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Menopause is a gradual process that takes months or even years.

As a man, I don’t completely know what subtle changes of estrogen and progesterone can do to a woman’s mood, temperature regulation, energy level, and especially to the regularity of her menstrual cycle. But I hear what women have reported to me in my clinical practice; I keep up on current research; and I have observed the changes in testosterone and probably other hormones in myself over the years. The effects of sexual hormones are profound. Studies show they can influence our behavior, learning ability, and sexual drive.

Over the years, a number of women have come into my clinic for help with what they thought were symptoms related to perimenopause. Perimenopause is the time before the cessation of ovulation and menses that can last for a few months to a year and, rarely, for up to ten or fifteen years. My experience and research tell me that if a woman experiences symptoms common to perimenopause for two or more years, she is more likely experiencing the effects of other health imbalances and not necessarily a drop in estrogen and progesterone due to primary loss of ovarian power.

Perimenopause and hormonal balance

The timing for perimenopause is different for each woman. Some women enter perimenopause in their thirties, but the average age is in one’s late forties or early fifties.

The process of menopause is not like flipping a switch—it’s often a gradual process that takes months or even years. Marked fluctuations in estrogen levels can occur and progesterone levels also decline as ovulation gradually ceases.

The tricky part for a woman and her herbalist is that hormonal balance is affected by a number of other factors besides age, including liver health and bile production, stress, diet, exercise, and overall health. The changes are often vague and inconsistent, so it may be difficult for a woman to identify what exactly is wrong. Such symptoms as reduced energy and sex drive, depression, and forgetfulness can come from a variety of causes, including poor nutrition or from sitting and staring at a computer screen all day. One recent study from Harvard Medical School found that perimenopausal women were twice as likely to experience depression than premenopausal women and four times more likely to be depressed if they also experience hot flashes.

Two different cases

I remember two patients who clearly illustrate why it is difficult to make quick decisions about perimenopause and its effects.

Harriet was fifty-one and had come into the clinic to see if herbal medicine could help her with symptoms her doctor said were related to perimenopause. She described her increasing feelings of irritability, sleeplessness, hot flashes, vaginal dryness, forgetfulness, and loss of interest in sex. According to Traditional Chinese Medicine (TCM), menopause and the time period leading up to it can be related to deficiency syndromes of the kidney, heart, or blood, and might include stagnation of blood and vital energy. Kidney yin deficiency (basically hormonal deficiency) is common. TCM can identify imbalances of other systems, such as the liver system, that can make symptoms of hormonal imbalance worse.