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You Are Not Crazy….Just Perimenopausal

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Did you ever get old overnight?

Where did these wrinkles come from? How come I can’t read without squinting? Why does my family think I am a bi&*@? Is it hot in here? Why can’t I sleep? When is my period going to come .. or stop? Why do I eat the same but gain weight?

Am I crazy? No, you are just in perimenopause, my dear.

The really crazy thing is when you go to talk to your doctor about it he tells you, ”There is nothing wrong with you” or “You just have to live with it.”

That is simply not true and I think part of the reason why Susan Somers and bioidentical hormones have become so popular. The doctors are not listening, so patients are going to what appears “safer and more natural” which I hate to say, is not necessarily true.

First, what is perimenopause?

Perimenopause may begin as what appears to be increasing moodiness and irritability and is often accompanied by erratic periods, some of which can be quite heavy. The ovaries will also start to wind down in a sporadic manner producing normal estrogen one month and low levels the next. Low levels of estrogen account for most of the symptoms of menopause. These symptoms include hot flashes, night sweats, insomnia, vaginal dryness, decrease in the blood supply to the vagina and thinning of the vaginal mucosa or tissue. These symptoms typically begin in your late 40s but often start as early as mid 30s.

What can I do about it? A lot actually.

The first remedy is lifestyle changes. Your body is telling you, “If you keep putting crap in, you’ll get crap out.”

What can my doctor do to help?

TSH is the most important hormone to check if you are having irregular bleeding, fatigue, weight gain or simply not feeling well. TSH checks your thyroid or your body’s regulator gland. If it is off, your whole body will be off. It is the most common endocrine problem as we age.

Many women will have their FSH checked. This hormone level is not that helpful in treatment. You can have a premenopausal level but still feel awful from hormonal fluctuations. This is the time that many doctors still say nothing is wrong with you, when in fact, everything feels wrong. You can also have a postmenopausal level one-month and back to premenopausal the next. I think it is important to base treatment on symptoms and not the level of this hormone.

What about hormone replacement therapy?

If lifestyle changes and herbal remedies do not alleviate symptoms, then many women benefit from hormone replacement therapy. The idea is to replace the hormones that your body is no longer making. The difficulty with perimenopause is that your body is still making the sex hormones, estrogen and progesterone, just at sporadic times and at sporadic levels. You cannot take a test by blood or saliva to match up what your body is supposed to make because this will vary from day to day until you go through menopause completely.

Many women in this time find birth control pills are of great benefit as they even out the hormones. They are strong enough to control the bleeding problems while taking care of the hot flashes as well as preventing pregnancy. Women still can get pregnant at this time. Many women who thought they were in menopause when their period stopped had quite the surprise when told they were pregnant.

What about bioidentical hormones?

Bioidentical is a term that means matching what your body makes. You can get bioidentical hormones from a drug company as well as from compounding pharmacies. I prefer to use the drug company form, as they must be made in FDA regulated laboratory and have rigorous testing. I am concerned about the lack of regulation in the compounding labs as well as lack of testing of the products. I also am leery of the amount of out of pocket money many of these pharmacies charge, preying on women’s desire to feel younger and falsely touting its safety.

The reality is that compounded pharmacies and drugs are not tested or regulated. Lifestyle changes and many hormones acquired through FDA testing are more effective and far safer.

Compounded drugs are also very tricky to use in the perimenopausal patient as the hormones are fluctuating. They are often not strong enough to control hot flashes and bleeding. I have used compounded pharmacies, especially for drugs that do not have FDA approval in women yet, like testosterone. It really depends on your symptoms so make sure your doctor will discuss options and don’t settle for, “You just have to deal with it.” Don’t be conned by bioidentical compounded pharmacies either.

How can medications help mood?

Often times evening out the hormones will even out mood, especially if the using drospirenone that is found in birth control pills, Yasmin and Yaz. Some women that don’t want hormones or find they are not enough will benefit from antidepressant medications. Some women do not need to take them everyday and only use them the second half of their cycle. There are many medications such as Sarafem, Lexapro, Wellbutrin and Cymbalta that can help and often times it involves trial and error to find the right one at the right dose.

You are not crazy and these changes are real. It is up to you to take the journey to feeling better. Maximize your lifestyle, minimize your stressors and consider supplements to help you in this discovery.


Add a Comment20 Comments

I am 37 and think that I have been in perimenopause for a few years now. I thought I was going crazy erratic periods, moods swings, hair loss, low libido, inability to lose weight regardless of how much I exercised or how clean I ate, etc... Then I started researching my symptoms and there it was but who knew? Everyone I mentioned it to said I was too young but the more I looked I started to discover I am in fact not too young. Very frustrating that no one talks about it! The only thing that keeps me feeling sane is to keep my diet clean (no processed foods) and for me gluten free. Everyone is different but I think what we put in our mouth makes a big difference in how our bodies react.

