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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
What do you think?......
I'm 48yrs old, on birth control and thinking about going off because of estrogen and history of breast cancer in my family.
As of this month, I have break through bleeding. My periods are OUT OF CONTROL.
So, my gyne wants to put in a Mirena, IUD. She stated that this should control the bleeding.
Right now, I can't go without a pad, because of the break through bleeding.
Before I can get the IUD inserted, I have to have my thyroid checked, and a mammogram. These are scheduled within the week.
Hopefully, this will take care of the problem.
Has anyone gone through this?
March 22, 2009 - 5:04pmThis Comment
I have a Mirena IUD and love it. Don't even know I have it in me and it totally stopped my "hemoraging". Barely have periods anymore. I've had it for 3 years now (only lasts 5 yrs. as opposed to a regular IUD which last 10). Well worth it. No pain during insertion, just some pressure. I think you'll be happy you did this. All the best.
April 1, 2009 - 10:09amThis Comment
I, too wish that I'd had more information about perimenopause before I was smack in the middle of it. The good news, though, is that I think we're the last generation that will feel like that. My sister, who's 43, has been aware of what to expect with perimenopausal changes since she was in her late 30s. I think it's like everything -- with better science comes more information, and with more information comes better science, especially as we keep asking questions and being determined to find the answers.
One of the reasons that it is so difficult to manage perimenopause and menopause is, however, that so much of the information is conflicting. Even if one trusts only medical doctors who deal regularly with these conditions, the information can be radically different. Do nothing. Use hormones. Use synthetic hormones. Use bioidentical hormones. Use natural treatments only. There are books upon books, philosophies upon philosophies, and testimonials upon testimonials. Even allowing for the fact that every woman is different and needs individual treatment, the philosophies still can seem in direct opposition to one another.
Let's hope that one thing we do for the next generations is smooth out the rough spots in the science, especially where hormone replacement is concerned.
March 16, 2009 - 8:52amThis Comment
Btw, I want to add that I think advice for women to take antidepressants during perimenopause and after menopause is horrendous! The problem is lack of hormones, most notable progesterone and estradiol. Antidepressants do nothing to address that problem and only mask it with a mental fog. Is this much better than what used to happen to women decades ago, being committed to asylums?
March 15, 2009 - 8:28pmThis Comment
I wish I would have known about perimenopause before I entered into it! I suffered needlessly for several years.... had bouts of rage and palpitations, got sick every 2 or 3 months, slept horribly.... when just a little bit of over-the-counter progesterone cream could have helped! When I finally figured out what was going on and started using progesterone, it was like a little miracle. Later on when I reached menopause, I started supplementing estradiol and had a similar miraculous effect. I'm angry that information about perimenopause is not disseminated to young women, and I'm angry that most doctors view perimenopause and menopause as a "natural" part of life to be ignored and suffered through. Perimenopause is the beginning of ovarian failure and menopause is the actual failure. Doctors would not dismiss the failure of any other organ.
Kristin, you might want to consider getting off of YAZ and onto bioidential hormones. If you are still perimenopausal, progesterone might give you just the relief you need. Pro-Gest is a good brand, it's very inexpensive, only cost me about $8/month. Do your research and consider supplementing estradiol when you are near or at the point of menopause. Estradiol is not only excellent at mitigating the vasomotor symptoms (e.g., hot flashes), it also can provide a great mood boost.
alysiak, I think that women who are well past menopause don't recall correctly their symptoms. I remember my mother having bad sweating hot flashes and horrible insomnia in her early 40's, but if you ask her about it today at age 79 she'll tell you she hardly had any symptoms at all. Not sure if these women are choosing to have selective memories or their memory is just unintentionally faulty. I doubt I will ever forget the 13 days of multi-times-per-hour sweating hot flashes that I went through before I begged my doctor for a prescription for EstroGel!
March 15, 2009 - 8:26pmThis Comment
I have thought about that -- about getting off the YAZ and onto bioidenticals. I only hesitate because 1) I need the birth control aspect of YAZ -- do not want to get pregnant right now, and 2) since I feel so good on YAZ, I hate to make a change (why fix something that's not broken). But, I do worry at times about the fact that I'm taking a "one size fits all" drug, and not really taking the time to figure out my exact hormone needs..... I guess I feel that if at some point I start experiencing perimenopausal symptoms again, I'll have to make a switch then.
April 1, 2009 - 11:47amThis Comment
I'd like to know how POST-menopause can be made easier, lol! This is pure angst for me.
March 13, 2009 - 4:29pmThis Comment
I feel for you..... if perimenopause is this challenging, I don't even want to think about the beyond.....
March 13, 2009 - 4:50pmThis Comment
What I find funny is that my mom, who turns 80 in a couple of weeks, claims she never went through all the weird stuff I've been going through. To listen to her, it sounds like menopause hit one day, lasted a little while, then was over. She's in pretty good shape, so, who knows!
March 13, 2009 - 5:13pmThis Comment
What a great article! I've been in the throes of perimenopause for probably 5 or 6 years now -- it just took me a while to figure it out. About two years ago I started on Yaz and am so grateful that I did. It has made a huge positive impact on my life in many ways. I would encourage any women in their 30's or 40's who are suffering from PMS, heavy bleeding, hot flashes, etc., to talk to their doctor about supplements that are mentioned in the above article. There are a lot of options to make perimenopause much easier.
March 12, 2009 - 10:13pmThis Comment