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What Is Pre/Perimenopause All About?

It can be a confusing time as hormones change and various symptoms start to appear, but is it pre/perimenopause or menopause itself? The late John Lee MD, who I was fortunate enough to work with on his London visits to talk about his work on natural progesterone, sheds some light.


A woman’s hormone balance can begin to shift at any time from her mid-thirties to her late forties, depending on a variety of factors such as heredity, environment, how early or late she began menstruating, whether she had any children (and if so at what age and how many) and her lifestyle. Was she exhausted trying to juggle career and family? Was she eating junk food, caffeine, sugar and alcohol or whole grains, fresh vegetables and fruits? Has she taken vitamins? Has she lived in the city or country? Was she exposed to toxins in the workplace?

Hormone balance is intimately connected to stress levels, nutrition and the environmental toxins encountered daily.

The ability of the follicles to mature an egg and release it may begin ‘sputtering’ so to speak a decade before actual menopause, creating menstrual cycles in which a woman does not ovulate, called anovulatory cycles. If she isn’t ovulating she isn’t producing progesterone from the ovaries and she may begin experiencing menopausal symptoms such as weight gain, water retention and mood swings. Menstrual cycles can continue even without the progesterone, however, so most women aren’t aware that the lack of progesterone is causing their symptoms. This is known as perimenopause or premenopause.

It used to be true that the majority of women began menopause in their midforties to early fifties. In the last generation however things appear to have changed. Women now may have anovulatory periods starting in their early thirties and yet do not experience cessation of periods (menopause) until their fifties. During this time the ovaries continue to produce estrogen sufficient for regular or irregular shedding, creating what is termed ‘estrogen dominance.’

Some women may go for years with irregular cycles and slowly wind down, or may just suddenly stop menstruating one month and never menstruate again. They may be overwhelmed with unpleasant symptoms or hardly notice what has happened other than not having to worry about birth control or buying tampons every month.

How menopause is experienced is as individual and unique as each woman.

During the many months of anovulatory periods, estrogen production may become erratic, with surges of inappropriately high levels alternating with irregular low levels. Periods of vaginal bleeding may become erratic, some much heavier than others.

When estrogen surges, women undergoing these changes may notice:

Breast swelling and tenderness
Mood swings
Sleep disturbance
Water retention
Tendency to put on weight

These may be the symptoms of estrogen dominance caused mainly by lack of ovulation and thereby lack of progesterone while their estrogen levels are still in the ‘normal’ range. Their doctors may check their estradiol levels and their FSH and LH levels, but rarely does it dawn on them that their patients’ progesterone levels are too low.

In taking the usual blood tests the doctor may find the estrogen normal that day or even a bit on the low side and FSH and LH levels a bit too high. On another day the estrogen might be elevated and FSH levels normal. If the former is found, the doctor may even prescribe some estrogen on the theory that the patient is nearing true menopause. The woman usually finds that this does not help her.

More often the doctor ascribes her complaints to emotional causes or simply some defect of Mother Nature that women must endure and I will discuss this phenomenon in later posts. For the present we will merely say that a rising percentage of women are experiencing premenopausal woes that are related to their hormones.


The late John Lee MD first coined the phrase ‘estrogen dominance’ and it is as relevant today as when he first wrote on the subject in his book ‘What Your Doctor May Not Tell You About Menopause’ from which this is extracted. It is still one of the best guides to Menopause by a dedicated and compassionate campaigner for women’s hormone health.

The views and opinions expressed on this blog are those of AnnA Rushton and do not necessarily represent the views of or Wellsprings Ltd