Too early for menopause – what is going on for a woman in her 40s?

“I am a 40’s something professional and busy mum. I’ve recently noticed I am so prone to emotional outbursts and often get tearful leading up to my period.  My emotions just seem to go into overdrive and I can’t control them.  I used to get the odd PMS symptom but nothing quite like this…”

In my practice I frequently see this as quite a common presentation for women in this age group.

These symptoms are to be expected, given the extent of hormonal change occurring in a woman during this period of time.

Referred to as perimenopause, in this transition period the ovarian hormones are in a state of constant flux.  This is responsible for giving women a high and a low emotional state which is often referred to as the “rollercoaster effect”.

This fact can often be overlooked due to its onset being 5-10 years before menopause, which has traditionally been the subject of greater medical emphasis.

As the function of the ovaries starts declining, the adrenal glands produce small quantities of sex hormones to make up for the loss. However, if there is any stress past or present which has not been dealt with adequately; there is increased cortisol secretion from the adrenals and even less sex steroid production. The demands of multi-tasking family and professional lives contributes to this stressful period.

It is a well-known fact that stress has a direct correlation with sleep so it’s of no surprise, sleep deprivation in turn escalates the stress response.  Add plummeting hormones to the mix and you have a recipe for an emotional rollercoaster consisting of irritability, tears and feelings of insecurity.

Sleep disturbances are also particularly common as progesterone levels are dropping more than oestrogen.  The imbalance in hormones can also cause difficulty in getting to sleep with multiple awakenings.  Sleep is not only important for sanity and daily repair of our tissues.  Sleep disruption also causes circadian biorhythm disturbances which carries on into menopause with added deleterious effects.

Establishing good habits

Healthy lifestyle interventions form the basis of positive health especially during this time can  go a long way to promote good health and minimize the symptoms .

 Specific personalised hormonal management may be required at this time as well.

Specific nutrients that can help address perimenopause-related emotional instability:

-Lack of sleep and stress can often cause reduced magnesium levels
-Effective in the form of Magnesium glycinate or Magnesium Threonate.
Evening Primrose Oil
-Source of essential fatty acids, vital for cell communication and hormone metabolism.
-An Indian ayurvedic herb that is well known for balancing brain neurotransmitters and maintains levels of physical and mental reserve in times of stress.
-Fosters positive mood and relaxation
Lignans-Play a supportive role in brain health
-Source of plant-derived sources of estrogen

Take the guesswork out with DUTCH Functional Hormonal testing

Every woman is different and it’s often difficult to grasp exactly what is going on in individual bodies during this transition period of peri-menopause.   I’d often recommend a dried urine test for comprehensive hormones (DUTCH), the most advanced test from a specialised lab in USA, to give you an overall picture of your sex and adrenal hormones.   This analysis provides detailed insight of the hormonal imbalances occurring within the body – enabling me to create a personalized program of the specific nutritional and hormonal support needed to help hormone balancing.

In cases, that require hormone therapy I usually will recommend bio-identical hormones. As the name suggests these hormones are identical in chemical structure to the hormones present in the body which means there are minimum side effects.

Regular physical and laboratory evaluations are recommended to achieve safe replacement.


Dr Avani Karl - Women's Health

Dr Avani Karl

As a Functional Medicine Practitioner, Avani uses an individualised treatment approach empowering patients to address the underlying cause of disease to achieve optimal wellness.  She has a particular interest in Women’s Health.