The Peri-2-Post Academy

Empowering Women Through Education

The Third Stage of Perimenopause 

It is during this stage that we begin to experience irregular periods and our first cycle that lasts for more than 60 days. 

The symptoms of elevated estrogen may begin to subside as a result of lower estrogen, even though it may still fluctuate during Stage 3 of the Peri-2-Post transition. Menstrual cycles become exceedingly irregular, and they are becoming more scarce. Circulating estrogen is more likely to be low during anovulatory cycles, and the prevalence of low estrogen symptoms increases significantly during extended periods without a cycle. An occasional burst of elevated estrogen may be observed, but the overall pattern is low progesterone and estrogen.

As an outcome, symptoms associated with elevated estrogen levels may diminish, while those associated with low estrogen levels often worsen.

  • VasoMotor Symptoms (Hot flashes/Night-sweats)
  • Genitourinary symptoms
  • Insomnia
  • Migraines/Headaches
  • Joint and Muscle pain
  • Skin/Hair  issues
  • Low sex drive
  • Brain fog

Migraines


Women have a much higher prevalence of migraines (18% vs. 6% with males), and they are also more likely to have more intense and prolonged headaches than men. Women’s migraines are most commonly related with puberty and perimenopause.


The pathophysiology of migraines has been demonstrated to be complex. Estrogen is associated in migraine pathogenesis, but its roles are multifaceted and not fully understood. The majority of studies on the topic concur that estrogen withdrawal is a critical component in migraine pathophysiology. This has been extensively researched in menstruation and postmenopausal women. However, the pathophysiology of migraines is more complex than can be explained only by the absence of estrogen.


According to one study, food triggers roughly 27% of migraines, while alcohol triggers another 38%. Common triggers include aged cheese, red wine, gluten, food additives, and preservatives, indicating histamine-estrogen connection may also play a role.


Avoiding dietary triggers and consuming anti-inflammatory magnesium-rich foods such as nuts, seeds, avocado, and fatty fish can be beneficial. Consuming turmeric on a daily basis may help to modulate the pathways involved in the inflammation associated with migraines.

Thinner, drier skin

Many women notice that their skin ages quickly in the later Peri-2-Post transition; it gets thinner, has less collagen, is less elastic, wrinkles more easily, and becomes drier.

Estrogen is essential for the production of collagen. Collagen is a critical protein that is present in every cell of your body, Collagen proteins are responsible for the support of the structure of bones, tendons, muscles, ligaments, and skin.

Cells known as fibroblasts are responsible for the production of the collagen found in your skin’s outer layer. Estrogen Receptors (ERβ) receptors are present on the surface of fibroblasts. Estrogen is necessary for the optimal function of these fibroblasts and the production of high-quality collagen. We are aware that estrogen levels decrease during the Peri-2-Post transition. The average woman loses 30% of her facial collagen during the initial five years of menopause. Afterward, the rate continues to decrease by
approximately 1% to 1.5% a year.


Other ways Estrogen Impacts the skin:

  • Estrogen facilitates the moisturization of the skin, impacting hydrolaunic acid production.
  • Estrogen promotes the skin’s synthesis of elastin,
  • Estrogen facilitates wound healing by modulating the inflammatory response.
  • Estrogen facilitates the vascularization of the skin.
  • Estrogen is essential for the maintenance of healthy and robust hair follicles.
  • Estrogen safeguards against oxidative stress.

Dry Skin Solutions:

  • Stay hydrated to help keep your skin tight and hydrated.
  • Consuming foods high in antioxidants, such as fruits and vegetables, can also help counteract oxidative stress and improve general skin health.
  • Use topical Vitamin C and E serums to  protect your skin from free radicals. Furthermore, using a retinol product in your skincare routine can help stimulate collagen formation and enhance skin texture.
  • Use moisturizers such as hyaluronic acid or ceramides to replace lost moisture and improve skin barrier function.
  • Consider using a topical DHEA cream to assist maintain hormonal balance and increase skin collagen and elasticity. DHEA is a precursor to both estrogen and androgens.
  • Consider Replacing estrogen with topical estradiol or estriol, which promotes skin elasticity, thickness, and epidermal moisture; it also reduces wrinkles and increases the amount and quality of collagen as well as the degree of vascularization.
  • Collagen can be taken as a supplement or in food. Several studies found that Hydrolyzed Collagen (HC) supplementation improves skin hydration and elasticity. Furthermore, long-term collagen use improves skin hydration and elasticity more than short-term collagen use. Not all sources of HC are equally effective. Even at the same dose and period of treatment, certain collagen sources outperform others.
  • Monthly facials can also assist to maintain healthy skin by increasing circulation, removing dead skin cells, and moisturizing it. Regular facials can enhance overall skin tone and texture, rejuvenating your complexion.
  • Red light treatment stimulates collagen formation, promotes vascularity, and reduces inflammation. It helps to decrease the appearance of fine lines and wrinkles, improve skin tone, and promote healing.


Hair Thinning ans Loss

During menopause, hair loss may appear as a diffuse thinning or a broadening of the part. The severity of hair loss during menopause can differ from person to person, and not all women experience significant hair loss.

The average person has 100,000 hair follicles on her head and will lose approximately 100 strands every day from “normal” hair loss. Hair follicles are extremely productive, going through cyclical rounds of rest  ~10% (telogen), 90% regeneration (anagen), and degeneration (catagen). Healthy hair functions at roughly 90% capacity, with 10% resting at any one time. Hair loss occurs when these phases are interrupted, either temporarily or permanently. 

Estrogen and progesterone keep the hair in the growing phase, which causes it to grow faster and stay on the head longer. When estrogen and progesterone levels fall, hair growth slows and hair loss becomes more noticeable. In addition, as estrogen and progesterone levels decline, the body creates more androgens.  It can be the androgen/estrogen ratio, rather than androgen-dependent mechanisms, may be a contributing factor in many cases. Androgens constrict hair follicles, resulting in hair loss on the head. The result is thinner hair strands and more hair in the rest phase.

It is also important to note that significant amounts of energy are needed and released during the active growth of hair. An estimated 160 kcal are needed to produce one gram of hair, which is equal to the energy need for six minutes of vigorous exercise that includes both arm and leg. Menopause causes metabolic dysregulation, this may be enough in some to impeeed hair growth.

Because estrogen has vasodilatory effects, blood vessel dilatation and improved blood flow are facilitated. Blood veins in the scalp may tighten due to the drop in estrogen levels after menopause, which could lessen the blood flow to the hair follicles. The reduced circulation may cause hair loss impede the supply of oxygen and nutrients, necessary for efficient hair growth.

Hair loss during menopause is primarily caused by hormonal changes (thyroid and cortisol can also play a role), stress, health conditions, medications, and nutritional deficiencies.

A well-balanced diet and supplements like biotin, zinc, iron, and vitamin D can help maintain hair growth and prevent hair loss.

Itching or Ringing in your Ears


The mucous membranes throughout the body are influenced by the estrogen level, which may also affect the inner ear, resulting in itching, irritation, or even tinnitus (ringing in the ears).


Estrogen receptors are found in cells in your ear and along the auditory pathway, including specific cells known as ‘hair cells’ that convert sound impulses into electrical signals sent to your brain. Damage to these hair cells is regarded to be one of the leading causes of tinnitus.


Some studies have shown that lower estrogen levels can cause variations in blood flow to the inner ear tube (the cochlear) and blood composition affect the regulation of electrical impulses generated by the cochlear’s hair cells, hence altering auditory signals. It is yet unclear the full roles that estrogen, testosterone, and progesterone have in hearing.

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