19: Crazy Perimenopause Periods: What’s the Deal?
Don’t Miss An Episode!
In this episode, we covered:
- Common period and cycle changes in perimenopause
- Uterine fibroids, polyps, endometriosis and adenomyosis
- Is it estrogen dominance or progesterone deficiency?
- Can you “regulate” your periods in perimenopause?
- What’s behind painful & heavy periods?
- How your gut is tied to your periods
- 7 ways to improve perimenopause periods
- Supplements I recommend for heavy/painful periods
Understanding Perimenopause Periods
Welcome back! Today I’m diving into those crazy perimenopause periods. This will definitely shed some light if you’re in your late 30s-40s and your periods are starting to change.
Common Changes in Perimenopause
Some things you may notice in perimenopause are:
- Your cycle is shorter; maybe you always had a regular 28-day cycle, but now it’s getting closer together, like every 22 days.
- Your periods are heavier; you may notice a very heavy flow where you have to change your pad or tampon much more frequently or you may have some clotting
- Your periods are more painful; you get cramps and have to take pain meds
- You may experience spotting at the midpoint of your cycle or days before your actual bleed
- Your periods may be longer, lasting 7-9 days, when they used to be 4-5 days
- Your cycle may be longer, lasting 40+ days; you may only get a period every 2 months, depending on where you are in perimenopause (earlier or later stage)
- Your periods may be lighter and shorter, lasting only 2-3 days
So what’s the deal?
The Role of Progesterone and Estrogen
Progesterone is declining. This hormone is needed for a healthy brain, thyroid, sleep, mood, energy, fertility, AND you guessed it – healthy periods. Progesterone counter-balances the effects of estrogen. After 35, you’re more prone to anovulatory cycles (where you don’t ovulate), so you don’t make much progesterone.
Fluctuating Estrogen Levels
Estrogen, typically in your 40s, starts to fluctuate a lot. And without enough progesterone, the highs and lows of estrogen will be more pronounced.
Estrogen is not bad – we need it! But we also need ample progesterone to balance it out.
Understanding Estrogen Dominance
So you have unopposed estrogen, which by default, puts you in an “estrogen dominant” state, even if you have low estrogen levels.
And since estrogen is more stimulating, it can lead to growths like uterine fibroids or polyps and it can cause flare ups of endometriosis (when bits of tissue grow outside of uterus; please know estrogen doesn’t cause endo, but can exacerbate it) or adenomyosis (when uterine lining grows in muscle of uterine wall). All of these can cause heavier bleeding and painful periods, and can all be worse in this stage of life. Estrogen can be the highest it’s ever been in your peri years, before your ovaries eventually stop producing it.
Addressing Progesterone Deficiency
So while you may think you have “estrogen dominance”, it’s more about “progesterone deficiency”. Lowering estrogen isn’t necessarily the goal (especially in your 40s since we’re already losing this hormone which has detrimental effects on our health). Improving estrogen metabolism or detoxification is the goal. That includes gut work, opening detox pathways, and removing estrogen-mimicking chemicals from your environment. Essentially, you want to ‘use estrogen, then lose it’.
And of course you want to hang on to progesterone as long as you can and consider replacing it at some point. Food & lifestyle changes only get you so far in perimenopause. Once your ovaries slow down production of your sex hormones, they’re not coming back.
Benefits of Progesterone
And progesterone is such an incredible hormone, it’s safe and I believe most women should be on it, as early as their mid-30s. With the amount of stress we have nowadays and the chemicals in our environment that mimic estrogen, we need progesterone to balance it all out. And it has far more benefits than just protecting the uterine lining.
All that said, even if you’re on HRT, your periods can still be unpredictable in perimenopause. It’s not always realistic to “regulate them”. If you cycle your HRT, you may have better luck but even cycling it doesn’t guarantee you’ll have a perfect 28-day cycle every month. Some women opt for hormonal birth control to mitigate symptoms and try to regulate their cycle. No judgment, but I do not recommend it, as those are synthetic hormones, not bioidentical, which mimics the molecular structure of the hormones you produce naturally.
Managing Heavy and Painful Periods
While irregular periods are incredibly annoying, they’re a bit more tolerable than painful or heavy periods. So I want to cover those a bit more in detail…
About 14-25% of women experience longer (which is more than 7 days) or heavier than normal menstrual bleeding.
It can happen at any age, but you may find it gets worse in your late 30s – early 40s, with the changes in progesterone and estrogen, as I mentioned.
Causes of Long or Heavy Periods
Some other reasons behind long or heavy periods:
- Poor estrogen metabolism, when you’re not detoxing efficiently
- Anovulatory cycle (when you don’t ovulate, you don’t make progesterone, common with perimenopause and PCOS – which is polycystic ovary syndrome -when the ovaries overproduce androgens, “male sex hormones” – we have these, just typically in lower amounts
- Thyroid dysfunction; an underactive thyroid (hypothyroidism) can cause heavy periods or more frequent periods – with hypothyroidism, your pituitary gland can release more prolactin hormone, which suppresses ovulation; you won’t make ample progesterone; and you can end up with an excess of estrogen
- Pelvic Inflammatory Disease (PID), which is an infection of one or more of the upper reproductive organs
- Coagulation disorder – your body’s inability to clot blood, such as von Willebrand disease
Dealing with Period Pain
When it comes to period pain, this is caused by prostaglandins, which are hormone-like compounds produced as part of a healing process. When levels are high, excess inflammation and pain will occur. Progesterone reduces prostaglandins, that’s why we want it.
