She’s Sneaky

SneakyShe’s sneaky.

Some days she’s subtle, but other days she plows through your body like a pack of alien invaders.

SHE is perimenopause… the mistress of disguise.

Signs of perimenopause can start as early as your mid-late 30’s. While you’re in the thick of raising kids (or considering having more), your ovaries may be looking toward retirement.

Maybe you notice that you’re just a little grouchier or that your periods aren’t quite as regular. Your PMS symptoms, which were once mildly annoying, are now raging. You gain weight even though you’re exercising and eating right.

Is this Normal?

Hormones begin shifting naturally around the age of 35 when estrogen and progesterone start to taper off very gradually prior to menopause. Because this is usually such a slow shift, many women may hardly feel this change happening in their bodies. However, for many women, these hormonal shifts may overwhelm the body’s ability to maintain balance. The result is severe symptoms that can go on for years. There are some very lucky women who don’t experience any of this until much later…and their symptoms are mild or non-existent. That’s normal too.

Is it PMS or Perimenopause?

Many of the symptoms of PMS overlap with perimenopause. In both cases, hormonal swings are the culprit. The difference is that PMS happens during the second half of your cycle. Perimenopause symptoms can happen at any time. Keeping a journal of your symptoms may help you sort this out if you’re not sure what’s going on.

How Can I know for Sure if I’m in Perimenopause?

The short answer is…you can’t. Lab tests in perimenopause can be unreliable because your hormones are bouncing around constantly on any given day. A lab test only gives a snapshot of what’s going on, and results can vary depending on the timing of the test. Many a woman has been dismissed with “your lab tests are normal” when she is, in fact, in perimenopause. You know your body better than anyone, so don’t settle for this if you feel like something is off.

If you do have blood tests, your doctor will most likely test your FSH (and maybe your estrogen or progesterone levels).  The closer your FSH is to 50, the closer you are to menopause.

It’s a Hormone Problem, not a Zoloft® Deficiency

The first sign of perimenopause that you are likely to notice is some change in your period. Shorter, longer, heavier, lighter. Other symptoms may come with time. Mood swings, fatigue, tearfulness, depression and insomnia are all relatively common.

It’s important to recognize what’s going on because many a woman has ended up on antidepressants or sleeping pills because she (and her healthcare provider) did not recognize that these problems were related to a HORMONE IMBALANCE and not true depression. Misbehaving hormones can often be corrected with lifestyle, herbal and nutritional supplements. In some cases, hormone replacement may be necessary, but that’s not always the place to start. The first step is to get tested to see what your imbalance is. This is important because signs of imbalance overlap. Low progesterone can look like low thyroid; high cortisol can look like low progesterone, etc.

What if That Doesn’t Work?

If changes in lifestyle don’t help, then it may be time to test your sex hormone levels and your cortisol levels. High cortisol levels can keep the rest of the musicians in your body’s orchestra from playing their best, so it’s important to have a picture of how you handle stress and address that first. Testing can be done with saliva, blood or urine (there are plusses and minuses for each method). Knowing your specific imbalances allows your hormone care provider to create a unique management plan for you.

What to do When Perimenopause Steals Your Sleep

Chronic insomnia is one of the most debilitating symptoms of perimenopause for a lot of women (myself included).

There’s nothing worse (IMHO) than lying awake staring at the clock while your hormones are having a PAR-TAY! What’s a girl to do???

Lack of sleep makes you cranky…that’s bad enough. But long-term insomnia can lead to other problems obesity, diabetes, hyper-tension, heart disease, depression, and impaired immune function.

Why do so many women suffer with insomnia in perimenopause?

Low levels of progesterone (the most common imbalance in perimenopause) contribute to sleep problems. Progesterone is calming and in perimenopause lack of ovulation leads to dramatic drops in progesterone.

In addition to an imbalance of the sex hormones during perimenopause, a lot of women suffer with high levels of the stress hormone cortisol, which can contribute significantly to chronic insomnia.

