Introduction

Most women in their 40s go through a phase called perimenopause. This falls between premenopause and menopause. Each of these stages differ greatly from one another. Women have normal menstrual cycles and no noticeable menopausal symptoms in premenopause. Menstrual periods then become irregular during perimenopause with few menopausal symptoms. In the end, a woman enters menopause which completely stops her periods.

Worldwide, around one billion women experience perimenopause and menopause every year. Both of the transitions can be extremely challenging. A lady going through perimenopause could constantly feel agitated and frustrated.

Every woman experiences the phase differently. Hence, treatment to manage the symptoms are usually customized. Bioidentical hormone replacement therapy (BHRT) is one such personalized treatment.

Symptoms of Perimenopause

Perimenopause lasts for four to eight years. A change in menstruation patterns, such as heavier or more frequent cycles, is one of the first signs of perimenopause. Changes also cause soreness in the breasts for many.

Common symptoms include:

• Mood changes: Irritability, anxiety, sadness
• Changes in sexual desire
• Trouble concentrating
• Headaches
• Night sweats
• Hot flashes
• Vaginal dryness
• Trouble sleeping
• Joint and muscle aches
• Heavy sweating
• Frequent urination
• PMS-like symptoms

Hormone Imbalances during Perimenopause

Progesterone and estrogen are important reproductive hormones. They are sourced by ovaries. Organs like the pituitary gland and hypothalamus regulate the hormones. Together, they form a network called the hypothalamic-pituitary-ovarian (HPO) axis. The axis balance is vital for timely periods.

Perimenopause is like the aging of ovaries. A woman's egg count decreases significantly. Moreover, the function of ovarian follicles (sacs that contain eggs) becomes irregular.

The HPO axis is disrupted in perimenopause. Alongside, estrogen levels fluctuate majorly. This is because of abnormal ovarian follicle formation and anovulatory cycles, which are cycles with no ovulation. As ovulation occurs less frequently, progesterone output falls. Endometrial hyperplasia, an unusual thickening of the uterine lining, and irregular menstrual cycles are caused by imbalance between estrogen and progesterone.

The unpredictable changes impact the rest of the functions in the body and manifest as several symptoms. For example, hot flashes and night sweats occur because estrogen fluctuations impact the hypothalamic thermoregulatory center.

Over time, the drop in estrogen becomes more severe. The decrease leads to an increase in Follicle Stimulating Hormone (FSH) levels. FSH production acts as a compensatory mechanism due to reduced negative feedback from ovarian hormones, intensifying symptoms.

Menopause is clinically confirmed after twelve consecutive months without menstruation. This period signals the end of ovarian reproductive function. Serum estrogen levels significantly decrease, and FSH levels remain consistently elevated.

Long-term Health Impact of Hormonal Imbalances:

Hormonal abnormalities that go untreated during perimenopause can cause problems down the road. Here are some common impacts:

Workplace loss:

Studies suggest that the symptoms can interfere with one's professional capabilities. This emphasizes the necessity of employer support.

Cardiovascular diseases risk:

Estrogen protects against heart diseases during reproductive years. Heart attacks, strokes, atherosclerosis, and hypertension become more likely by the imbalance.

Hormonal fluctuations also alter lipid metabolism by increasing bad cholesterol.

Lower bone density:

Bone density is altered. Lack of the hormones decreases bone mass and increases the risk of osteoporosis and may even lead to fractures.

Increased weight:

Weight gain is common during perimenopause. This increases the risk of metabolic syndrome, type 2 diabetes, and other obesity-related health problems. In addition, it leads to a decline in muscle mass and metabolism.

Mental health disruption:

Lack of hormones directly affects mental health. This can lead to mood swings, depression and anxiety. Unfortunately, they can last even after menopause, especially for women with existing mental issues.

Urogenital atrophy:

Urogenital tissues change as a result of an estrogen shortage. Urinary incontinence and vaginal atrophy may result from the modification. After menopause, these problems could get worse. Over time, it causes chronic discomfort, sexual dysfunction, and an increased risk of urinary tract infections.

Skin changes:

Estrogen influences skin health. Its reduction in perimenopause can result in thinner, less elastic skin with more wrinkles. Collagen decline can affect the overall health of connective tissues.

Impact on Well-being:

The symptoms can significantly affect relationships, career, and a woman's overall sense of self.

Limitations of Traditional Treatments for Perimenopause Symptoms

There are different types of treatments for perimenopause symptoms that act as a temporary solution. Some of them include:

Hormone replacement therapy:

Hormone replacement for perimenopause involves supplementing hormones into the body. For instance, estrogen therapy for perimenopause may help with vaginal dryness and hot flashes. But it increases the risk of breast cancer, stroke, and blood clots.

Progesterone addition could improve the results. But it can also cause mood fluctuations, weight gain, and bloating. Combination does not make estrogen therapy less risky. Therefore, hormone therapy for perimenopause may not be the best option for all.

Pharmaceutical treatments:

Antidepressants can be used to treat hot flashes, sadness, and mood swings. Common antidepressants are serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs). However, their side effects include nausea, weight gain, sexual dysfunction, and emotional numbness.

