During the second stage of the the Peri-2 Post Transition, our cycles become more irregular and may vary in length by more than 6 or 7 days. We’re likely to have low progesterone and often higher but variable estrogen.
In this stage, women may oscillate between anovulatory (decreased estrogen, an egg is not released) and normal cycling. Anovulatory cycle allows for a rise in early higher FSH levels in the next cycle. This higher FSH creates an abnormally large number of ovarian follicles, each of which produces more estrogen, Resulting in much higher estrogen than normal.
This means that overall estrogen levels are still high, but its fluctuations are becoming more pronounced, with some really notable low spots. From these higher levels estrogen has not only further to fall, but it may also fall lower than we are accustomed to.
This causes symptoms of both estrogen withdrawal; including headaches, depression, weight gain, vaginal dryness and night sweats, and excess estrogen; like allergy symptoms, irritable mood, anger, fluid retention, and breast soreness.
Symptoms of high and fluctuating estrogen include:
Higer estrogen symptoms:
- Breast Pain
- Heavy and painful periods
- Histamine-related symptoms/allergy symptoms
- Increased duration of cervical mucus
- Poor sleep
Lower estrogen symptoms:
- Aches & Pains
- Abdominal weight
- Hot flashes and nightsweats
- Mood swings, anger, and irritability
- Poor sleep
- Vaginal Dryness
The Biochemistry behind some of the symptoms
Vasomotor Symptoms:
Vasomotor Symptoms may start occurring. Fluctuating estrogen levels and decreased progesterone levels cause hot flashes and night sweats. While often associated with the later stages of of the Peri-2-Post transition, because of the dramatic fluctuation of estrogen, they often start during this stage.
Hot flashes are caused by heightened sensitivity to changes in body temperature. The decrease in estrogen levels during the Peri-2-Post transition increases the sensitivity of neurons in the hypothalamus, which operate as internal thermostats. These thermostats become, overly sensitive. When body temperature rises even little, the hypothalamus appears to overcorrect, behaving as if you are in a 180-degree sauna.
This response causes blood vessels on the skin’s surface to dilate. Wider capillaries enable more blood to reach the skin’s surface. In addition to dilation of the blood vessels, the brain sends a signal to the sweat glands to start producing perspiration. You may have palpitations were your rate rate increase by 5 to 25 beats per minute, causing anxiety-like experiences.
The intensity and frequency of hot flashes might vary depending on genetics, race, and ethnicity. Women of Asian ethnicity are the least likely to report symptoms, whereas Black women are the most likely to experience them. Your general health may be relevant here too. Certain women may be more susceptible to experiencing frequent and severe hot flashes due to high blood pressure and stiffening blood vessels.
Research shows Peri-2-Post women may also have an increase of flashes in response to a variety of sensory cues, such as anxiety, altitude, alcohol, spicy food consumption, and acute stressors.
Mood swings, anger, and irritability
A decrease in estrogen production can lead to increased moodiness, irritability, and anger.
Estrogen affects the production of serotonin and sensitivity of serotonin receptors in the brain. Serotonin is a neurotransmitter that helps regulate your moods. Estrogen also influences the production and the effects of endorphins, the “feel-good” chemicals in the brain. Estrogen protects nerves from damage and stimulating nerve growth.
The significant fluctuations in estrogen levels during this stage have a profound effect on mood and the ability to manage emotions. Mood swings, irritability and anger may also be more pronounced in women who experienced more severe PMS earlier in their lives, or who have a history of depression.
Tingling or shock-like sensations in the extremities
The peripheral nervous system is also influenced by estrogen. Intermittent discomfort, tingling or electrical shock like sensations in the extremities may result from decreasing levels of estrogen.
When estrogen levels are low, it can result in the misfiring of nerve signals. Electric shock sensations, often described as zaps or jolts of electricity traveling through the body, may result from this miscommunication. These sensations frequently begin immediately prior to the onset of a hot flash.
Tingling extremities or tingling under the skin are similar to electric shocks, but they are more reminiscent of the sensation of pins and needles, like when your foot falls asleep. It is also referred to as paresthesia. There are two potential factors at play in this situation. Low estrogen levels can result in hypersensitivity of nerve endings, and circulation can also be impacted by the decrease in estrogen. This results in a reduction in blood flow to the extremities. Both of which can contribute to neurologic symptoms in the extremities.
Other reasons for tingling feelings in our extremities include medical disorders, therefore please rule out these more serious possibilities. Some common conditions that might produce tingling in the extremities include: Diabetes, Nerve damage or compression (ie:carpal tunnel syndrome) and vitamin deficiencies.
New or Worsening Allergy Symptoms
It is not uncommon for women to develop new allergies or symptoms similar to those of allergies during the Peri-2-Post transition. Initially, you may not link these symptoms to perimenopause. Histamine is often the culprit.
