NATUROPATHIC DOCTOR IN ONTARIO
Is it PMS or Perimenopause?
How to tell if you are premenstrual or perimenopausal
PMS or Perimenopause?
How can you tell when your hormonal symptoms have left the PMS DEPARTMENT and entered PERIMENOPAUSE LAND? Honestly, it can be hard to tell, especially because a lot of perimenopausal symptoms look like exacerbations of PMS symptoms. Let’s dive into why that is.
Progesterone Deficiency in PMS and Perimenopause
Some women who experience premenstrual symptoms do so because they have a relative progesterone deficiency. Meaning, that instead of pumping out a robust amount of progesterone to counterbalance the high levels of estrogens circulating in the luteal phase of their cycle (the 2 weeks prior to their period), they are making a bit less of the estrogen-blocking hormone, leaving the estrogen to overstimulate some cells (such as breast tissue, leading to symptoms of premenstrual breast tenderness for example).
Symptoms of Low Progesterone in the Premenstrual Phase
- Breast tenderness
- Irritability, mood swings
- Premenstrual anxiety
- Insomnia, possibly accompanied by nightsweats
- Bloating (due to increased water and sodium retention)
Relatively low progesterone in the premenstrual/luteal phase also contributes to heavier periods, as estrogen’s stimulating effect on the endometrial lining is not adequately counterbalanced by progesterone, leading to the development of a thicker lining, which of course needs to be shed as menses.
What contributes to low progesterone?
- Age! From 35 years old onwards, even if a woman is ovulating monthly, she is likely making less progesterone than she did in the 2 decades prior. For some women this level gently declines, month to month, until she softly transitions to menopause around the age of 51. For other women this shift occur rapidly or erratically, and inherently is more symptomatic.
- Anovulatory cycles. Once the ovaries do get closer to retirement (the average age of the last period is 50-51 years of age, but this can vary by a decade or more on either side), they usually sputter rather than come to an immediate full stop. Meaning, an ovulation will be missed here and there. And remember, progesterone is only made once ovulation occurs, so if an ovulation is missed, it means that a women has the elevated estrogen levels that the body is making to attempt to ovulate, but without the secreted progesterone to match it, a woman will experience a delayed and eventually heavy period. This is why we often see women in perimenopause experiencing flooding periods, which can sometimes be so bad as to affect their work as they bleed through layers of clothes at the office.
- Stress. Progesterone can be converted to cortisol, and at times of chronically high stress, the adrenal gland may need to tap into the sex hormone system to poach some components in order to maintain an appropriate stress response.
And there are also many other factors that impact progesterone levels, like thyroid hormone, prolactin and cholesterol levels.
So is it PMS or Perimenopause?
So what does all of this mean? It means that low progesterone in the premenstrual phase is possible at any time in a woman’s life, and therefore can contribute to PMS at any time. However, for women over 35, and especially women closer to 45, a low progesterone balance is increasingly likely. Also, women at this stage of life are often deep into their careers, possibly juggling kids, and sometimes also caring for aging parents. Not only is there a physical disadvantage at this stage, but also severely constraining life circumstances that often shoot up stress (and therefore poach progesterone), but also hinder the woman’s ability to commit to the self care needed to smoothly navigate this tricky time.
Prioritizing the staples of health makes a HUGE difference for PMS and perimenopausal symptoms. Optimal nutrition 80% of the time, moving your body and making sleep king is an absolute must. I emphasize with my patients that if they want to be able to enjoy their retirement years, or if they want to be there for their kids as grandparents to their kids, they need to shift some of their efforts to self-care, otherwise the body just won’t run on fumes for that long. Beyond that, making sure any lab test results are addressed (if vitamin D is low, supplement with vitamin D, if thyroid hormones are off, correct that, etc). It is however an excellent time to consider bioidentical hormone therapy with micronized progesterone. At this stage a small top-up of progesterone can dramatically improve sleep, anxiety and periods. We add in just enough to counterbalance the estrogen levels, and at the same time work to improve the body’s ability to safely clear the excess estrogens. This is often life-changing for severely affected women. Curious about if bioidentical hormone therapy is a good option for you? Let’s chat 🙂
PMS vs. Perimenopause Self Test
Your Doctor: Meet Dr. Sarah
Dr. Sarah Goulding is a licensed naturopathic doctor in Ontario and has a BSc in neuroscience and biology from Dalhousie University (2004), and did her 4-year naturopathic training at the Canadian College of Naturopathic Medicine (2010). She’s since accumulated over a decade of clinical experience, and refined her practice to focus on women’s health and digestion. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).
Dr. Sarah Goulding blends science and compassion, and acts as a personal health researcher to help you navigate your health. Tools that she uses include nutrition, supplements and botanicals, bioidentical hormones, and lifestyle modifications. The closer you get to the root cause, the gentler the therapies needed to resolve the issue.
