The menopausal transition 

Menopause is the transition period in a woman’s life from reproductive to postreproductive life. This transition is marked by 3 distinct periods: perimenopause, menopause and postmenopause, with the entire transition lasting up to 10 years.

Perimenopause is the commencement of the transition, marked by a gradual decline in reproductive hormones causing irregular menstrual cycles and other unpleasant symptoms. Perimenopause typically begins in the early 40s, however can begin as early as 35 years of age and can last several months to several years.

Menopause is officially defined as the point in time when a woman has not menstruated in 12 months. This typically occurs between the ages of 45-55 and marks the ending of reproductive life for a woman.

Postmenopause is the period after menopause when ovulation has ceased and many of the symptoms associated with perimenopause and menopause begin to lessen and eventually cease altogether.

Many women experience an array of symptoms throughout this transition period including: hot flushes, night sweats, brain fog, fatigue, low libido, vaginal dryness, difficulty sleeping and mood changes, among other physical, mental and emotional symptoms. These symptoms largely occur due to a decline in reproductive hormones, namely oestrogen, progesterone and testosterone.

Women’s reproductive hormones

Oestrogen

Oestrogen is often considered the primary female reproductive hormone, and is an umbrella term for three forms of oestrogen:

E1 (oestrone) - produced by the adrenal glands and fat cells, the dominant form of oestrogen after menopause.

E2 (oestradiol) - produced by the ovaries, involved in ovulation, thickening of the uterus lining. 

E3 (oestriol) - the primary oestrogen produced in pregnancy.

Production of oestradiol begins to decline in perimenopause, which largely contributes to the vasomotor or physiological symptoms. Beyond the reproductive system, oestradiol also plays a role in collagen synthesis, neurotransmitter synthesis, bone resorption and muscle mass. Declining oestrogen thus not only contributes to the negative symptoms of menopause, but can increase the risk of non-reproductive disorders such as osteoporosis and cardiovascular disease.

Progesterone

Progesterone is often referred to as the calming hormone, and plays a role in regulating the menstrual cycle and prepares the uterus for pregnancy. Progesterone has calming effects on the nervous system by interacting with GABA receptors in the brain, thereby regulating mood and promoting healthy sleep. Low progesterone is associated with premenstrual syndrome and premenstrual dysphoric disorder.

During the menopausal transition, progesterone levels decline more rapidly than oestrogen levels, which can cause symptoms of oestrogen dominance such as painful menstruation and tender breasts as the balance between the two hormones is mismatched, along with progesterone deficiency symptoms such as erratic menstruation and anxiety.

Testosterone

Testosterone is the forgotten female reproductive hormone as it is more commonly associated with males and male fertility. Nevertheless, women produce and require testosterone for healthy libido, muscle mass and mood amongst other functions. Some testosterone is converted into oestrogen, contributing to the pool of oestrogen in women. With age, testosterone production declines, leading to an equal decline in libido, muscle mass and mood.

Hope and relief for menopausal women

Whilst the decline of female reproductive hormones may appear to be an unpleasant process, a number of herbal medicines have been shown in scientific and traditional literature to reduce the symptoms of menopause and reduce the disease risk factors which are associated with this life period. Herbal medicines have a number of actions such as acting as phytoestrogens (plant oestrogens), supporting progesterone production, interacting with neurotransmitters to improve mood, regulating stress response and calming the nervous system. Working with a natural healthcare practitioner who can tailor a treatment plan for your specific menopausal concerns may produce the greatest symptomatic relief. In many cultures, the menopausal transition is revered as a time when a woman attains wisdom, and is a period which should be embraced.

Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679703/#:~:text=During%20the%20years%20preceding%20menopause,with%20low%20levels%20of%20estrogen.