Estrogen Matters is a non profit global health initiative
   to provide medical perspective about menstrual health
   the menopause transition and post-menopause health

 
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A fresh start . . .  every month
 
The temporary layer (the functionalis) of the uterine lining
grows anew during each menstrual cycle.
After the temporary layer is released during the menstrual period, 
the uterine lining is about 2mm thick.

As estrogen levels increase, the uterine lining regenerates

to a thickness of 11mm by late in the follicular phase.

 

   

Heavy Menstrual Menstrual Bleeding During Peri Menopause . . .

 

often results because their is less progesterone hormone to hush endometrial tissue growth. As a result the uterine lining grows a bit thicker and there is an increase in uterine blood vessels. Increased uterine tissue and cell growth contributes to increased menstrual fluid.  Increased uterine blood vessels and/or blood vessels that are not closing when they should contribute to increased menstrual blood.

 

To reduce peri menopause heavy menstrual bleeding that is due to diminished progesterone and estrogen dominance it is helpful to tone down estrogens stimulatory effects. The section below relates options to naturally tone down the effects of estrogen. There is also a section regarding why menstrual cycles become closer together during the menopause transition. There is a lot a material to read but this information will help ease the menopause transition.

 

 

How to naturally hush excess estrogen during perimenopause

 

Peri menopause is a time of low progesterone production which can lead to estrogen dominance for many women. This results in a variety of symptoms including heavy menstrual bleeding. Diminished progesterone production during peri menopause allows for more uterine tissue, blood vessel and nerve stimulation by the estrogen hormone.

 

Below are a few non-medical natural options to moderate or tone down estrogen to reduce peri menopause heavy bleeding. Dong Quai (an herbal supplement) has been demonstrated to suppress estrogen (estradiol) synthesis. Oat bran absorbs excess estrogen. Milled Flaxseed neutralizes estrogen. This trio works in synergy to neutralize the effects of estrogen dominance.

 

Meat/dairy that has hormones will increase women’s hormones. It is best to avoid meat and dairy that has added hormones especially during the first two weeks of the menstrual cycle, when estrogen levels are naturally increasing. During these two weeks the intensity of estrogen contributes to uterine tissue and blood vessel growth. More intense estrogen stimulates greater tissue growth which contributes to heavy menstrual bleeding.

 

In addition, meat/dairy foods contribute to the synthesis of arachidonic acid from the cell membrane. Arachidonic acid is an inflammatory mediator that stimulate substances (prostaglandins and thromboxane) which cause blood vessel spasms and dilatation. Changes in uterine (endometrial) blood vessels contributes to heavy and irregular menstrual bleeding. Replacing meat/dairy with soy foods and cold water fish will reduce/block the production of inflammatory mediators that effects uterine blood vessels.

 

Keep in mind, hot flashes occur when tiny blood vessels open wider than normal allowing for an increase in blood flow, which is experienced as a sense of warmth. For many peri menopausal women fluctuations in estrogen effects uterine blood vessel function and tone contributing to heavy menstrual bleeding.

 

Adding oat bran, even homemade oatmeal/flax cookies, oat/soy muffins each day, plus the herb Dong Quai while limiting meat/dairy will impact heavy menstrual bleeding during peri menopause. Estrogen levels begin to increase within two days of the current menstrual period. Estrogen levels peak on days 12/13 and again around days 20/21, after the onset on the last menstrual period. However, to help reduce heavy menstrual bleeding it is important to moderate estrogen each day of the month.

 

Note: for women who experience heavy bleeding due to estrogen dominance during peri menopause it is best to avoid aspirin (use ibuprofen) and avoid the herb red clover. Aspirin thins blood, the herb red clover mimics estrogen. Also note excess weight contributes to excess estrogen.

 

Heavy peri menopausal menstrual bleeding in general will not be reduced by health food store type progesterone cream this type cream is not potent enough to effect menstrual bleeding.

 

Sources:

Estrogen and Progestin Bioactivity of Foods, Herbs and Spices

David Zava phD, Charles Dollbaum MD

Cancer Research Division California Public Health Foundation Berkeley California 94704

 

Vascular Smooth Muscle A-actin distribution around endometrial arterioles during the menstrual cycle

K.M. Abberton, N.H. Taylor

Dept Ob/Gyn, Monash University Clayton, Victoria Australia

 

 

 

 Understanding Changes in Menstrual Bleeding During Peri Menopause 

 

The menopause transition, referred to as peri-menopause, gradually begins five to six years preceding true menopause. True menopause tends to occur around age fifty and is noted by the absence of menstrual bleeding for a year.