Gabapentin is used to manage hot flashes in women who cannot use estrogen therapy. Its may include dizziness, fatigue, and drowsiness.

Clonidine reduces hot flashes; but can result in constipation, dry mouth, and dizziness.

Bisphosphonates are employed to prevent and treat osteoporosis. However, long-term use may lead to serious side effects like jaw issues and femoral fractures.

Over-the-Counter remedies:

Supplementing with vitamins and minerals maintains good health and increase vitality. However, they may possibly interact with other medications and cannot completely avoid all symptoms.

Phytoestrogens and herbal supplements are commonly used for mild symptoms. Yet, their effectiveness is inconsistent. Moreover, they may also interact with other medications.

Non-prescription pain relievers, while helpful for managing headaches and muscle aches, do not directly address the root cause of the symptoms.

Benefits of BHRT for Perimenopausal Women (Bioidentical Hormone Replacement Therapy)

BHRT is a common treatment to manage perimenopause. It uses hormones that match those naturally made by the body. These hormones, from plants like wild yam and soy, copy the body's hormones closely. The approach makes them compatible and may also reduce side effects.

The aim of BHRT is not to forcefully raise hormone levels, but to gradually restore the natural balance. It mimics the natural hormonal changes that occur before perimenopause.

Customized BHRT Approach for Perimenopause

BHRT follows a step-by-step process:

1. Lab Testing: The doctor will order blood tests to assess present hormone levels (estrogen, progesterone, testosterone). This helps identify specific imbalances.
2. Personalized Treatment Plan: Based on the test results, the doctor will create a customized plan to address your unique needs. The goal is to adjust hormone levels back towards a balanced state.
3. Precision Dosing and Delivery: BHRT involves carefully calculated doses and delivery methods (pills, creams, gels, etc.). The best form depends on individual health and preferences.
4. Regular Check-ups: You'll have follow-up appointments to monitor your progress and symptoms. The doctor may adjust your dosage or delivery method as needed for optimal results.

How BHRT Addresses Perimenopause Symptoms

The versatility of BHRT is its standout feature. The doctor can customize an individual treatment plan based on the main symptoms. Here’s how BHRT helps deal with perimenopause symptoms:

• Hot flashes and night sweats: Restoring hormonal balance, mainly with estrogen and progesterone, effectively eases these symptoms.
• Sleep disturbances: Balancing estrogen and adding calming progesterone can improve sleep quality, leading to deeper sleep and fewer night sweats.
• Mood swings and depression: Stabilizing mood, reducing anxiety, and addressing fluctuations help ease symptoms with hormonal balance.
• Vaginal dryness and discomfort: Reversing the effects of reduced estrogen levels promotes lubrication and enhances sexual function.
• Brain fog and cognitive decline: Improving memory, focus, and concentration enhances mental clarity and cognitive performance.
• Bone loss and osteoporosis: Maintaining bone health and lowering osteoporosis risk, especially for those with a family history, is supported.
• Cardiovascular health: Estrogen's potential protective effects on the heart may be improved with BHRT.

Safety and Efficacy of BHRT for Perimenopause

FDA-approved bioidentical hormones are considered safe after rigorous testing. However, all hormone treatments, including BHRT, have inherent risks.

It carries risks such as:

• Potential increased cancer risk: Further research is needed, but some studies suggest a possible link between BHRT and certain cancers.
• Cardiovascular concerns: Blood clot formation and stroke are potential risks associated with BHRT.
• Worsening of side effects: Hormone imbalances caused by BHRT can lead to intensified side effects.
• Weight gain: Weight gain is a potential side effect of BHRT.
• Breast health concerns: Discussions about breast health are crucial when considering BHRT.
• Endometrial hyperplasia: This thickening of the uterine lining is a possible risk with BHRT.

Individuals considering BHRT should engage in thorough discussions with their healthcare providers to assess individual risks and benefits. If you're based in Canada, start your journey towards managing perimenopause with a convenient online consultation with S&H.

Get personalized advice on perimenopause treatment in Canada from the comfort of your own home. Online consultations offer flexibility, discretion, cost-effectiveness, and convenience compared to in-person clinic visits.

Importantly, the term "bioidentical hormone" used by some compounding pharmacies is often a marketing strategy, implying natural and superior qualities without concrete evidence. It goes without saying that compounded bioidentical hormone therapy (cBHT) should not be used routinely when FDA-approved options are available.

The current lack of adequate labeling for cBHT preparations, which excludes crucial information like usage instructions, contraindications, potential adverse effects, warnings, and responsible person/company details, hampers safe and effective use by both patients and prescribers.

Safety concerns also arise from diverse BHRT pellet formations and uncertainties in compounding difficulty. Limited pharmacokinetic and bioavailability data make evaluating safety, efficacy, and product variability challenging.

Well-designed clinical trials are needed for reliable evidence, as marketing claims often lack support. The link of perimenopause and BHRT may not be valid for everyone, especially those with a history of breast cancer or blood clots. Always consult a specialized healthcare professional to assess perimenopause BHRT options and potential risks and benefits.