Perimenopause: She’s Not Simply an HRT Deficiency
Perimenopause is a hormonal transition in a woman’s life that often occurs in the 8-10 years before menopause.
It is known as a time of “hormone chaos”, because hormones can fluctuate wildly during this time, often resulting in intense and disturbing symptoms.
Many women come to me and blame estrogen and progesterone alone for the symptoms they’ve been experiencing in perimenopause. However, it is important to note that estrogen and progesterone are not the only hormones that are shifting!
In perimenopause, we often see dysfunction in many other hormones, which can include insulin, cortisol, DHEA, testosterone, and thyroid hormones. There is actually an entire symphony of hormones in the background that have an impact on a woman’s ovarian function, and therefore, her estrogen and progesterone levels and their functionality.
If it was as simple as prescribing HRT alone (progesterone ± estrogen), then every woman in perimenopause would have complete relief in her symptoms. I’ve now been in practice for 13 years, and I know that it is never that simple!
It is essential that we build a woman’s health foundations, even if HRT is part of the plan. Individualized nutrition and lifestyle recommendations, targeted nutrient supplementation, and any indicated adjunctive therapies are the core of any treatment plan for a woman in perimenopause.
These foundational recommendations help to regulate the symphony of hormones (ie insulin, cortisol, thyroid hormones) that impact female sex hormones and perimenopausal symptoms. We will often see significant improvement in the intensity and frequency of symptoms when we work on the foundations, even if HRT is being used.
I will never recommend HRT alone, because a woman’s health in perimenopause is affected by an entire symphony of hormones that are impacted strongly by nutrition and lifestyle factors. I will always address nutrition and lifestyle factors, because they are truly the backbone of health in perimenopause.
In my experience, HRT can be an incredibly helpful tool in perimenopause. But I will say with conviction that nutrition and lifestyle medicine can be incredibly powerful, too.
-Dr. Melanie Reidl, ND
