Perimenopause Mayhem | Stress, Mood, Sleep

Back in my student days, I recall only two seminars that have really stuck with me to this day. One was seeing the genius women’s health advocate Ruth Trickey talk all things women’s endocrinology which blew my mind and forged my resolve to work in women’s health. The other, bizarrely, was one on perimenopause and menopausal endocrinology.

Bizarrely because at that stage, I was thinking menopause was too far in the future and not an area that held much interest for me when there were so many other things to learn about like PCOS and PMS and endometriosis (oh my!)

But this particular lecture had me hooked. Because for the first time, it taught me how intrinsic the adrenals were in the management of perimenopause. And it also taught me that women were different to men. And as such, we need to be treated differently that we had historically been treated.

What Is Perimenopause?

Watch the Video: All About Peri (menopause)

Perimenopause is the transitional period between the ovaries regularly ovulating each month providing us with our vital, juicy hormones, and their retirement (I think after 40 odd years of dedication they deserve their permanent long service leave!)

It can start from your late 30s to late 40s/early 50s and last anywhere between a 2-3 years up to up to 12 years for 1 in 10 women. For most women, symptoms of perimenopause will last around 4 years, and once you haven’t had a period for more than 12 months, it’s generally considered that you have reached menopause.

Perimenopause can be a time where your cycle fluctuates greatly and it’s not uncommon to experience longer, shorter or totally irregular periods with bleeds becoming lighter or extremely heavy.

And while this is a normal and natural progression of the loss of progesterone and oestrogen, the “in between bit” can leave us also suffering through hot sweats, night sweats and insomnia, weight gain, increased anxiety, depression and a prevalence of autoimmune conditions like Hashimoto’s. And a lot of these latter symptoms have to do with the tie back to our adrenals and the link to cortisol.

Physical Symptoms of Perimenopause

  • Insomnia
  • Hot flushes
  • Night sweats
  • Flooding + increased clotting
  • Shorter or longer/changeable cycle
  • Cessation of period for a few months or longer
  • Increased breast tenderness
  • Fatigue
  • Crawling or itchy skin
  • Headaches/migraines
  • Vaginal dryness/painful sex
  • Increased PMS symptoms
  • Low thyroid function/increase in autoimmune diseases
  • Weight gain

Emotional Symptoms of Perimenopause

  • Anxiety
  • Depression
  • Mood swings
  • Irritability
  • Reduced ability to cope
  • Loss of libido
  • Brain fog and forgetfulness

Nurturing our Adrenals in Perimenopause

In times of stress, our adrenals release cortisol, and through perimenopause, the hormonal fluctuations increase our vulnerability to stress. This heightened stress response and sensitivity to cortisol can be enough to not only increase the instances of hot flushes, but trigger or further exacerbate certain autoimmune conditions. 1

Another reason behind the need to nurture our adrenals is because once our ovaries stop producing oestrogen, progesterone and testosterone, we’re left with the adrenal gland to support whatever hormones we need in the second phase of our life. And the head honcho is a steroid hormone called DHEA.

DHEA is the “mother hormone” and it can convert into oestrogen and testosterone. However, it starts its natural decline in our 20s and unfortunately it’s hard to get it back. So the better our adrenal function and the less we demand our adrenals pump out cortisol, the better the production of these hormones to help us through menopause.

Tip: one of the best ways we can naturally restore DHEA is through the emotion of AWE (Heartmath Institute)

Natural Ways to Increase DHEA

Herbs like: Tribulus, Withania, Korean ginseng and Rhodiola increase both DHEA and testosterone. Testosterone is an anabolic steroid hormone meaning it likes to build. And both of these hormones are necessary for improved bone density, neuroplasticity, increased muscle mass, energy reserve release and mood and motivation through peri.

Natural Treatments for Perimenopause

For natural treatment of night sweats and hot flushes, read Herbs for Hot Flashes

We can also look to natural treatments to help support our adrenal and nervous system to help with mood, fatigue and overall coping ability.

Oestrogen is calming to the nervous system and important in reducing anxiety.

When we have low oestrogen, we produce a small corpus luteum (sometimes called a luteal phase defect) which means a small amount of progesterone is also created…

Some of the herbs we use to support oestrogen modulation include Wild Yam and Shatavari.

Progesterone and All About ALLO

Progesterone is also important in mood modulation as it creates a metabolite called Allopregnenalone. ALLO helps to regulate cortisol and create GABA, a calming neurotransmitter so both these hormones are essential in helping manage levels of anxiety in perimenopause. In fact, reduced progesterone and ALLO in cerebrospinal fluid has been linked to more severe mood disorders including:

  • PMDD – Premenstrual dysphoric disorder
  • GAD – Generalised anxiety disorder
  • MDD – Major depressive disorder
  • PTSD – Post-traumatic stress disorder. 2

Not only that, it’s thought that Progesterone and ALLO are involved in release of a stimulator of brain nervous tissues called BDNF, or brain derived neurotrophic factor. BDNF is important as we age as it protects against brain cell degeneration, aids neuroplasticity and improves nerve cell communication and survival. 3

So by improving the follicular (or first 2 weeks) phase, we encourage better hypothalamus-pituitary-ovarian (HPO) axis communication, more balanced FSH, better oestrogen levels allowing for a more robust ovulation, a bigger corpus luteum creating more progesterone, allopregnenalone and a better overall luteal phase to support sleep, mood, anxiety and brain health.

One of the best herbs to support the HPO axis and increase progesterone is Vitex agnus castus. Vitex helps build a healthy corpus luteum, decreases prolactin which can inhibit ovulation, and increases dopamine which can increase our mood and feelings of pleasure and motivation.

