The words pre– and peri-menopause are used to describe the years leading up to (and one
year after) the last period ever, when the levels of reproductive hormones become lower
and more erratic, and symptoms of hormone withdrawal may be present. Perimenopause
literally means “around menopause”. Symptoms of menopause can begin as early as age
35, although the majority of women who become aware of them about 10 years later.
Thus, perimenopause can last for a few years, or for even longer than ten years, since the
average age of menopause is 51 years old.
It is commonly believed that the decrease in estrogen and progesterone are responsible
for the “symptoms of menopause” that many women endure, such as hot flashes. More
accurately, it is the result of unpredictable fluctuations in hormone levels due to the loss
of the Pituitary – Ovarian feedback loop. As women age the ovaries alter their response
to “Follicle stimulating hormone” Follicle Stimulating Hormone (FSH), which is
released by the pituitary gland. As the coordination between the two is lost, less estrogen
is made by the ovaries, and it is made less consistently. FSH levels increase, and are
often used to diagnose whether a woman has reached menopause. Menopause itself, is a
natural life change, not a disease state or a disorder, and terms like “diagnose” can make
women feel that they may not control of this process, which is certainly not the case. Hot
flashes for example, are triggered by fluctuations in estrogen, rather than an estrogen
deficiency. Hormone Replacement Therapy (HRT) can decrease the experience of hot
flashes by raising hormone levels above the natural fluctuations – thereby keeping
hormone levels more consistent. No fluctuations – no hot flashes! (However, the
increased risk associated with hormone replacement therapy, breast cancer, heart attack,
and stroke is still debatable. For more information see the Women’s Health Initiative
(WHI) study.)
The human body is quite amazing and usually does not need replacement therapy.
Women’s bodies are actually created with the physiology to support them through
perimenopause! Unfortunately our stressful lifestyles and diet often deplete this natural
resource we have within our bodies. The adrenal glands, two little glands that sit above
our kidneys, are responsible for producing the majority of estrogen during menopausal
years. The adrenal glands are more well known for producing epinephrine and
norepinephrine, commonly known as adrenaline, as well as cortisol – the ‘stress
hormone’ and DHEA – the precursor of our sex hormones. Our overtaxing lives often
have our adrenal glands working overtime, depleting their capability to manufacture sex
hormone precursors. Androstenedione, which is produced by the adrenal glands, is
converted by the enzyme Aromatase in our fat cells into Estrogen. This is the primary
source of estrogen in menopausal women, as the ovaries decrease their production of

Although more body fat does not translate to more aromatase activity, women with very
little body fat may experience more hormonal issues. Other contributing factors include
lifestyle concerns such as insulin resistance and hypoglycemia, possibly secondary to
diet, exercise / overtraining, and stress levels. These demanding conditions create an
“adrenal cascade” as the adrenals can only produce a fixed amount of the essential steroid
Pregnenalone per day. During times of stress the body is more concerned with survival
than reproduction. Therefore, sex hormones are one of the first to be sacrificed.
Other common symptoms of menopause such as depression, bone loss, and mood swings
have also been linked to adrenal imbalances. Sleep difficulties are associated with
cortisol levels – high cortisol levels hinder the ability to fall asleep; and low cortisol
along with hypoglycemia, are linked with inability to stay asleep, as well as waking up
tired even after sufficient sleep time. Cortisol also increases the body’s sensitivity to
adrenaline, so irritability and heart palpitation symptoms may additionally be correlated
with adrenal imbalance. Some women also experience pseudo-hot flashes where they do
not experience a temperature change, yet sweat excessively. This is also a sign that the
adrenals are involved and are in a maladaptive state.
Lifestyle changes that address blood sugar stability; adrenal fatigue; gastrointestinal
issues including food allergies, leaky gut syndrome, gall bladder conditions and essential
fatty acid nutrition; as well as liver clearance and detoxification of medications and
hormones are prime areas for improving overall health and wellness. Modifications in
these areas can have profound effects in decreasing the symptoms of menopause. Just a
simple assessment of metabolic functioning and some guidance on how to implement a
few lifestyle changes can be life altering.
Dr. Jacqui Slavin D.C. of Functional Wellness in Edwards, specializes in Functional
Endocrinology and addresses the physiology of hormone imbalances by assessing organ
system function and determining areas in need of optimization and modulation. For an
initial consultation, please call 970-376-7779 to schedule an appointment.