A Cheat Sheet For Perimenopause & Menopause
Perimenopause and menopause are a big deal! If your life right now was a movie it would be The Hormone Wars, starring Estrogen and Progesterone. The physical, mental and emotional changes you are experiencing are one of the most significant aspects of midlife for women. And the more you know and understand the more success you can have navigating this unique time in life. This issue is the cheat sheet you have been waiting for and a starting point for future conversations.
The Basics
Perimenopause
Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause and marks the end of your reproductive years. Perimenopause is also called the menopausal transition. Did you know, you can expect to enter perimenopause in your early 40s? And some women may begin experiencing symptoms as early as their mid to late 30s.
Menopause
Menopause simply means that your monthly bleeding has stopped. Once you have gone 12 consecutive months without having a period you are officially done with perimenopause and in menopause. On average, women make this final transition into menopause around age 51. The best predictor of when you will hit menopause is when your mother went through menopause, assuming she didn’t have a hysterectomy. For such a simple definition, this word packs a punch!
Postmenopause
Postmenopause is the period of time after you have not had your period for one year. You can still have menopausal symptoms during this time.
Estrogen and Progesterone
The changes you are experiencing are driven by fluctuating levels of the sex hormones estrogen and progesterone. Simultaneously testosterone levels are also declining which happens naturally and gradually as we age. With regard to estrogen and progesterone, their absolute levels as well as the ratio between the two are important. Pay attention to and note any physical, mental and emotional changes and discuss with your doctor. And get your hormones checked!
Impact of changes in estrogen levels
Fluctuating levels of estrogen can cause havoc on your life as your body gets used to having less estrogen. Normal symptoms include insomnia, hot flashes, night sweats, mood swings, anxiety and depression, loss of libido, vaginal dryness and fuzzy thinking.
Impact of changes in progesterone levels
Progesterone levels out of balance in relation to estrogen levels can contribute to weight gain, a decreased sex drive, mood swings, anxiety & depression and irregular menstrual cycles. An imbalance can also cause adult acne and brittle hair and nails.
Impact of changes in testosterone levels
As we age testosterone levels gradually decline. Some women may notice this decline and others might not. It is not only libido levels that can be impacted, but also energy levels, mood and ability to concentrate or focus.
So What Can You Do
From my experience the first thing to do is get your hormones checked as soon as you start to notice any changes. This way you and your doctor are working from specifics. I first had my hormones checked when I was 43. My PMS was getting worse, particularly my mood swings and I was constantly snapping at my kids. After reading one woman’s story of embracing bioidentical hormones so her kids wouldn’t remember her as a raging bitch, I thought, “yes, I need these too!”
Once you have taken this step then you can begin exploring the myriad of treatment options. I like to group options into three categories: diet & lifestyle, traditional and alternative. I have elaborated on each below and included my own experience where relevant. Your doctor can help you decide which are best for you.
Diet and lifestyle
I know you have heard this before, but diet and lifestyle can have a HUGE impact. In addition to using bioidentical hormones, this is where I have focused most of my own efforts. Some of the most important areas to focus on:
i) Prioritize sleep - Adults need 7-9 hours of sleep. I am in bed by 10 and get up at 6 or 6:30.
ii) Move your body - Current exercise recommendations for adults are a minimum of150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise a week. Ideally a mix of aerobic and resistance training. In addition to working out I move as much as possible throughout the day. I hang from our pullup bar, do air squats, calf raises, go to the bathroom farthest away from where I work...you get the idea.
iii) No junk food or processed food and watch the sugar - Eat real food and focus on vegetables, high quality protein and fat. Empty calories and fake food make me feel like crap.
iv) Manage and/or remove stress - While small amounts of stress are fine, long-term stress is unhealthy. I meditate, take short walks, spend time outside, do box breathing (see Drips & Drops below) a couple of times a day and journal at night.
v) Limit caffeine and alcohol consumption - Caffeine and alcohol can both disrupt sleep and as my acupuncturist says, for hot flashes and night sweats these are like adding fuel to a fire (I find sugar has the same effect). I hate that this is true as I love wine with dinner. But when I’m going through a phase where I am having night sweats, cutting back on alcohol is one of the first steps I take.
Traditional medical treatments
Traditional treatment approaches include Hormone Replacement Therapy (oral, creams, patches) to balance progesterone and estrogen levels, antidepressants for anxiety and depression, and Clonodine and Gabapentin for hot flashes at night. Ask your doctor for other options. I have weighed the pros and cons of HRT and currently take bioidentical estrogen, progesterone and testosterone.
Alternative treatments
Alternative approaches include acupuncture, meditation, herbs like Black Cohosh, supplements like Vitamin D and Calcium, CBD Oil, and exercise. As with traditional treatments ask your OBGYN which might be best for you. If they don’t have a perspective, you might seek out an Alternative Medicine practitioner who can work in tandem with your OBGYN. I have tried most of these and currently use acupuncture, meditation, supplements and exercise to help manage my symptoms. I have used CBD oil in the past which appeared to reduce the severity of night sweats.
Additional Sources of Information
Blogs
If blogs are your favorite way to get information, check out Healthline’s rating of the top 10 menopause related blogs of 2020. I don’t subscribe to any but I was surprised to see that one of the top 10 was written by a man!
Books
When it comes to books, Christine Northrup’s, The Wisdom of Menopause, always comes to mind. My sister-in-law, who is a few years older than me, turned me on to this book back in my early 40s. While there are now dozens of books on the topic, if I were to recommend one book, it would be Menopause: All You Need to Know in One Concise Manual.
Websites
While there are SO many websites out there it is overwhelming, I have found these to be helpful. For a perspective and information offering an alternative to conventional medicine check out Women’s Health Network. For additional general information or to find a doctor check out the North American Menopause Society. And then there is Gennev, a new company offering not only information and products but telehealth support for women in midlife.
Podcasts
The last time I checked there were over 25 podcasts related to menopause. They cover everything from firsthand accounts and expert advice on Not Your Mother’s Menopause to more informal discussions of the realities of menopause and midlife on Itchy and Bitchy to a look at effective natural solutions and lifestyle changes on Essentially You. I’m sure you can find one for you.
Apps
There are apps for everything these days. One of the most useful is the one I use to track my cycle. Before perimenopause my cycle was 32 days every time. Now it ranges from 18 to 71 days and it would be impossible to track without an app. I share this data with my doctor which along with regular hormone testing has been an important part of treating my symptoms. I use Menstrual Calendar FMC which is free. Two other highly rated cycle tracking apps are Flo Period Tracker & Calendar and Clue Period & Cycle Tracker. And, if you want something to track menopause symptoms check out Caria: Menopause & Midlife.
Online classes
And last but not least, there are online classes. I have not taken this course but the description was intriguing enough to mention here, Magic Menopause, A Women’s Health Masterclass. Others that might be worth checking out are Empowered Menopause and Perimenopause Masterclass: Feel Like Yourself Again.
Parting Thought
Midlife can be an amazing time in our lives. Different cultures have different views on menopause and post-menopausal women. Many western cultures place a high value on youth and women in perimenopause and menopause might be made to feel like less valuable members of society. But there is another way. In other societies the wisdom of women in midlife is celebrated and they gain new freedom and status.
See you next week...