Vitex may also helps increase levels of melatonin which is our circadian rhythm hormone that helps us sleep. Both progesterone and oestrogen impact the production of melatonin, so decreases or shifts in these hormones may also reduce the amount of melatonin produced leading to insomnia and a crazy sleep cycle.

A Final Word on Emotional Support through Perimenopause

Some of our best mood supports are from nature and the combo of Hypericum perforatum, or St John’s Wort, and Actaea racemosa, or Black Cohosh have been successfully trialled showing reduced emotional menopausal symptoms and flushing, whilst improving sleep and sexual wellbeing.

1. Hoyt LT, Falconi A. Sci Med 2015; 132; 103-112
2. Wirth MM. Front Endocrino (Lausanne) 2011; 2; 19
3. Singh M et. al. Neuroscience 2013; 239; 84-91

perimenopause kate powe naturopath

Need help managing your perimenopause transition? Kate is a qualified naturopath who is passionate about helping women heal from hormonal havoc and inspiring women to know their own power, worth and wisdom.

Kate offers one-on-one Skype consults for irregular cycles, PMS and period pain, endometriosis, PCOS, peri-menopause, mood swings, fatigue and mental and emotional stress.

Simply drop me an email to see how I can help you!

6 thoughts on “Perimenopause Mayhem | Stress, Mood, Sleep”

  1. Hi Kate,

    Just stumbled across your very informative site. I am an RN and appreciate the feed back loops you explained in user friendly terms, lol..but have a question:
    Does DHEA protect the amygdala and in doing so reduces the anxiety and fear mode that seems to have taken hold of many of us menopausal and post menopausal women? I used to be such a super adventurous person , now at 58 ( or even 54 already) I react to everything and my motto seems to have gone from : jump in, then make it work..

    To : avoid, avoid, avoid..
    Feeling depressed, reactive, exhausted and never happy any more, running on adrenals only( which seem to have gone on hols long before pre sort of “rubber ducked” ( cockney for f%$#@) all the time, can’t cope well any more, keep to myself but it fuels anxiety as feeling isolated..

    Does wild yam ,which cannot be converted by our body according to many studies bar via a lab conversion, in drop form actually help progesterone levels?? Apparently the Diosin( ?
    of Wild Yam does not convert to progesterone in its natural form…

    Please advise
    Cheers, Birgit

    1. Hi Birgit,

      I’m not sure I know the answer as to DHEAs effect on the amygdala but it definitely declines somewhat dramatically post-30.

      As for wild yam, you’re correct. No amount of wild yam cream will do anything to make progesterone in your body (biochemically impossible). It can however have some impact on stress and anxiety levels (but that has nothing to do with it increasing progesterone).
      The confusion is bio/body-identical progesterone is made from wild yam (in the lab) and IS an exact match to your body’s own progesterone. Progesterone makes the metabolite allopregnenalone and this will have an effect on the GABA receptors in your brain (aka will calm you down, help you sleep etc) as well as reducing heavy periods/thinning the uterine lining.

      Best way to take progesterone for its full effect is an oral capsule (Prometrium or Utrogestan) from your doctor.

  2. Hi Kate,

    I’m going through perimenopause and started close to 3 years ago at age 44. With a passion for natural health but with symptoms getting to a point of more than I could handle i did some research and resorted to the big guns – the menopause centre in Sydney. They were fantastic and prescribed me Prometrium and Dim Plus. What a revelation! Really helped however my mind was always on loop saying “this is materialistic help, and drugs, a crutch for your body – you need to come off this stuff, your body should just work!”

    I then decided to stop taking these and went down the classical homeopathy route. My homeopath advocates for taking nothing except remedy – no coffee, tea, macrobiotic diet, meditation, hell even mint toothpaste was out!

    Whilst I know on some level stuff has come up and out, in the mean time my perimenopause symptoms have gone totally AWOL again and in fact worse. I haven’t slept for months, developed incessant tinnitus, I’m stressed out, eating sporadically as I’ve gained weight that I can’t shift (so I cycle between bingeing and fasting in a bid to get rid of the weight and recalibrate) so I find myself in a bit of a spot again (that’s putting it extremely mildly)!

    My question to you is, do you see taking Prometrium as harmful, as in long-term? Keen to get your thoughts from a naturopath’s perspective. I hate taking drugs, I won’t even take panadol but I can’t sustain the sleepless nights and feeling shit all the time. I’m currently seeing a naturopath here in Perth, WA but he too does not advocate for western synthetic drugs me thinks.

    I’d love some of your wisdom.

    Kind regards,


    1. Hi Yvette, thanks for your question.

      Remembering Prometrium (micronized or body-identical progesterone) is not a synthetic drug (unlike the synthetic ‘progestins’ such as Levonorgestrel in the Mirena IUD and some OCPs), I frequently refer my clients to discuss Prometrium with their GPs for peri-menopause.

      Micronized progesterone is brain, bone and heart protective and is perfect for peri where oestrogen is fluctuating significantly and we need to balance out the extreme highs of oestrogen (i.e. IMO this is not the time for combo HRT!) It also sounds like there may be some histamine issues with the tinnitus too (which can be exacerbated by high oestrogen amongst other things).

      Of course, I can’t offer you specific/personal advice without a consultation, but in general, ruling out any other contraindications, I see micronized progesterone as a very positive addition in the peri-menopausal phases (always looking at diet/lifestyle/herbal support/nutrient first 🙂

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