Hormonal Havoc: Perimenopause Affects Women's Mental and Physical Health; Silent Symptoms you Can't Ignore

The human body undergoes several transitions, especially in women, such as puberty, reproductive age, perimenopause and menopause. Perimenopause is the transitional phase before a woman undergoes menopause which brings a lot of hormonal changes.

This period lasts until the ovaries stop producing eggs, during which time there is a decrease in the amount of estrogen, inhibin, anti-mullerian hormone etc they produce. Although some women may experience it as early as their mid-to late-30s, it typically lasts from about 42-50 years of age.

Does perimenopause affect cognitive health?

In an interview with HT Lifestyle, Dr Meghana Nyapathi, Consultant-Reproductive Medicine at Milann Fertility Center in Bengaluru, answered, “Yes, it does. During this phase, women’s ovarian hormones are seen to deplete. Ovarian hormones such as estradiol, a primary and naturally occurring estrogen hormone regulate female reproductive cycles and have many other roles in the body including the brain.”

Role of Estradiol in brain function
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Dr Meghana Nyapathi shared, “Estradiol directly influences the neurotransmitter function or reorganises our brain circuit along with blood flow to the brain, and synaptic plasticity all relates to changes in memory performance. Thus, women and men undergo different ageing processes, especially in early midlife when reproductive ageing is more critical for women than chronological aging. However, till now cognitive ageing was rarely considered a women's health issue.”

How brain adapts to hormonal changes?

Dr Meghana Nyapathi revealed, “It is also the phase when the glucose level in the brain starts reducing, and glucose is the primary fuel for brain cells to use. In case of reduced glucose availability ,the brain then looks to other metabolic sources to provide the necessary fuel to function—that is, the brain adapts to a new hormonal environment to maintain functioning.”

Perimenopause symptoms

Progesterone and estradiol are two important hormones in the regulation of menstrual cycle. Therefore, the menstrual cycle becomes irregular when the estrogen level is unequal at this time. Dr Meghana Nyapathi said, “This implies that the ovaries may not release an egg during some cycles, and bleeding may occur twice a month or once every two months. When a woman experiences change in the bleeding pattern or an infrequent menstrual cycle, it is the first indication that she is approaching menopause.” According to her, the following are the symptoms and issues noticed during this time:

• Hot flashes, which typically happen at night and involve a sense of extreme heat, perspiration, and a fast heartbeat, lasting for a few seconds to minutes.
• vaginal dryness,
• mood swings and
• sleeplessness
• ow estrogen may also result in recurrent urinary and vaginal infections. Additionally, she may have incontinence. i.e. unable to hold urine or stool because of reduced muscle tone. This may also result in low self esteem and mental health issues.
• decrease in bone density, leading to osteoporosis—which results in brittle bones.
• women may also experience male balding pattern as a result of an increase in testosterone relative to estrogen, which may also cause them to grow more facial hair.

Probabilities of further perimenopausal health problems

Dr Meghana Nyapathi said, “During this time, lipid profile also goes crazy, and increased LDL and triglyceride may result from decreased estrogen levels. Poor cholesterol levels are also a major risk factor for heart and brain strokes during perimenopause. The anticipated duration of this perimenopausal phase is five to ten years.”

Diagnosis

Dr Meghana Nyapathi pointed out, “In order to rule out a thyroid disorder, which can also result in hormonal imbalance, the doctor typically requests blood tests. Follicle-stimulating hormone(FSH) and AMH testing are the most common assays. Oestrogen levels fall and FSH levels rise during menopause. Another test that measures ovarian reserve is anti-mullerian hormone (AMH), which when low, indicates that a woman is approaching menopause. To assess the endometrial thickness and rule out abnormalities like cervical cancer, the doctor also requests specific blood tests and imaging.”