I have many patients who absolutely know their current symptoms must be the result of their “hormones” but they just do not fit the definition of menopause. These women range in age from early 30s to late 40s with sometimes startling different symptoms or history. For example, “Elizabeth” presents as a 39 year old female with irregular, extremely heavy, clotting periods. She complains of cramping, breast tenderness, and increased anxiety. In contrast, “Sarah” presents as a 45 year old female with weight gain and insomnia. Sarah does not have periods due to uterine ablation preformed 2 years prior.
These patients are experiencing peri-menopause, which can also be called estrogen dominance. Estrogen dominance is a term defined by John Lee, M.D. and refers to the relative deficiency of progesterone levels in relation to estrogen levels. Symptomatically, estrogen dominance can present as irregular periods, heavy periods, water retention, breast tenderness, difficulty losing weight, mood swings, insomnia and depressed mood or anxiety.
Beginning in her mid-30’s, a woman’s ovarian function begins to decline causing decreased levels of estrogen and progesterone. Even while women are still menstruating regularly, anovulatory cycles become more and more common with age. Without ovulation, there is no corpus luteum and therefore very little progesterone is produced. Xenoestrogens in the environment also exacerbate the problem as they add to the overall estrogenic influence on the tissues.
When testing hormone levels, estrogen dominance is illustrated by low progesterone to estradiol ratio during the luteal phase. Day 19, 20 or 21 of the menstrual cycle would be ideal to obtain serum levels on these patients. Most women with estrogen dominance are treated with cyclic progesterone during specific days of their cycle. This treatment will take months to reach peak effectiveness. As with any medical condition, your physician would be the best start for discussing your symptoms and concerns.