Cortisol is one of your “fight or flight” chemicals. In a perfect world, your cortisol levels are high in the morning and gradually decrease during the day to very low levels at bedtime.  But in our overstressed world, many women have a bedtime RISE in cortisol.

This interferes with restorative REM sleep, and interrupts sleep rhythms. That’s why so many women in perimenopause say they are able to fall asleep, but can’t stay asleep. High cortisol levels can also cause racing, panicky thoughts, heart palpitations, and even panic attacks. If you have high levels of cortisol, you will not be able to sleep even if you are exhausted. Women often describe this feeling as “tired but wired.”

How to Balance Hormones and Lower Cortisol Naturally

The most obvious way to control cortisol is to reduce stress. That’s easier said than done for most of us. You can’t just press an “OFF” button on your life! But there are changes that can help. Consider these ideas:

  • Learn to say NO. It’s a complete sentence.
  • Sometimes “good enough” is good enough. Be willing to accept some imperfection.
  • Get regular exercise…but not too close to bedtime.
  • Avoid caffeine and alcohol. Both elevate cortisol levels. Alcohol also increases estrogen levels which may worsen imbalances with progesterone.
  • Unplug at least an hour before bedtime. Screen light interferes with melatonin production.
  • Try a magnesium supplement before bed. Magnesium is a calming mineral. I like magnesium glycinate because it’s least likely to cause diarrhea.
  • Don’t skip meals. Doing so increases cortisol.

It may be tempting to resort to over-the-counter sleep aids (they contain antihistamines) or prescription sleep medications. But these don’t treat the root cause of insomnia and may make you dependent. Over time, they work less effectively…which means you need higher and higher doses to do the job. As someone who’s been there and done that, I don’t recommend this approach. Get to the bottom of the problem.

There are supplements that can help with balancing hormones and controlling cortisol. However, it’s best to target these to your specific imbalance. Saliva testing is an easy, non-invasive way to find out exactly what’s going on. If you’re suffering from insomnia and want to know more, Let’s Talk.

The Power of Progesterone

It’s time to talk about progesterone. This magical hormone is Snow White to the 7 Dwarves of menopause (Itchy, Bitchy, Bloaty, Sleepy, Sweaty, Forgetful and Psycho). She keeps them cool, calm and collected. Despite her role as Best Supporting Actress, she’s probably the most ignored of the bioidentical hormones.

So what’s progesterone?  It is the hormone that a woman’s ovaries produce in the second half of her menstrual cycle.  In the first 14 days of the cycle, estrogens are large and in charge! They grow the cells of the uterus to prepare it for implementation of a fertilized egg.  At day 14, presumably when ovulation occurs, estrogen production wanes and progesterone kicks in.  Progesterone’s job is to slow down the growth of the endometrial cells and to develop their function.  If you become pregnant and a fertilized egg implants itself, progesterone levels will continue to rise.  If not, progesterone drops signaling the start of menstruation and the whole process starts over again.

So, progesterone slows the growth of cells stimulated by estrogen and develops their function.  But progesterone does a whole lot more.  Progesterone receptors are located in the blood vessels, the liver, breast tissue, the bone, and the brain, and the hormone has an important influence in the functioning of all those parts of the body.

But here’s the thing.  Most of your progesterone is produced by the ovaries. That means, when your ovaries slowly wind down their functioning through the menopausal years, progesterone production slows down right with it.  If you’re not ovulating, you’re not making progesterone. Period.

Estrogens, however, can be produced by other cells in the body besides the ovaries, namely fat cells that convert testosterone into estrogens.  Plus, we are all exposed to compounds in the environment that act like estrogen in our bodies (xenoestrogens). You can read about that here.