September 6, 2012 - 10:18pm
EmpowHER Guest

Very knowledgeable reading. This is such a great resource that you are providing.
528 LED Strip

April 10, 2012 - 7:13pm
EmpowHER Guest

I'm 49 and my change in menstrual cycle began a few months ago, while I was still 48. In the last 6 months, I had 2 menstrual cycles - one normal, and the second one lasted 3 weeks with terrible cramps and clots that made me shiver. I had also changed my lifestyle drastically. I stopped exercising, ate whatever I wanted whenever I wanted, ate lots of fast food. I was eating for my depression. After the bad cycle, I had an endometrial biopsy done. I thank God it was normal, but I'm on a low dose progesterone pill to help with my heavy cycles. I also found out I have a small fibroid. So.......I've eliminated wheat, processed foods, unhealthy food and drink. I eat less, eat healthier and I'm going back to exercising every day. The doctor stated I could get a Mirena IUD so I am considering doing that once I lose some weight. I'm trying to ride into menopause healthy and without problems. Oh, and I started having the palpations and anxiety when I was 45. Off and on, always right around the time my cycle came on....and I was eating horribly then too. The solution for staying healthy for menopause is eating right, eating light, exercising (even if it's just walking an hour a day), drinking lots of water, taking a good multivitamin, getting 7 -9 hours of sleep every night and most importantly, keeping God first in your life.

June 29, 2011 - 1:26am
EmpowHER Guest

I am 49 and started my premeno: very heavy periods, anemia, loss of motivation, fatigue, mild depression, water retention. The doctor prescribed yaz, but I am reluctant to go on hormonal replacement...I have never been on a birth control pill before. I am not sure about the risk of breast cancer etc...
What are the best natural remedies, that could possibly help normalize the blood flow and rid me of water retention and puffiness? Also, is yaz totally safe to take? Any advice will be greatly appreciated.

May 10, 2010 - 9:52am
(reply to Anonymous)

I can't answer to whether or not Yaz is "totally safe," but I've been on it for nearly three years now and have had a very good experience with it. I'm 44 and recently had my annual exam with my gynecologist. I asked her some questions about Yaz since I'd seen some TV ads regarding lawsuits. Her response was that since I'm healthy and in good shape, I should be fine on Yaz. There are of course risks with it, as with any other birth control pill, such as blood clots, etc., but in my case the benefits far out weigh the risks.

May 10, 2010 - 10:23am
EmpowHER Guest

starting to go thru menopause but so far the only symptons are no periods. Like to read the comments so if I go thru the rest I get an idea of what to do or where to go

August 31, 2009 - 6:12am
EmpowHER Guest

I thank everyone for posting their true comments. I am thirty six and I feel horrible. I wake up in the middle of the night with rapid heartbeats and that really freaks me out. I am diagnosed with panic attacks and anxiety. Son on top of palpatations, rapid breathing, mood swings, being irritable....I feel so out of touch. It is difficult for me to enjoy things because I focus on my feelings daily. It is diificult for me when I go to the doctors and they say nothings wrong, yet I feel all these feelings. I am currently searching for a doctor who will listen and not just prescribe me some anti-depressant. I would reallly like to talk to some of you for support, feel free to e-mail me at [email protected]

August 4, 2009 - 3:59am
EmpowHER Guest

I don't remember taking anything. It hurts more when it's removed, (my old IUD), but no where near labor pains. Maybe some slight cramps afterward but truly nothing that I even remember. It probably wouldn't hurt to take an Advil or two, but I seriously don't think you'll need anything more. I wonder if the nurse read that or actually experienced it. My guess would be the former.

Good luck and no need to worry....it is worth whatever cramping you experience. Just not having to deal with those heavy periods is worth any amount of pain!

April 2, 2009 - 4:07am
EmpowHER Guest

Great! Thanks for answering my questions.

The nurse at the office told me that I would have pain as if I was in labor. That made me nervous. You've made me feel better about it.

Did you take something before the appt? Like an 800mg Motrin or valium?

My dr. stated that she may pre-med me with one of those.
Do I need it?

April 1, 2009 - 11:24am
EmpowHER Guest
Anonymous (reply to Anonymous)

I had labor like pains with the endometrial biopsy, so I know if I have an IUD implanted I will have to be sedated. The biopsy only lasted a few minutes and I was crying. Real tears. I'm 49. It's worse than a regular PAP smear which I really don't like. I would definitely suggest you ask for meds before the procedure if though the insertion doesn't take a long time.

June 29, 2011 - 1:34am
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