 

Physiological changes associated with peri-menopause result from alterations in ovarian function due to diminished fertility. During peri menopause these natural alterations in ovarian function often affect changes in the menstrual cycle. The following is an overview regarding the hormonal communication that generates a monthly menstrual cycle and the changes in these hormonal messages that gradually shut down the menstrual cycle.

   

In women of childbearing age, the brain sends a monthly message to the ovaries, via follicle stimulating hormone to stimulate the maturation of egg containing follicles in the ovaries. The developing ovarian follicles produce the hormones estrogen and inhibin B. The hormone inhibin B relays a message to the brain to pause the follicle-stimulating hormone message. The hormone estrogen (estradiol) stimulates the cells of the uterine lining to grow and increase in number to generate a nurturing womb in anticipation of pregnancy.

 

However, close to midlife, during peri-menopause, a woman's egg follicles gradually become depleted. There are fewer eggs to become developed and these remaining eggs are less responsive. In an effort to stimulate these less responsive eggs the brain sends more frequent messages of FSH to the ovaries to stimulate egg production. The hormone inhibin B normally switches off (regulates) follicle stimulating hormone. During peri menopause inhibin B levels fall due to the decreased number of ovarian follicles. This reduction of inhibin B contributes to the dys-regulation of follicle stimulating hormone.

  

This normal and gradual lessening of egg production results in erratic fluctuations of follicle-stimulating hormone and estrogen which in turn contribute to the production of very low levels of the hormone progesterone. These fluctuations in hormonal levels often contribute to the physiological symptoms that many women experience during peri-menopause.

 

During peri-menopause the gradual lessening of egg production, and thus fertility, often results in anovulatory (non-fertile) menstrual cycles. Essentially, during an anovulatory menstrual cycle an egg follicle is not released from the ovary. As a result, the corpus luteum does not form and only trace amounts of the hormone progesterone are secreted. 

 

Anovulatory menstrual cycles are dominated by the estrogen metabolite: estradiol. In addition to the growth and maturation of an egg-bearing follicle, estrogen stimulates the growth and formation of the uterine lining (the endometrium).

   

During an ovulatory (conceptual) menstrual cycle, luteinizing hormone stimulates a ripened egg follicle to separate from the ovary for fertilization. When the egg follicle separates from the ovary the space that remains is the corpus luteum. The corpus luteum secretes the hormone progesterone. Under the influence of progesterone the glands lining the womb secrete glycogen which will provide energy for the fertilized egg. The secretion of progesterone also helps regulate and suppress the secretion of estrogen. In ovulatory menstrual cycles, the hormone progesterone provides counterbalance to estrogen.

 

However, for many women during peri-menopause an egg does not separate from the ovary which results in no corpus luteum production and levels of progesterone that are to low to counterbalance estrogen. As a result, estrogen dominates the menstrual cycle allowing the cells lining the endometrium to increase in mass and number. The unopposed estrogen allows for the functionalis layer of the endometrium to thicken to more then normal.

 

In addition to un-needed blood vessels, inflammatory *exudates and proteolytic enzymes, menstrual fluid includes the shedding of the temporary layer of the uterine lining. This extra thicken uterine lining contributes to the increased menstrual flow that many women experience during peri-menopause.

 

* exudates defined

a fluid with a high concentration of protein and cellular debris which has escaped from blood vessels

and has been deposited in tissues, or on tissue surfaces, usually as a result of inflammation.

 

 

 

About FSH

follicle stimulating hormone

  

The hormones Inhibin A and B

direct follicular development.

 

Inhibin B has a major role
in triggering the menopausal transition.

 

Inhibin B is a glycoprotein synthesized by

ovarian granulosa cells.

 

Inhibin B normally switches off (regulates)
follicle stimulating hormone.

 

During peri menopause inhibin B levels fall
due to the decreased number of ovarian follicles.


This reduction of inhibin B contributes to a rise

in follicle stimulating hormone.

                              

 

 

 

 

 

 

  Why Menstrual Cycles 
                                            Often Become Closer Together During Peri Menopause

shorter cycles occur because hormone levels are not potent enough to maintain the uterine lining: the endometrium.

