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Perimenopause usually begins between the ages of 40 and 45. It lasts four to ten years until menopause is reached. Menopause marks the point 12 months after the last menstrual period. Perimenopause brings with it dramatically fluctuating hormone levels. This can lead to a variety of noticeable changes, such as mood swings, sleep problems, and weight gain . But what exactly happens to the hormones?
The female cycle: A finely tuned system
During the fertile years, the menstrual cycle is controlled by a harmonious interplay of hormones. The most important players are estrogen, progesterone, FSH, and LH.
Estrogen regulates the development of the uterine lining, supports bone health and influences the cardiovascular system.
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Progesterone stabilizes the uterine lining, promotes sleep and has a calming effect on the nervous system.
FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are control hormones from the pituitary gland. They ensure the maturation of eggs and ovulation.
A typical cycle begins with menstruation. The old uterine lining is shed. At the same time, new follicles mature. Estrogen is released, stimulating the regeneration of the uterine lining. The surge in LH triggers ovulation. After ovulation, the corpus luteum forms from the remaining follicle. It produces progesterone and prepares the body for a possible pregnancy. Without fertilization, hormone levels drop. The uterine lining begins to shed, and menstruation begins again.
Estrogen and progesterone: their role in the cycle and the changes during menopause
Estrogen: The key hormone for fertility, bones and metabolism
Function in the cycle
Estrogen is produced primarily in the ovaries. The most important form during the fertile years is estradiol , which plays a significant role in the female cycle.
Influence on follicle maturation :
In the first half of the cycle (follicular phase) , FSH (follicle-stimulating hormone) promotes the growth of one or more follicles in the ovaries.
These follicles begin to produce estradiol .
The larger the follicle, the more estradiol is produced.
A high estradiol level signals the pituitary gland that the egg is mature. At the same time, it leads to a surge in LH , which triggers ovulation.
Influence on the uterine lining :
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Estradiol ensures the rebuilding of the uterine lining (endometrium) after it has been shed during menstruation.
The mucous membrane becomes thicker and more vascularized to allow potential implantation of a fertilized egg.
Influence on the entire body :
Bones : Stimulates the incorporation of calcium and protects against osteoporosis.
Brain : Promotes serotonin and dopamine production, regulates mood and cognitive functions.
Skin and hair : Supports collagen production and ensures elasticity.
Cardiovascular system : Protects blood vessels from calcification and keeps cholesterol levels balanced.
Changes during menopause
During perimenopause , estrogen production becomes more irregular.
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Follicles initially continue to grow, but they produce uneven amounts of estrogen.
This leads to hormonal fluctuations that can cause typical symptoms such as hot flashes, breast tenderness, headaches and mood swings .
While some cycles still have high estrogen levels, others are characterized by sudden drops in estrogen.
After menopause , estradiol levels drop permanently.
There is no longer any functioning follicular tissue that produces estrogen.
The consequences of estrogen deficiency are skin aging, an increased risk of osteoporosis and cardiovascular diseases .
Progesterone: The corpus luteum hormone with a calming effect
Function in the cycle
Progesterone is produced by the corpus luteum in the second half of the cycle (luteal phase). The corpus luteum forms from the follicle that remains after ovulation .
Influence on the uterine lining :
Progesterone stabilizes the uterine lining built up by estrogen.
It ensures that the mucous membrane continues to thicken and is well supplied with blood in order to absorb a fertilized egg.
If fertilization doesn't occur, progesterone levels drop and the lining is shed. Menstruation begins again.
Influence on the entire body :
Progesterone has a calming effect on the nervous system . It enhances the effects of GABA , a neurotransmitter that reduces anxiety and promotes sleep.
Progesterone causes a slightly elevated body temperature after ovulation.
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Progesterone has a regulating effect on fluid balance : it has a diuretic effect and can reduce water retention.
Changes during menopause
Progesterone is the first hormone to permanently decline during perimenopause . This leads to a condition called corpus luteum deficiency, which causes the progesterone-producing cells to become increasingly inefficient. In addition, ovulation becomes less frequent .
Without ovulation, no corpus luteum forms and progesterone production stops.
This has the following effects:
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Irregular cycles : Since progesterone stabilizes the cycle, its absence leads to shortened or prolonged cycles.
Increased irritability and anxiety : Without progesterone, the calming effect on the nervous system is missing.
Sleep disorders : Progesterone deficiency can increase difficulty falling asleep and waking up at night.
After menopause , progesterone levels remain consistently low, comparable to those of men.
How the interaction between estrogen and progesterone changes
Before menopause, there is a dynamic balance between estrogen and progesterone. Both hormones regulate each other:
Estrogen builds up the uterine lining – progesterone stabilizes it.
Estrogen stimulates – progesterone calms.
Estrogen retains fluid – progesterone has a dehydrating effect.
During perimenopause, there is initially a relative estrogen dominance before both hormones decline permanently. This not only alters the menstrual cycle but also affects mood and many other physiological processes.
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Testosterone: More than just a “male hormone”
Testosterone, often referred to as the "male hormone," also plays a crucial role in women. It contributes to muscle and bone health , promotes libido , increases energy , and supports cognitive performance . During menopause, testosterone levels slowly decline. This can manifest as a loss of muscle strength, sexual desire, and energy .
But testosterone can do even more: It has anti-inflammatory effects . It regulates the immune system by reducing the production of pro-inflammatory messengers . At the same time, it supports anti-inflammatory processes that protect the entire body.
With the gradual decline in testosterone levels during menopause, chronic inflammation can increase , particularly in the joints . Many women report new or increased joint pain and stiffness , often described as "menopausal rheumatism." Without the protective effect of testosterone , cartilage regeneration can be slowed, increasing the risk of osteoarthritis .
A sufficiently high testosterone level not only helps to maintain muscles and bones , but also protects against inflammation-related joint problems , which can become more frequent during menopause.
The role of cortisol: The stress hormone in focus
Cortisol, produced by the adrenal glands, is a key hormone for stress management and energy balance. During menopause, declining estrogen levels affect cortisol regulation. The more estrogen drops, the higher cortisol levels rise. This has far-reaching consequences:
Stress : The body becomes more sensitive to stress stimuli. This can increase cortisol production and worsen menopausal symptoms.
Weight gain : High cortisol levels promote fat accumulation, especially in the abdominal area. This is a classic symptom of weight gain and menopause.
Sleep disorders : Increased cortisol in the evening disrupts the natural sleep-wake rhythm.
Bone health : Cortisol promotes bone loss and increases the risk of osteoporosis.
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Mood swings : High cortisol levels affect neurotransmitters such as serotonin and GABA, increasing susceptibility to anxiety and depression.
Neurotransmitters: The connection between hormones and psyche
Menopause affects not only sex hormones but also neurotransmitters in the brain. These interactions explain many of the emotional and cognitive symptoms of this phase.
Dopamine
- Role : Dopamine is responsible for motivation, drive and reward.
Changes : The decline in estrogen can reduce dopamine production. This, in turn, can lead to difficulty concentrating and a loss of zest for life.
Serotonin
- Role : Serotonin regulates mood, sleep and appetite.
Changes : Falling estrogen levels reduce serotonin production, which promotes depressive moods and sleep disorders.
GABA (gamma-aminobutyric acid)
- Role : GABA is a calming neurotransmitter that reduces stress and anxiety.
Changes : Progesterone enhances the effects of GABA. Conversely, a progesterone deficiency during menopause can lead to irritability and inner restlessness.
