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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