steroidal hormones like estrogen and progesterone drop to very low levels.
It's a ramping down of the ability to have babies.
The problem is that mother nature likes to co-opt systems.
In fact, it will use estrogen in women to carry out critical tasks that it doesn't do in men (where estrogen is present but at a much lower level).
Look no further than serotonin control which we'll look at below.
Talk about a game-changer - it's called the "feel good" neurotransmitter but that belittles its role in your health and wellness.
To zoom out a bit, a new piece of research looked at species that have a perimenopause/menopause (most don't).
Us and killer whales share this trait.
Basically, the thought is that it's advantageous to our babies to have grandmother help rather than having her own babies.
Again, these rules were written 10's, 100's of thousands, if not millions of years ago.
It's interesting though!!
How does perimenopause affect my health going forward
Perimenopause ends. Thank goodness.
Many of the symptoms tied to perimenopause above may subside or calm down with the transition to menopause.
But maybe not!
Look, estradiol and progesterone have their hands in the works of almost every critical system in your body.
Just look at any of the symptom links above to dive into a critical system (heart, brain, hormones, gut, etc).
We always start with how estradiol and/or progesterone operate in that space.
Next, the real confusion out there.
Why perimenopause is so different from menopause
It's all about flux.
Change in hormones are driving this train...right into a wall!
The transition from monthly cycles (pre-perimenopause) to no cycle and reduced hormones (menopause) can be traumatic.
Obviously, not for every woman but the 25% stat with debilitating transitions probably make up the most avid readers of this article.
Many of the symptoms of perimenopause listed above are tied not to levels of estradiol but CHANGES in estradiol levels.
Estradiol doesn't just slowly glide down into oblivion.
There can be erratic miscommunications with its upstairs boss FSH.
Last attempts to squeeze out another egg by juicing estrogen levels
A lack of response from the hypothalamus back to estrogen.
This can cause spikes and drops by the week, day, and even hour.
It's wild to have a sudden bout of anger or depression which resolves 20 minutes later.
Especially, if you haven't had this for the prior 48 years! (I promise).
Check out our review of perimenopause versus menopause to get the full story with research backing it.
The star of this play (it's a tragedy) is estradiol.
Estrogen's key role in our health and wellness
We really can't express just how powerful estrogen is for your general health.
First, understand estrogen's role in the body.
There are two receptors (ERa and ERb) with the following general attributes:
- ERa is pro-growth in all the good or bad that entails
- ERb is more of a regulatory agent across mood and other systems
We think of pro-growth as "cancer" but what's the opposite of growth?
Atrophy. Withering. Death???
Estrogen's effects are most notable in supporting skin and hair vitality but those same effects are in the brain, bones, heart….everywhere!
Let's take just one example (any of the perimenopause symptom links above will dive into subsystems).
Estrogen and serotonin and/or BDNF
This is such a far-reaching pathway that we'll drill down into one area.
It's incredibly relevant to women in perimenopause since the first line of medical offering seems to be SSRI's which boost serotonin (see how SSRI's really work).
SSRI's boost serotonin availability...temporarily until the brain offsets this one-direction approach and reduces receptivity (called normalization).
Estrogen has direct control over both the production (tryptophan) and removal of serotonin (MAO).
And...it's left the building...or it's simultaneously lighting the building on fire!
What your doctor may not tell you (or know, frankly) is that when researchers peel back the cover, BDNF is doing the heavy lifting of serotonin.
It's the brain's fertilizer. Actually, any nerve throughout the body.
When researchers block the enzyme (called task) needed only for BDNF, the anti-depressant effect of SSRIs and serotonin go away!
BDNF is pro-growth. Every time you learn something new (like what you just read), BDNF is released to build out the neuron connections to "lock" that new info in.
It's beautiful really.
Think of the impacts this has on scary perimenopause symptoms:
- Cognitive decline
- Memory loss
- Fatigue and exhaustion
The last two are intimately tied to brain maintenance effects of serotonin and indeed, BDNF.
Exercise and meditation both have their effects via BDNF as well!
Why haven't we heard of it? Not sure. You have now!
The important part of our discussion is that estrogen is "pro-growth" via serotonin and BDNF channels.
This may speak to how estrogen has such dramatic effects on supporting our brain (called neurogenesis) and the net results:
Thus, estrogen has striking effects that range from alterations in behavior [5–13], structure (spine morphology, density, and spine synapses; Table 2), and physiology (potentiation of glutamatergic inputs in area CA1.
Those are literally the components of building, repairing, and maintaining the "stuff" of your brain!
All from estrogen.
That's only one (albeit a powerful one) pathway estradiol supports.
The Siberian rhubarb review really goes into the ERb side of the coin since it primarily interacts with that receptor.
The Germans have studied it in detail with impressive results.
What about progesterone?
Progesterone's countering force to estrogen
Where estrogen is pro-growth, progesterone is pro-repair.
It has powerful anti-inflammatory support benefits throughout the body.
This makes sense if you look at the two hormones yin-yang effect in our monthly cycle.
Estrogen peaks before the egg is released (gearing up for making a baby).
Funny how mother nature also uses estrogen to boost libido right before this period as well.
Progesterone releases right after the egg is released and it calms the immune response so that the mother's body doesn't attack any new fetus and/or placental sac.
The placental sac is actually created by the father's genetics so technically, it is a foreign entity!
This immune and inflammatory calming effect is found throughout the body (again, mother nature co-opts existing tools).
Just one example I found to be critical during perimenopause for sleep symptoms.
Progesterone boosts GABA which is our "brake" pedal in the body.
It's critical for sleep and anxiety...two common symptoms during perimenopause.
