In your forties, you may find you don’t cope as well with stress. It happens because losing progesterone during perimenopause can destabilize the HPA (adrenal) axis or stress response system.
This recalibration of the nervous system is why perimenopause is associated with an increased risk of anxiety, depression, and insomnia.
👉🏽 Tip: HPA axis dysregulation is the medical term for “adrenal fatigue.”
Progesterone stabilizes the HPA axis or stress response system
Progesterone is not just a reproductive hormone. It’s also a brain and nervous system hormone.
Progesterone does two important things in the brain:
- It promotes neurogenesis (new nerve growth) in a part of the brain called the hippocampus which is the main regulator of the HPA (adrenal) axis.
- It converts to the beneficial neurosteroid allopregnanolone (ALLO), which calms GABA receptors.
The end result is that progesterone promotes neurogenesis and GABA and increased capacity to cope with stress.
As you approach menopause, you lose progesterone.
Losing progesterone will make it harder to cope with stress but only until your HPA axis can recalibrate. After that, you should recover your ability to cope with stress.
How to survive perimenopause
More rest and self-care. You’re in a vulnerable time but it won’t last forever. You have permission to slow down and look after yourself until you achieve menopause.
Magnesium is a powerful stress-reliever. It boosts GABA, blocks glutamate, reduces adrenaline, regulates cortisol, and promotes sleep. If you take one supplement during perimenopause, let it be magnesium. (See 8 ways magnesium rescues hormones.) Magnesium glycinate works best because the amino acid glycine has its own beneficial calming effects.
Taurine is an amino acid and neurotransmitter that calms the brain by boosting GABA and blocking glutamate and adrenaline. Taurine is depleted by estrogen, so women have a higher requirement for taurine than men. I commonly prescribe a combination of magnesium and taurine for my perimenopausal patients.
Reduce histamine and mast cell activation by avoiding cow’s dairy and alcohol and maybe taking an anti-histamine for bad premenstrual days. The PMS of perimenopause is like “PMS on steroids.” Read The role of mast cells and histamine in PMS and PMDD.
Ashwagandha (also called Withania somnifera) is an “adaptogen” that reduces neuroinflammation in the hippocampus and stabilizes the HPA axis. It also reduces anxiety and promotes sleep (hence the Latin name somnifera or “sleep-inducing”).
Progesterone. Micronized progesterone capsules are effective treatments for many symptoms of perimenopause including insomnia. Progesterone is called Prometrium or Utrogestan and is entirely different from the progestins of hormonal birth control or conventional HRT.
For more information, read Chapter 10 of Period Repair Manual: “What Happens in Your Forties.” It’s a deep dive into the many symptoms of perimenopause including anxiety, insomnia, hot flushes, and heavy periods.
Ask me in the comments.