Hot flashes and night sweats. The epitome of what comes to mind when we hear the words ‘menopause’. For some reason, we have been conditioned to think that a massive hormonal shift is occurring in our bodies and the only things we should (or could) experience because of it are hot flashes and night sweats.
Puberty – when hormones start to release from a woman’s ovaries culture and society understand that there can be systemic changes in that woman’s mental, emotional, and physical state. When a young woman is young through her transitional years of puberty we understand that the changes she is experiencing are not because of “her” but because of her hormones. The teary nights and yelling fights aren’t because she is a bad person they are because she has an inner storm of hormones occurring and she has never had to deal with them before.
Pregnancy - When a woman is pregnant often we talk about the mood swings, tearfulness, irritability, and memory changes (pregnancy brain anyone?) that can come with the sudden significant shift of hormones. Even though it can be very challenging, we still have an understanding that the shifts that are occurring in our body are due to our hormonal changes.
Perimenopause – Here’s where for some reason things get foggy. As a woman transitions through perimenopause, her ovaries are starting the process of shutting down. Hormone levels are drastically fluctuating daily. Ovulation can become irregular and sporadic. Massive hormone shifts are occurring yet culturally we still don’t seem to ‘get it’. It can be tricky – puberty and pregnancy are obvious shifts. Perimenopause is hard to know because women can still be getting a regular period. When a woman is going through perimenopause and experiencing all the symptoms of hormone shifts – irritability, anxiety, tearfulness, memory changes, skin changes, libido changes, etc etc etc we try and find out what’s ‘wrong’ with her – why is she acting this way. To me, it’s so obvious. It’s the massive changes occurring daily within her.
I have heard this statement from so many women. Sleep is often one of the first things to get disrupted as hormone changes start to occur. Often it isn’t the falling asleep that is the issue – but more the staying asleep. If night sweats/hot flashes start to arise these can disrupt sleep even further. Many women have gone to see their doctor and they end up on prescription medication for sleep. There is no judgment on being on a sleeping pill – but it is important to understand why your sleeping patterns have significantly changed. Your sleep problem didn’t just start of the blue – your sleep disruption is a product of your hormone changes. Prolonged disrupted sleep starts to shift sleeping patterns so your brain doesn’t even know how to rest for a full night anymore. Disrupting sleep is the perfect recipe for impacting mood. Cue the next common symptom of perimenopause – mood shifts.
Many women face big changes in mood in perimenopause. I say changes because I don’t need to label it as ‘depression’ or ‘anxiety’ because it is a change from your normal that is highly likely related to the major hormone shifts (and sleep changes) that you are likely facing. Sally also states “I find that my fuse is shorter with everyone. It’s not that I have a low mood it’s just that I don’t have patience like I used to”. Our hormone balance has an impact on our mood. No question. Disrupting sleep also has an impact on mood. No question. Poor sleep rarely makes people ‘sleepy’ – it makes them feel anxious, teary, and overwhelmed easily. Understanding that these mood shifts are due to a hormonal shift can be very empowering for women.
“I am gaining weight around my middle and everything that I have done in the past for weight loss doesn’t seem to be working”. On top of not feeling like yourself mentally and emotionally there are physical changes that occur in perimenopause as well. Weight gain around the middle – even with no changes in exercise or eating patterns, is a common one. Your body stores fat differently with changes hormone levels. This doesn’t mean that there is something ‘wrong’ with you or that your diet is bad now. It means that we need to work on weight loss for this phase of your life- taking hormone shifts into account.
Talking about the reality of hormone changes can sound all doom and gloom but it doesn’t have to be. Firstly- not every woman experiences these symptoms – and secondly – if you are experiencing them know that it is your hormones making you feel like a different person. Lastly, of course – there is so much to be done to help women through this transition period in their lives. This is the beauty of modern medicine and a scientific approach. We get to debunk old school thinking about hormone fear and instill evidence based safe effective approaches.
So – back to Sally- what did we do. Well, firstly I asked her a ton of questions. We spend an hour discussing everything – including her digestive health, diet, mood, sleep, pain experience, family history, personal medical history, medications, allergies, etc etc etc. We also spent a good chunk of time discussing her hormone status – her last menstrual period, what her cycles were/are like, the length of them, the flow, breast tenderness, vaginal dryness, hot flashes, night sweats, libido, you get the point.
Hormone levels fluctuate massively during peri-menopause – so why test them? We test them so we can get a baseline level. To see if a woman would be a possible candidate for hormone therapy. If a women is still releasing huge surges of estrogen you better believe we won’t be giving her estrogen or I know she will probably be emailing me asking why she feels worse. Every woman is unique so it is critical to understand the individual sitting in front of you.
I also recommended a 30-day anti-inflammatory diet. I find a diet re-set can be very critical in the early stages of perimenopause. It can help to re-establish a healthy digestive tract and lower fasting insulin levels. Women often note a significant change in mood and hot flash intensity from just diet alone.
After this visit, we will follow up in 3 weeks when all her blood work results are back so we can come up with a personalized plan to getting Sally to feeling like herself again.
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