Hormones and Histamine
And unopposed or fluctuating estrogen affects something called histamine (this is released by mast cells and promotes inflammation in the body). Histamine also has an effect on pain. Many women notice histamine-like symptoms are worse in perimenopause, such as allergies, anxiety, insomnia, hives, skin rashes, itchy skin, brain fog, headaches, shortness of breath, nausea, and vomiting. I have an episode about histamine coming up, so stay tuned for that.
Bowel Movement Changes
Lastly, you may also notice changes to your bowel movements around your period.
During the first half of your cycle, or your follicular phase, estrogen slowly starts to rise, increasing smooth muscle contractions in your digestive tract. This is when you tend to have good poops and optimal digestion.
Follicular and Luteal Phases
In the 2nd half, or your luteal phase, about 2 weeks after your period, estrogen starts to dip and progesterone rises – if you ovulate, which as you know is spotty in peri.
Progesterone is a muscle relaxant, so things slow down, becoming difficult for your bowel to contract, and that can cause constipation. Constipation and acid reflux are common side effects when you start progesterone HRT. But typically they subside. If not, it likely means you need some gut support.
Not only are menstrual cramps influenced by prostaglandins, but so is your bowel! Higher levels of these prostaglandins result in more bowel contractions, and that’s when we have loose stool or what some women call “period poops”.
Improving Your Perimenopause Periods
So in a nutshell, to improve your crazy peri periods, you need to support a healthier progesterone/estrogen balance, which means considering progesterone HRT, make sure your detox pathways are open, replenish lost nutrients needed to support detoxification, and manage inflammation.
Functional Testing is a Guide
We teach you how to do all this in The Hormone Rescue, and we give clients access to functional testing like an HTMA minerals test and GIMAP stool test.
The GIMAP helps us look at your gut function, levels of bacteria, any overgrowths, infections, inflammation, and a marker called beta-glucuronidase.
Beta-glucuronidase is an enzyme that helps eliminate waste and estrogen from the body. When it’s too high, it’s problematic. To decrease levels of beta-glucuronidase, you want to improve the overall gut microbiome and eat foods high in glucuronic acid, such as apples, brussel sprouts, broccoli, cabbage, lettuce/greens and citrus fruits like oranges.
Fiber Over Supplements
Some clinicians like to use Calcium D-glucarate or DIM supplements, to support estrogen metabolism. But I don’t find these all that helpful and prefer clients to incorporate more fiber into their diet mostly via vegetables, fruits, and a fiber supplement like SunFiber, as well as support nutrients needed for detoxification.
ACTION STEPS:
- Assess and manage the stress in your life; I know this is so much easier said than done. But more often than not, women worry about things they cannot control, say yes when they should say no, and don’t prioritize self care. Please make time for this. You may also consider the use of adaptogens like Rhodiola, Ashwagandha, or Maca – I’ll link to the Maca brand I like in the show notes.
- Avoid extreme exercise – please don’t skip exercise; we need movement, but take some rest days. Consider a mix of strength training, walking and yoga or pilates.
- Eat enough whole foods and follow an anti-inflammatory diet – animal protein, healthy fats, lots of veggies and some fruit (listen to episode 18 for the perimenopause “diet” I recommend).
- Ditch endocrine disrupting chemicals found in plastics, fragrance, phthalates – these can contribute to estrogen excess
- Reduce or remove alcohol – it can lead to higher levels of circulating estrogen, creating symptoms of ‘estrogen dominance’ like heavy, painful periods; can reduce the production of progesterone; it messes with the liver’s ability to metabolize hormones, so excess hormones get recirculated in the body
- Some other supplements to consider: quality fish oil (I’ll link the one I like in the show notes), magnesium (a star mineral that supports hundreds of functions in the body), ginger/curcumin (anti-inflammatories), sulforaphane (which inhibits prostaglandins), or Boswellia, also known as known as frankincense, and is a great anti-inflammatory for pain relief.
- And of course, consider adding in bioidentical hormones, like progesterone.
OK, hope that helped and see you next week!
– Claudia
AS MENTIONED IN THIS EPISODE:
MACA: Grab the Maca I recommend HERE
FISH OIL: Grab the Fish Oil I recommend HERE (code: claudia123).
WORK WITH US: The Hormone Rescue Program
SOURCES:
https://www.nichd.nih.gov/health/topics/menstruation/conditioninfo/irregularities
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9717552
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901331/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818825/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473414/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994343/
https://www.ncbi.nlm.nih.gov/books/NBK499959/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924872/
https://pubmed.ncbi.nlm.nih.gov/16117603/
https://www.sciencedirect.com/science/article/abs/pii/S0965229918307969?via%3Dihub
Claudia Petrilli is a Functional Health Coach, Integrative Nutrition Coach, Women’s Health Educator, and creator of The Hormone Rescue program. Having experienced debilitating periods, digestive issues, a sluggish thyroid, a pituitary tumor, and perimenopause symptoms in her late 30s, she knows exactly what it’s like to get dismissed by doctors and spend years searching for answers.
To connect with Claudia Petrilli:
FREE GIFT: Peri-What?! The Must-Have Guide for Navigating Hormone Changes in Your 40s
WORK WITH US: The Hormone Rescue Program
QUESTIONS? EMAIL: claudia@claudiapetrilli.com
LOVE THE SHOW?! Please subscribe, leave a 5-star rating, review, and share, so that other women can find this podcast for guidance and support through their perimenopause journey!