Histamine is a chemical that regulates many physiological functions; secretion of gastric acid, inflammation, and the regulation of vasodilatation and bronchoconstriction just to name a few. It is an essential component of the immune system and is highly beneficial to the body when in appropriate quantities. Nevertheless, individuals may experience a variety of symptoms and issues when histamine levels are elevated, particularly during the Peri-2-Post transition.
The symptoms of histamine intolerance may be exacerbated during Stage 2 specifically because of the elevated estrogen. Histamine levels are elevated by estrogen, which in turn elevates histamine levels, thereby initiating a cycle that induces numerous symptoms. High histamine levels can exacerbate other perimenopausal symptoms.
The frequent symptoms of histamine are;
- Anxiety
- Digestive issues (loose stools, bloating, or cramps)
- Headaches and migraines
- Heavy Periods
- High estrogen symptoms, worsening PMS
- Hives
- Itchy skin
- Nausea
- Poor Sleep
- Runny nose
How to Manage Fluctuating Estrogen Levels
To support healthy estrogen levels, limit alcohol consumption, eat cruciferous vegetables and high fiber foods for their ability to aid in breakdown and removal of estrogen.
Eat more Phytoestrogens. Phytoestrogens are adaptogens. They can be useful when estrogen levels are elevated or depressed. Phytoestrogens bind to the same cellular receptors as estrogens. Phytoestrogens are considered weak estrogenic substances. When a phytoestrogen binds to an estrogen receptor, it stops estrogen from having its effects. On average, phytoestrogens are roughly 2% as strong as estrogens. Thus, when estrogen levels are high, substituting a phytoestrogen for an estrogen result in significantly reduced estrogenic activity at a given binding site. If estrogen levels are low and estrogen-binding sites are vacant, supplementing them with phytoestrogens containing 2% estrogen activity will result in an overall rise in the systemic estrogenic effect. Some phytoestrogens include; flaxseed, peaches, garlic, red clover, cruciferous vegetables, sesame seeds, cashew, pistachios and almonds. Soy is also a well-known phytoestrogen, be careful with sourcing it is a highly genetically modified and pesticide crop, additionally many have an allergy or sensitivity to it.
Reduce your exposure to xenoestrogens found in plastics and pesticides.
Avoid foods that cause inflammation, such as highly processed foods and those high in carbohydrates, as well as those that cause histamine release, such as dairy and alcohol. Histamine-rich foods include red wine, champagne, hard cheese, avocado, smoked or canned fish, shellfish, soy sauce, deli meats, yeast, bananas, dried fruit, dry nuts, bone broth, fish stock, vinegar, fermented foods such as sauerkraut, and chocolate.
Supplements:
Check your Vitamin B6 levels. Vitamin B6 promotes histamine clearance and increases GABA levels. Vitamin B6-rich foods include pork, poultry, and sunflower seeds.
Calcium d-glucarate supports healthy estrogen metabolism by preventing the recabsorption of estrogen from your colon.
Check your Iodine levels. Iodine down-regulates estrogen receptors, which reduces estrogen sensitivity, particularly for breast symptoms. Iodine is typically safe at low levels, however please speak with your heath care professional especially if you have thyroid disease.
References:
- Nanette Santoro, MD The menopausal transition. The American Journal of Medicine (2005) Vol 118 (12B), 8S–13S
- Padilla SL, Johnson CW, Barker FD, Patterson MA, Palmiter RD. A Neural Circuit Under- lying the Generation of Hot Flushes. Cell Rep. 2018 Jul 10;24(2):271–7.
- Kandiah J, Amend V. An exploratory study on perceived relationship of alcohol, caffeine, and physical activity on hot flashes in menopausal women. Health . 2010;02(09):989–96.
- Bacciottini L, Falchetti A, Pampaloni B, Bartolini E, Carossino AM, Brandi ML. Phytoestrogens: food or drug? Clin Cases Miner Bone Metab. 2007 May;4(2):123–30.
- 23 Park H, Parker GL, Boardman CH, Morris MM, Smith TJ. A pilot phase II trial of magnesium supplements to reduce menopausal hot flashes in breast cancer patients. Support Care Cancer. 2011 Jun;19(6):859–63.
- Padilla SL, Johnson CW, Barker FD, Patterson MA, Palmiter RD. A Neural Circuit Underlying the Generation of Hot Flushes. Cell Rep. 2018 Jul 10;24(2):271-277. doi: 10.1016/j.celrep.2018.06.037. PMID: 29996088; PMCID: PMC6094949.
- Cohen, L., et al., “Short-term use of estradiol for depression in perimenopausal and postmenopausal women: A preliminary report,” Amer Jour Psychiatry 2003; 160:1519-22.