Hormones and perimenopause: It's not in your head!

As I reviewed a hormone panel with a lovely woman this week, and then had a conversation with someone else in the community at lunch regarding her menopausal symptoms, it hit me:

Many women as they approach menopause (peri-​menopause) and enter into menopause officially often feel unheard, like they are going crazy, and there is little that can be done about it. It’s disappointing. Why is that?

  1. A lack of understanding on the part of health professionals to properly assess a woman
  2. The incorrect intervention assisting a woman with that appropriate stage
  3. Women themselves feeling sheepish, or embarrassed, about how their symptoms are affecting their lives

Let’s go into further discussion about the three points above:

1. A lack of understanding on the part of health professionals

Perimenopause is the stage before menopause actually starts, and can be 10 years before menopause hits. That’s right ladies, 10 years before you stop menstruating you can be having symptoms of menopause. If you think about it, it’s not that strange. Before you started menstruating, there were a few years of symptoms (hair growth, breast development, mood swings), and there are similar predictable symptoms as women stop menstruating:

  • Mood swings
  • Irregular periods
  • Regular periods, but different than normal
  • Weight gain
  • Depression
  • Anxiety
  • Hemorrhaging
  • Fatigue
  • Joint pains

Vague, yes? It’s confusing for you experiencing the symptoms, and often we can also have changing blood levels of hormones during this phase as well, leading to symptoms that look like menopause, but are not actually true menopause yet:

  • Low/​high estrogen
  • Low/​high progesterone
  • Low/​high testosterone
  • Low/​high melatonin
  • Low/​high cortisol (our major stress hormone)

To know whether your hormones are starting to bounce around, you need to test, and often, that isn’t done. Why? Everyone assumes a women is either in perimenopause or in menopause, and rarely is it checked, it is just based on symptoms. While it’s true that clinical experience does often lead us in one direction over another, my recent experience has demonstrated that we can never truly know unless we look at the hormone levels in the person.

2. Incorrect intervention to support the woman’s stage

So, if you haven’t assessed correctly, you can guess that what often happens is that the wrong treatment is selected. Estrogen is given for hot flashes, when it’s actually a progesterone deficiency. Hormone replacement therapy is given when really a woman just needs a lot of vitamin B6 (which is involved in hormone synthesis in the liver). As a result, the person on the treatment feels like they should be getting better, but really, they’re not, because they’re stagnating.

3. Women feeling embarrassed about their feelings and sensations

Women, you know your bodies best. No one can really tell you that what you are experiencing is fine, if the treatment hasn’t supported your symptoms yet. There is no need to be embarrassed about feeling not like yourself, however. There is SO much shame that we really need to not be putting upon ourselves, as Brené Brown would say. The hormonal swings that estrogen and progesterone are capable of can impact mood and brain function so profoundly that you can literally not be yourself. There is nothing wrong with that at all, other than finding out where the imbalance lies and supporting it best.

My recommendations?

  1. Get tested ladies. Find out where your hormones are.
  2. Get educated on the type of hormone replacement (herbal, bioidentical or other) that:
    a) makes sense for you
    b) reduces your symptoms
    c) has the least amount of additional side-​effects that you may need to consider
  3. Give it a try, and set out some realistic goals with your health care provider about what quality of life will mean for you over the next few years. This will change as your hormones do their dance.
  4. Get educated on hormones and the possibility of change. Does (or did) your menstrual cycle always behave like it should? No. Yes, it totally sucks that you may experience symptoms of perimenopause and menopause for a period of time. But think about it — if someone had told you when you were a preteen that you could be menstruating for 30+ years, you would have been completely hysterical. I’m not saying that you will be suffering for 30+ years with menopausal symptoms, but you may want to learn about it in order to deal with it at some point. The devil you know is better than the one you don’t, yes? And speaking of, there are some wonderful menopause-​supporting books out there, including:
    The Natural Menopause Book, Amanda McQuade Crawford
    What you Must Know about Bioidentical Hormone Replacement Therapy, Amy Lee Hawkins

It’s not in your head! Find out what’s happening and feel like yourself again.

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