     Whether a woman has a conceptual or non fertile menstrual cycle, whether a woman is 28 or 48 years old, cyclic menstrual bleeding occurs due to estrogen and/or progesterone withdrawal. When the brain determines that a pregnancy has not occurred hormonal levels (most significantly progesterone) drop, the blood vessels (microvasculature) of the uterine lining regresses and menstrual bleeding occurs.

  

    Oral and transdermal contraceptives provide a continuous level of estradiol and/or progesterone usually for three weeks per month. The fourth week of oral contraceptives is a row of placebo pills. Taking the placebo pills allows for hormonal withdrawal, which results in menstrual bleeding. Removing a transdermal contraceptive patch also allows for hormonal withdrawal, which results in menstrual bleeding. Extended cycle oral contraceptives add several more weeks of hormones and then placebo pills which allow for withdrawal menstrual bleeding. Oral contraceptives with fewer placebo pills shorten the days of menstrual bleeding. The key point to understand is that withdrawing the contraceptive drops the hormone levels which results in menstrual bleeding.  

  

   During peri menopause, estrogen production by the ovary is erratic. Estrogen levels are unpredictable and can fluctuate between low, normal and high. An increase in estrogen contributes to heavier menstrual bleeding. A decrease in estrogen production contributes to less cell growth and maintance of the uterine lining. Essentially estrogen levels are too low to maintain and support the uterine lining. The cells breakdown, the blood vessels regress and menstrual bleeding occurs.  

 
    During the reproductive years a woman's menstrual period occurs around the 28th to 32 day. During peri menopause the menstrual period may come around days 22 thru 28. These shorter cycles often result because less estrogen is released due to diminished follicular development. The decrease in estrogen production contributes to less cell growth and maintance of the uterine lining. The cells breakdown, the blood vessels regress and menstrual bleeding occurs.

 

    Many women notice that during day 4 or 5 of the menstrual period, bleeding may stop for several hours and then return briefly. This fluctuation is an example of how estrogen affects the endometrial microvascular.  A few days after the onset of menstrual bleeding the functionalis begins to regenerate: grow anew. Estrogen released from primordial follicles, stimulates the regeneration of the surface endometrial epithelium (tissue), while menstruation is occuring. The estrogen secreted by this growing follicle causes prolonged vasoconstriction enabling the formation of a clot over the denuded (shed) endometrial vessels.  When bleeding may stop for several hours and then returns during day 4 or 5 of the menstrual period it is because estrogen is beginning to stabilize the arterial blood flow of the functionalis and basilis layers of the endometrium.

 

   Irregular cycles and shorter cycles are also the result of nonfertile cycles and diminished progesterone. The hormone progesterone is secreted by the corpus luteum after an egg is released by the ovary. Progesterone allows the cells of the uterine lining to mature, so that the uterine lining (womb) can accept and nourish a fertilized egg.  Perimenopause is a transition of diminished egg maturation and release. When an egg is not released from the ovary the corpus luteum does not form and only trace amounts of the hormone progesterone are secreted. Perimenopausal progesterone levels are significantly reduced and will not contribute to maintaining the uterine lining.

 

    Keep in mind, it is the withdrawal of progesterone or a blocking of progesterone receptors results in menstrual bleeding. Diminished estrogen production, due to weak egg development combined with diminished progesterone production often results in shorter cycles because these hormone levels are not potent enough to maintain the endometrium.

 

   Changes in menstrual bleeding during peri menopause occur naturally due to diminished fertility.  Low dose birth control pills, prescription hormone replacement and bio-identical hormone replacement are therapeutic options that can help moderate estrogen and progesterone levels and regulate monthly menstrual cycles during peri-menopause.  

 

The menopausal transition is a natural process.

Menstrual cycles that occur closer together are part of this natural transition. 

  

 

 
  

Menstrual Bleeding Stops . . . for one year, this is menopause

 

Insufficient follicular development results in significantly estrogen production; with little estrogen available to stimulate the endometrium, menstrual bleeding stops. The peri menopause gradual lessening of egg production, eventually transitions to menopause: characterized by no menstrual bleeding for a year as a result of no egg production.

 After menopause estrogen (estradiol) production drops by about 90%.  

 

 

 

 

 

 

  

 

 

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Information is provided for educational purposes to help individuals form an understanding of biological processes as they effect health. This information is not intended for medical diagnosis or treatment.

   

 

     site originated Sept 2006, page updated January 2010