Carrie, a 53-year-old woman, complained of exhaustion, brain fog, anger, and poor sleep to her integrative functional medicine doctor. She suspected it was due to her hormones, but her periods were still regular, and she showed no signs of menopause that she could see.
She didn't experience hot flashes, and her periods were average in length and frequency, however her blood flow was noticeably higher when she menstruated. She had already seen her PCP for this problem, and her blood testing revealed that she had normal thyroid function, normal blood counts, a complete metabolic profile, vitamin D, and no evident abnormalities. Carrie's PCP suspected depression, but she didn't agree with the diagnosis and couldn't escape the notion that her hormones were out of whack.
Work in the lab (1/25/20)
A salivary hormone panel by ZRT was acquired during her luteal phase because she is still cycling (day 19-21 of her cycle). Her test results indicated normal estradiol levels, a considerable drop in progesterone, and a much lower progesterone-to-estrogen ratio.
Early perimenopause is characterised by normal or high estradiol levels and low progesterone levels. During the early stages of perimenopause, over 20% of women experience difficulties sleeping, cognitive impairments, and mood disturbances.
Interventions
We began by boosting her progesterone levels because her oestrogen was normal and she continued to experience cycles. On days 14-25 of her cycle, she began taking Prometrium 100mg qhs. Progesterone supplements may be a highly functional treatment for early symptomatic perimenopausal symptoms, and Carrie saw a big difference after only a few weeks. Her sleep had improved drastically, and she felt calmer, more resilient, and more like herself.
Work in the lab (10/23/10)
She returned nine months later to have her blood checked now that she was on progesterone.
Her estradiol level remained unchanged. Her progesterone level increased from 14 to 74, which is an improvement, but she is still on the low end of the normal range. At 24, her progesterone-to-estrogen ratio was still low (optimal is 100).
I upped her progesterone to 200mg qhs and only had her take it on days 14-25 of her cycle. Carrie informed her doctor two months later that she was feeling great, that she was back to normal, and that she wanted to stick to her present treatment plan for the time being.
After a Year
A little more than a year later, Carrie returned to the clinic. She hadn't had a period in four months and was experiencing night sweats as well as feeling angry and worried. She was having difficulty concentrating at work and had lost all interest in sex.
(09/18/21) Follow-up lab work
Her oestrogen levels have now plummeted to 1.1pg/mL (normal is 1.3-3.3 pg/mL), according to her test results. This is consistent with her symptoms, particularly the night sweats and lack of a monthly period. She has made the transition from perimenopause to menopause.
Interventions
May help Carrie get through this difficult time, I started her on a low-dose estradiol patch (0.025 mg/day) and increased her progesterone therapy to a daily 200mg micronized progesterone tablet.
Carrie noted an improvement in her mood and less night sweats after a few weeks on this regimen, but she isn't completely back to normal. In the future, we may need to alter her dose even further. She'll have to return in three months to retest her levels and evaluate how she's progressing.
Summary
Many women find the shift from perimenopause to menopause to be an unpleasant experience. Although menopause is defined as the absence of a menstrual cycle for a period of twelve months, hormonal changes may begin years before a woman misses her first period. These hormonal fluctuations may cause changes in sleep, mood, and cognition, all of which may have a big impact on a woman's happiness and health. Hormone testing may helps practitioners to detect these changes early on and related actions that may enhance a woman's quality of life significantly.
The article "An Integrative Functional Medicine Approach to Perimenopause: A Case Study" was appeared first on Rupa Health
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