Perimenopause and Menopause: Understanding the Root Causes and Environmental Triggers

Perimenopause is the transition phase leading up to menopause, typically beginning in a woman’s 40s, but symptoms can start much earlier. Menopause itself is defined as the point at which a woman has not had a menstrual cycle for 12 consecutive months.

However, the journey leading up to that milestone varies greatly from one woman to another. Some may experience symptoms as early as their mid-to-late 30s, long before they expect any hormonal shifts.

To date there are over 60 known symptoms of the perimenopause, ranging from brain fog, itchy ears to irregular menstruation and low mood.

In clinical practice, I am increasingly seeing women under 40 presenting with what looks like early perimenopause. After thorough hormone testing and an in-depth medical history review, a recurring pattern emerges: chronic stress and anxiety.

All too often women are carers, professionals, students, wives, mothers, and homemakers, often juggling multiple roles simultaneously. In this relentless balancing act, something eventually gives way, and more often than not, it is the body that suffers.

The chronic stress of modern life pushes the body into a near-constant state of ‘fight or flight,’ prioritising survival over reproduction.

The adrenal glands, which produce both stress hormones and some sex hormones, divert resources to cortisol production because cortisol is essential for survival. This process, often referred to as the "pregnenolone steal," means the body sacrifices the production of oestrogen, progesterone, and other vital sex hormones to fuel the stress response.

Not all women respond to stress in the same way, and genetic predisposition plays a significant role in how the body handles hormonal shifts. Some women have a genetic tendency to convert sex hormones into cortisol more readily, making them more vulnerable to early hormonal depletion. When combined with a high-stress lifestyle, poor sleep, and inadequate nutrition, these women may experience perimenopausal symptoms far earlier than expected.

One of the most overlooked aspects of perimenopause is the fact that hormones are not infinite.

While we naturally experience hormonal fluctuations with age, how a woman navigates life stress can make the difference between a manageable mid-life transition to one filled with debilitating symptoms.

Chronic stress drains the body’s hormonal reserves faster, and women who have spent decades in high-pressure, high-stress environments may find themselves facing perimenopause earlier and more intensely than expected.

The Role of Neurotransmitters in Perimenopause

Hormonal shifts, stress, and poor nutrition don’t just affect reproductive hormones - they also impact neurotransmitters, (the brain’s chemical messengers) that regulate mood, sleep, and overall mental wellbeing.

When these neurotransmitters decline, women experience increased anxiety, low mood, and even depression.

• GABA (Gamma-aminobutyric acid): Helps promote relaxation and calm the nervous system. Reduced progesterone levels (which support GABA) can lead to heightened anxiety and restlessness.

• Serotonin: Often called the "feel-good" neurotransmitter, serotonin is closely linked to oestrogen levels. A drop in oestrogen can result in mood swings, low energy, and increased feelings of depression.

• Melatonin: Essential for regulating sleep cycles, melatonin production declines with age and stress. This, combined with fluctuating oestrogen and progesterone levels, can contribute to sleep disturbances in perimenopause.

Once these neurotransmitters drop, anxiety increases, and low mood and depression become a reality - often prompting women to seek medical intervention. While medical help may be warranted for many, lifestyle support such as Hypnotherapy, mindfulness, and other stress-management practices should be prioritised alongside conventional treatment.

On average, a woman will experience approximately 450 menstrual cycles in her lifetime. This monthly cycle is almost a prelude to what the perimenopause may offer - fluctuating hormones, mood changes, and shifts in energy. However, many women take hormonal contraceptives for years, which suppress the natural rhythm of their cycle.

Contraceptives can "put to sleep" the body's natural hormone production, altering mood, personality, and emotional regulation. Women who have been on birth control for decades may not immediately notice they are perimenopausal because their hormonal fluctuations have already been artificially managed for so long. However, the side effects of long-term hormonal suppression can contribute to mental health challenges, further complicating the transition into midlife.

Beyond genetics, environmental factors also contribute to hormonal imbalances, including:

• Endocrine-disrupting chemicals: Found in plastics, pesticides, skincare products, and household items, these can mimic or block natural hormones, contributing to imbalances.

• Nutrient deficiencies: Many women are depleted in key nutrients needed for hormone production, such as magnesium, zinc, vitamins C & D; B vitamins and essential fats.

• Blood sugar dysregulation: Poor dietary habits, high sugar intake, and insulin resistance can worsen hormonal fluctuations and symptoms like fatigue, mood swings, and weight gain.

• Gut health issues: A disrupted gut microbiome affects the metabolism and detoxification of oestrogen, leading to imbalances. Stress can have a devastating impact on gut health and may create a vicious cycle of gut and hormone related issues.

• Sleep deprivation: Poor sleep increases stress hormone production, and a lack of melatonin and progesterone can really intensify the situation.

Given the clear link between chronic stress and early hormonal disruption, it is vital that stress management, emotional resilience, and hormone health education become a standard part of school curriculums. Young girls and adults should be taught how to manage life’s pressures in a way that protects their long-term hormonal health.

This may include:

• Understanding how stress affects hormones and overall wellbeing.

• Learning practical tools for managing anxiety and building resilience.

• Recognising early signs of hormonal imbalance and knowing when to seek support.

• Implementing self-care strategies that support long-term hormonal health, such as proper nutrition, movement, and sleep hygiene.

Perimenopause and menopause are not just about declining oestrogen levels; they reflect a lifetime of hormonal, emotional, and environmental influences. The more we understand and address these factors, the smoother the transition can be.

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Faizana Karim is an experienced Naturopath and Nutritional Therapist that specialises in women’s midlife hormonal health.

You can contact her via her website: www.cedarnutritionandwellness.co.uk

Instagram: cedarnutrition_uk