Perimenopause is the stage where the levels of oestrogen and progesterone become unpredictable before the body fully enters menopause. — Freepik
Perimenopause marks the transitional phase leading up to menopause, often commencing as early as a woman’s mid-thirties, although it is most commonly seen between the ages of 40 and 44.
During this time, the body undergoes substantial hormonal shifts as oestrogen and progesterone levels fluctuate.
These changes can lead to various physical and emotional symptoms, impacting both well-being and quality of life.
Hormonal interplay
It is evident that understanding the dynamic interactions between key female hormonal players – thyroid (T3 and T4), oestrogen, progesterone and cortisol – is crucial for our overall health, especially during the perimenopausal phase.
Recognising how these hormones influence each other can significantly enhance our ability to manage health-related challenges during this transitional period.
This is especially as perimenopause can manifest through a myriad of symptoms, ranging from mood fluctuations to sleep disturbances and fatigue.
Oestrogen, primarily produced in the ovaries and existing in various forms, plays a pivotal role in regulating the menstrual cycle and supporting several physiological functions, including bone density and cardiovascular (heart) health.
As oestrogen levels decline during perimenopause, many women experience symptoms such as hot flashes, night sweats and mood swings.
Moreover, oestrogen significantly impacts thyroid hormone activity.
Elevated oestrogen levels can lead to increased production and altered metabolism of thyroxine-binding globulin (TBG), which binds thyroid hormones in the bloodstream.
Consequently, this can result in lower levels of free thyroid hormones (T3 and T4), potentially mimicking hypothyroidism, which is characterised by fatigue and weight gain.
This condition, often termed functional hypothyroidism, may not always be evident through standard lab tests.
Progesterone, the hormone that typically balances oestrogen, exhibits a predictable pattern during a regular menstrual cycle.
However, during perimenopause, this rhythm can become irregular, leading to a state of relative oestrogen dominance.
As progesterone levels decline more rapidly than oestrogen, women may experience anxiety issues, increased water retention, heavier menstrual bleeding and heightened anxiety.
Crucially, progesterone also plays a role in thyroid function, as it aids in converting T4 into the more active T3 form utilised by cells.
Thus, low progesterone levels can exacerbate thyroid-related issues during this critical transition.
Cortisol, often referred to as the body’s stress hormone, is produced by the adrenal glands and is integral to managing stress responses, metabolism and immune function.
Chronic stress and elevated cortisol levels can disrupt the hypothalamic-pituitary-thyroid (HPT) axis, further complicating thyroid hormone production and the conversion of T4 to T3.
This dysregulation can contribute to symptoms resembling hypothyroidism, adding another layer of complexity during perimenopause.
Given the pronounced impact of cortisol during this phase, it is essential to address stress management strategies.
Mindfulness practices, regular physical activity and balanced nutrition can help mitigate cortisol’s effects, promoting both physical and mental well-being.
The thyroid gland, often deemed the body’s thermostat, regulates metabolism and energy levels.
During perimenopause, fluctuations in hormone levels can significantly affect thyroid function, leading to common complaints such as fatigue and weight gain.
Therefore, monitoring thyroid health during this transition is vital, as understanding the interplay between oestrogen, progesterone, cortisol and the thyroid hormones is crucial for effective health management.
Managing symptoms
Symptoms experienced during perimenopause can vary widely among women.
The common ones include:
- Irregular menstrual cycles – hormonal fluctuations may disrupt regularity.
- Hot flashes and night sweats – these are hallmark signs of declining oestrogen levels.
- Emotional shifts – mood swings, increased anxiety and irritability are often reported.
- Sleep disturbances – night sweats and anxiety can lead to disrupted sleep patterns.
- Weight changes – hormonal shifts can alter metabolism and fat distribution.
Recognising these symptoms can empower women to navigate their perimenopausal journey with greater awareness and understanding.
It is also possible to help manage these symptoms with the following strategies:
A balanced diet is foundational during perimenopause.
Focusing on nutrient-rich foods, including lean proteins, fruits and vegetables, can aid in hormonal balance.
Incorporating phytoestrogens from sources like soy and flaxseeds can naturally help modulate oestrogen levels.
Additionally, a low-glycaemic diet can stabilise blood sugar and alleviate some symptoms.
Exercise is a cornerstone of effective perimenopausal management.
Engaging in a mix of cardiovascular, strength-training and flexibility exercises, including yoga, can alleviate stress, enhance mood and assist in weight management.
Implementing stress-reduction techniques is critical during this transition.
Mindfulness practices, such as meditation and breathing exercises, can lower cortisol levels and promote mental clarity.
Pursuing hobbies and activities that bring joy also significantly enhances emotional well-being.
Prioritising sleep hygiene is essential for maintaining hormonal balance.
Establishing a calming bedtime routine, minimising screen time before sleep and creating a comfortable sleep environment can significantly improve sleep quality.
Consultation with a healthcare provider specialising in hormonal health is crucial.
A tailored approach to hormone therapy, if necessary, along with monitoring symptoms, can facilitate effective management strategies.
Being proactive
The hormonal intricacies of perimenopause present both challenges and opportunities for women navigating this transition.
Understanding the roles of oestrogen, progesterone, thyroid hormones and cortisol can empower women to take proactive steps towards managing their health.
By focusing on nutritional choices, incorporating exercise, managing stress, ensuring good sleep hygiene and seeking professional advice, women can navigate this phase with confidence and resilience.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
