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.