The rollercoaster of perimenopause and flushing

3 June 2022

The rollercoaster of perimenopause and flushing

Wildly swinging levels of oestrogen is the driving force behind many characteristics of perimenopause. I want to spend some time focusing on this lifestage, rather than menopause. Perimenopause is the transition period from our reproductive adulthood to menopause (1 year after the last menstruation), and can begin as early as 35 and end as late as 59, the uniqueness of womanhood can be seen right there!

It is normal in perimenopause to experience hot flushes, night sweats, sleep disturbances, sore breasts or lumps, arrhythmias, chest pains, anxiety, changes in flow and weight gain - but why?

The ovaries are being super stimulated (imagine a car at a set of traffic lights revving its engine to head off at breakneck speed once the lights turn green) and more eggs are “recruited” each cycle. As a result oestrogen levels become higher & unpredictable so ovulation, if it does occur, has lower-than-normal progesterone levels. In other words, we are in a state of unopposed erratic high & then plummeting low oestrogen. It’s quite literally a wild roller coaster ride.

Perimenopause potentially can be 10+ years, variable & unpredictable but is wildly different from menopause which is a situation of consistently natural low oestrogen levels.

While I can't say how long your perimenopause will last, there is a lot you can do & no one should suffer from lack of sleep or anaemia caused by heavy, frequent periods. Here are a few key points:

  • Exercise is beneficial in mitigating a lot of the unpleasant symptoms of perimenopause, including hot flashes & night sweats
  • Herbal medicine: there are many good herbal combinations and specific nutrients to help with symptoms. Some herbs promote progesterone so please work with a qualified practitioner.
  • Hormone therapy: for some, taking cyclical progesterone can be a game changer in perimenopause.



Let’s talk about the why’s of hot flushes in perimenopause

There are two phases to perimenopause, the Early Stage most often starts in women aged 40 to 44, can last up to 4/6 years, marked by persistent change of seven days or more in the length of your menstrual cycle. If you have a space of 60 days or more between periods, you're likely to then be in late perimenopause.

As we see in the diagram the early stage especially heralds erratically high & then dropping off levels of oestrogen against dramatically low progesterone.

The Hot flushes experienced by many, can be attributed to the dips in oestrogen on the perimenopause rollercoaster (from high to normal or normal to low). How do these plunges in oestrogen levels cause hot flushes? 

The plunges cause a release of adrenaline, a brain stress hormone. In normal function, adrenaline narrows the range of body temperatures in which we feel comfortable, called the thermoneutral zone.

In pre perimenopause & asymptomatic women there is a thermoneutral zone (about 0.4ºC), within which fluctuations of the core body temperature do not trigger compensatory mechanisms such as flushing or sweating.

In first stage perimenopause & symptomatic women, the thermoneutral zone is considerably narrowed due to elevated adrenaline activated by dramatic shifts in oestrogen, so that even minor fluctuations in core body temperature will reach the limits of the zone, and initiate a thermoregulatory response = Hello hot flushes 

A significant trigger of perimenopause hot flushes is the high-normal or normal-low fluctuations in oestrogen which in turn trigger adrenaline, narrowing the thermoneutral zone.

Oestrogen and progesterone also strongly interact with a number of neurotransmitters (Nt’s) adding to the flushing. When oestrogen dips, this causes a situation of lower levels of serotonin in the blood (oestrogen is needed to make these feel good Nt’s; serotonin & Dopamine - ahhh I hear you say, also why my mood is impacted!) Lower circulating levels of serotonin activates a chain reaction causing hot flushes.

So, implementing strategies that reduce adrenaline activation makes perfect sense. These are my 4 non-negotiable recommendations at this life stage to best manage the adrenaline surges:

  • Exercise (not excessive forms like HIIT)
  • Reducing mental stress - practice yoga or meditate for 15 mins a day
  • Stabilising blood sugar levels by eliminating non essential sugars in smoothies, fruit juices, cakes, biscuits and sweets
  • Giving up alcohol (sorry - but perimenopause is not a time to be drinking wine with the girls)

Hormone therapy can also be helpful, especially progesterone (Utrogestan) to oppose fluctuating oestrogen.

Research shows that 750mg a day vitamin C can help boosts progesterone levels

Magnesium bisglycinate boosts GABA which is the brain’s main calming or inhibitory neurotransmitter - calming the brain, reducing adrenaline, and stabilising the brain’s thermoneutral zone.

The amino acid Taurine is an excellent companion to magnesium for hot flushes. Like its partner magnesium, it calms the brain. It also supports healthy mitochondria, thereby helping to prevent the drop in brain energy associated with losing oestrogen.

Finally understanding your Nutrigenomic profile is SO important at this lifestage. We can assess: how well you are able to clear adrenaline & oestrogen or conversely make serotonin - using Lifecode Gx hormones & detoxification panels provide gold dust information to help support you.

In health,