Under placebo, blood sampling procedure was associated with marked sleep disturbances, which were considerably reduced under progesterone treatment: mean duration of wake after sleep onset was 53% lower, slow-wave sleep duration almost 50% higher, and total slow-wave activity (reflecting duration and intensity of deep sleep) almost 45% higher under progesterone than under placebo (P ≤ 0.05).
I take my bio-identical progesterone orally at night and it knocks me out!
The anti-inflammatory effect is critical across many symptoms:
- Perimenopause sleep symptoms
- Perimenopause anxiety symptoms
- Perimenopause allergies symptoms
- Perimenopause pain symptoms
Auto-immune is a key factor here and it's primarily hitting women (tie to hormones??) and is in flux during perimenopause and menopause.
CBD has interesting results of the pathways for various symptoms but what about the core levels of these hormones.
As I said, my first doctor (and many others) will say….
Your (low) hormones levels are fine for your age
Really? Let's go there now.
The importance of supporting hormone levels going into menopause
We're going to leave the heavy lifting to our estradiol guide but just a quick snapshot.
CBD can help with some of the imbalances left by estrogen and progesterone disappearing act but it can't directly plug in the holes in the dam.
Only estrogen and progesterone can carry this weight.
There's been such a scare in the medical community from a 2002 study that pointed to cancer and blot clot risk with hormone replacement therapy.
I take bio-identical oral progesterone and estradiol cream.
We wanted to really understand the risk and if you read any of our articles, we rely heavily on NIH research.
It's a fascinating bit of history on the hormone replacement front.
Reads like a thriller but with millions of women suffering ever since for no good reason.
Siberian rhubarb can address many of the modulatory roles of estrogen (ERb) but not the pro-growth side which is critical.
No growth is atrophy in the body. Women's bodies rely on estrogen for this push.
The environment, stress, chemicals, damage, etc are the insults and they're not going anywhere soon!
Look at the review and make your own decision.
I wish I would have known all this when my third doctor grabbed by the arm when I wanted to increase my bio-identical progesterone and told me, "You'll get a STROKE!!!".
At my worst point (summer of 2018), I was almost done.
A psychotic break from an ER prescribed nausea drug combined with my Lexapro (a known no-no) left me suicidal.
I felt so bad that I didn't want to be here anymore. Turns out that's a potential side-effect for SSRI's (See CBD versus SSRIs for suicidal and homicidal thoughts).
I can tell you that two years out after scrambling to learn everything I could about what was happening to me, I feel better than I have in a decade.
Looking at some of the research on fisetin and berberine to reverse epigenetic aging...I plan on feeling even better.
Let's look at why this can be a rebirth.
Why perimenopause can lead to a better you! (seriously...you'll see why)
During your 40's, we're stretched way to thin.
It's a never-ending state of need.
I fell victim to this constant drumbeat and didn't notice how my health was changing.
Remember that progesterone is dropping starting late 30's.
Even estradiol starts to see fluctuations in your mid 40's. You may not notice the wonky periods around then.
You're too busy!
Here's the deal...if you've read this far, you've probably hit the same wall I did.
This is good! A wake-up call.
Those lucky ladies who glide through perimenopause (or so they say...Thanks mom) don't realize that the vital force of estrogen and progesterone are no longer manning the ship.
The connection with later dementia, cancer, bone loss, and all the reasons that put women in nursing homes are well established now.
Mother nature gave you a wake-up call albeit with a nasty tone.
It's time to right the ship.
Here's what I did:
- Regularly check hormone levels to dial in appropriate supplementation based on my body's processing (critical!!....we're all different in terms of genetics and surroundings).
- Supplement with bio-identical estradiol/estrone and progesterone (oral)
- Supplement key pathways (see Dre's list for perimenopause supplements here)
- Exercise daily - just 30 minutes of swimming
- Mindful meditation - 10 minutes daily (see exercise and meditation for neurogenesis)
- Supplement with Siberian Rhubarb for cancer protection against estradiol (if it really exists...see estradiol review) Buy here
Listen to your body. You'll likely see effects very quickly with the hormones.
Finally, CBD is critical to my entire process.
We didn't start a CBD brand and then get perimenopause.
We started a CBD brand BECAUSE of perimenopause!
I tried 3-4 of the biggest brands and had a terrible allergic response (see CBD and perimenopause allergies).
40-60% of people have histamine issues and it goes up as we get older and for women.
Sound like perimenopause to you?
That's how we found CBD isolate and the rest is history.
We go into CBD's benefits across the various perimenopause symptoms above.
- Remember the serotonin pathway we looked at above for anxiety, depression, and a slew of pathways tied to perimenopause loss of estrogen?
- Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain.
Allodynia is heightened pain sensitivity.
There are many studies like this at our CBD and serotonin review or sprinkled throughout the perimenopause symptom reviews (since serotonin is key lever tied to serotonin).
I take 150 mg in the morning and 150 mg at night as 300 mg is the optimum level for neurogenesis (brain repair...hint hint BDNF).
What else can we do?
Tools to make a good perimenopause happen
Here's the snapshot list from Dre's list of supplements for perimenopause:
The net effect is this...information is power with perimenopause.
It can turn from the worst period of your life into a resurgence of personal and health vitality.
Once you understand what's going on and that you're not losing your mind or health....you can claw your way back out.
Check out my story here just as a confirmation that it's not just you and you're not falling apart.
THAT's how powerful estrogen and progesterone are.
Now...if the doctors would catch up, maybe half the population wouldn't feel like second thoughts.
Be well. Be informed. Let's take care of each other.
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.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.