EP.381/ Early Perimenopause Changes and Symptoms for Endometriosis Patients
Last week I talked about why those of us with endo may be experiencing earlier perimenopause, and why we’re at greater risk of early menopause and Premature Ovarian Insufficiency. This week, in case you’re in this group, I wanted to share what is happening in the first half of perimenopause and the symptoms to look out for, as for us endo peeps, they’re a bit different from the average.
In roughly the first half of perimenopause, we start to experience the following hormonal changes:
Follicle stimulating hormone starts to increase as oestrogen levels very, very gradually begin to drop in our early 30s. The FSH rise occurs because our body attempting to stimulate more oestrogen production.(1)
This increase in FSH triggers fluctuating levels of oestrogen, and these levels can be significantly higher than our normal levels.
Luteinising hormone which triggers ovulation also fluctuates in attempt get our ovaries to ovulate.
Progesterone begins to go down because we’re are beginning to skip ovulation on some cycles, and because the corpus luteum which is developed after ovulation and produces progesterone, is no longer able to release sufficient progesterone as our ovarian function begins to decline.(2)
So, how does this manifest in terms of symptoms for us endo folk and girlies?
Cycles start to shorten - they may begin with just one or two days so for example, 30 days becomes 28, 28 becomes 26 and so on. This may not happen each month, some months will be your normal time frame and then you may get random shorter or longer cycles.
You may notice you start to get the occasional anovulatory cycle (lack of ovulation) or your body has to attempt a few times to get a successful ovulation.
Endo symptoms can worsen or return due to higher oestrogen levels and this is often why clients come back to me if we’ve worked together in the past.
Oestrogen dominance symptoms can worsen or appear due to elevated oestrogen levels and/or lower progesterone levels - breasts become tender and more swollen, PMS is worse, water retention may increase, periods become heavier or clots are bigger or increase.
ADHD, which us endo folk are almost twice as likely to have, may worsen due to the way that high and low oestrogen levels affect the brain and neurotransmitter levels. Additionally, research has found that those with ADHD experience an earlier onset of perimenopause symptoms, typically between 35-39 in contrast to those without ADHD, who experienced perimenopause between 45-49. Unfortunately, the recent research also found that symptoms tend to be more severe for those with ADHD than those without, including mental symptoms like depression, somatic such as insomnia and urogenital symptoms such as bladder issues. (3)
Research has also found that PTSD symptoms are worse in perimenopause (and I wanted to raise this because I have many clients who have PTSD related to medical trauma) but tend to be less severe post-menopause. (4)
And finally, research has also found that depression symptoms tend to be worsened by oestrogen variation and low progesterone levels in perimenopause. (5)
PMDD can worsen due to fluctuating hormone levels and having a history of depressive illness like PMDD increases one’s risk of developing depression during this time.(6) Again, people with endo have a five times higher odds of PMDD (7), and those with ADHD are three times more likely to have PMDD (8).
Migraines and headaches can occur due to hormonal fluctuations.(9)
Hot flashes and night sweats tend to come later in late perimenopause and menopause, oestrogen regulates our temperature control so when that starts to lower we tend to see more of those symptoms. Now it’s important to note that oestrogen fluctuates up and down in perimenopause, so you may have some times when oestrogen does dip and you feel more of these symptoms.
Finally, whilst we don’t have much research on this yet from an MCAS specific perspective, we do know that endo is heavily linked to mast cell dysfunction and that we are at higher risk of conditions linked to MCAS, like POTS and h-EDS. Now oestrogen increases mast cell activation, so you may find you have more histamine-related and inflammatory reactions as well, and I see a lot of worsening MCAS symptoms in this time frame as a result.
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References
1) https://academic.oup.com/edrv/article-abstract/19/4/397/2530801
2) https://pubmed.ncbi.nlm.nih.gov/18285413/
3) https://www.researchgate.net/publication/339516698_Psychiatric_comorbidity_among_women_with_endometriosis_nationwide_cohort_study_in_Sweden, https://pmc.ncbi.nlm.nih.gov/articles/PMC12538516/, https://pubmed.ncbi.nlm.nih.gov/41330200/
4) https://pubmed.ncbi.nlm.nih.gov/37610715/
5) https://pmc.ncbi.nlm.nih.gov/articles/PMC7075107/
6) https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/culture-of-care/events/par/17-december-2024/nicsh-pmdd-and-suicidality-17-12-24.pdf?sfvrsn=71eeed4a_5, https://www.drlouisenewson.co.uk/knowledge/pms-pmdd-and-menopause
7) https://pubmed.ncbi.nlm.nih.gov/39990556/
8) https://www.sciencedirect.com/science/article/pii/S0022395625006776, https://pmc.ncbi.nlm.nih.gov/articles/PMC7617793/
9) https://pmc.ncbi.nlm.nih.gov/articles/PMC10395791/#b4-195e987
Produced by Chris Robson