So, during perimenopause, progesterone is dropping but estrogens may not be, leading to a condition called estrogen dominance.  This basically means that you don’t have enough progesterone to balance out the activity of the estrogens still floating around in the blood stream, not to mention the fact that you don’t have as much progesterone to have all of its beneficial effects on the blood vessels, bone, brain, etc. Estrogen dominance causes all kinds of symptoms such as:

  • Depression
  • Anxiety
  • Panic attacks
  • Aching body and joints
  • Fatigue
  • Breast tenderness
  • Decreased sex drive
  • Mood swings
  • Allergy symptoms
  • Insomnia
  • Weight gain
  • Water retention
  • Hair loss
  • Migraines
  • Heavy periods and bad cramps

Does any of this sound familiar?   Welcome to perimenopause! So what’s the medical community been giving to women who complain of these symptoms since the 1950’s? Estrogen and antidepressants! This makes no sense. They likely need progesterone.

I have worked with dozens of women with perimenopausal and postmenopausal symptoms and 90% of them have some level of estrogen dominance on their hormone tests. So progesterone is the key.  And the best part is that bioidentical progesterone is safe, easy to use and often resolves symptoms without the need for much estrogen, if any.

And p.s…if you don’t have a uterus, you STILL need natural progesterone! You don’t need synthetic progesterone (Provera®) which affects only your uterus, but doesn’t give you all the other goodies that go along with the natural form.

As always, I welcome your comments and questions.

How to Tell the Difference Between PMS and Perimenopause

Most women know that menopause is defined by the end of the menstrual cycle and typically occurs between the ages of 45-55. But many women don’t know about perimenopause. Perimenopause is the stage in a woman’s life that prepares her body for menopause during the 5-10 years before menopause actually happens. During this stage, estrogen levels are rising and falling, progesterone is dropping, and testosterone may be increasing (chin hairs anyone?). All of this can add up to a host of unpleasant symptoms!

Symptoms of perimenopause often go undiagnosed because they can look a lot like premenstrual syndrome (PMS).  Anger, anxiety, backache, bloating, mood swings, fuzzy thinking, loss of sexual desire, and irritability are a few overlapping examples.

Women who don’t know they’re going through perimenopause may experience these symptoms for years and years without even considering that dropping hormone levels may be to blame. In the meantime, they may simply feel like there’s “something wrong” with them or that they’re going crazy.

PMS or Perimenopause?

So how can you tell if your bad mood is merely a by-product of a bad day or if it’s actually one of the symptoms of perimenopause? Track the frequency of your mood swings, food cravings and other related symptoms. If they happen in the 2 weeks before your period and then go away, it’s probably PMS. But if you’re experiencing the symptoms all the time and can’t figure out what they’re related to, it’s likely that you’ve entered perimenopause.

What’s a Girl to do?

Despite the fact that an estimated 35 million women are going through perimenopause, the medical community often fails to recognize what’s going. Walk into to your doctor’s office with complaints of anxiety and mood swings and you’re likely to walk out with a prescription for an antidepressant. Got hot flashes? You may get a prescription for estrogen that you don’t need. The first step is awareness. The second step is to get your hormones back in balance.

How do I get my hormone levels back in sync?

Once you’re pretty sure that your symptoms are related to perimenopause and a hormonal imbalance, it’s time to take action. It’s very helpful to know which hormones are out of balance so your action plan can target the specific problem. Testing can be done with saliva, blood or urine. Each method has its plusses and minuses. I use saliva testing because it’s easy, non-invasive and gives a “free” hormone level (that’s the amount of active hormone in your body).

Once you have your results, it’s important to find someone who’s knowledgeable to guide you through creating a plan. Lifestyle changes and supplements are a great place to start and can help about 80% of women find relief, but it’s important to choose products that fit your specific needs and don’t interact with other medications you may be taking. Many physicians are not familiar with the use of BHRT and supplements to manage menopause. Your pharmacist, an herbalist or a naturopath can be an excellent resource for this kind of information.

Your hormone levels may act up as early as 35 or as late as 55, but when they do, remember that perimenopause is an important, healthy and natural stage of your life as a woman. In short, there is nothing wrong with you or your body!