Dr. Mary Claire Haver

I absolutely just don't feel like myself or brain fog.

So perimenopause begins in the brain and then the rest of the organ system start waking up and realizing that that steady and kind of ebb and flow that was very predictable supply of estrogen and progesterone is not going as planned.

So we can have joint pain, we can see asthma changes, we see lots of skin changes, we see muscular changes.

And one of the first things that my patients mentioned to me

is that they see body composition changes, suddenly having increasing amounts of fat deposits around their abdomen that they never really experienced before.

Also, with the aging process, we're losing muscle at a higher rate than we ever have in our lives before.

So what I was under the assumption was in perimenopause, there would just be this steady state decline.

I really didn't understand what was really happening.

It was never taught to me.

What's actually going on is because the brain is searching, searching, searching for estrogen, it starts producing more and more and more stimulating hormones in the form of LH and FSH at much higher levels than you ever saw post-puberty.

And that is just pummeling the ovary

causing it to hyperstimulate in some cases.

So we're seeing estradiol levels sometimes in perimenopause at very erratic levels, sometimes as high as three and 400.

So those of you who have gotten a diagnosis of estrogen dominance, remember a one-time blood draw is not really helpful in perimenopause.

A one-time urine test, a one-time saliva test is only giving you the tiniest snapshot in years and years and years of what actually looks like hormonal chaos.

And this chaos can last as it peters out as the ovary supply of eggs just keeps declining over time until we reach no more eggs that are producing any more hormones.

And that is full menopause.

So that transitions.

So you at 44 who asked the question, you're not feeling right.

Your cycles aren't really that irregular yet.