You’re a woman in your 30’s and cannot remember the last time you had your period. You have taken the pregnancy test, found it to be negative, yet you feel drained of all energy all the time. Your headaches are more frequent, you seem to be living with permanent PMS symptoms, and you feel moody and cranky all the time. Could you already be walking down the rocky road to Menopause?
Perimenopause is a time of transition when a woman’s ovaries start to slow down the production of hormones. It may be as soon as her 30s, or it may not be until sometime in her 40s or even 50s. Regardless of when symptoms begin, actual menopause may still be years away. That’s a long time to be “in transition.”
So, what to expect? First, you should know that no two women’s experiences are exactly alike. Estrogen is responsible for a lot more bodily functions than we generally give it credit for, and its slow withdrawal from the body has a set of side effects that sometimes even medicine can’t quite explain.
Are you Battling Perimenopause?
Perimenopause can be difficult to distinguish from more general changes in hormones due to aging or common midlife events — such as children leaving home, changes in relationships or careers, or the death or illness of parents. Given the range of women’s experience of Perimenopause, it’s unlikely that symptoms depend on hormonal fluctuations alone.
So, here are some symptoms of Perimenopause that every woman in her 30’s should be aware of:
On average, Perimenopause lasts three to four years. It can, however, go on for a decade according to data from Harvard Women’s Health Watch. When your period hasn’t been showing up when it’s supposed to, it might be related to Perimenopause. Periods during Perimenopause can also get shorter and lighter — or longer and heavier, or a combination of the two. If you notice anything that simply doesn’t feel right, like heavy clotting, trust your intuition and make an appointment to get yourself checked out.
With less progesterone to regulate the growth of the endometrium, the uterine lining may become thicker before its shed, resulting in very heavy periods. Also, fibroids which are benign tumors of the uterine wall, and endometriosis which is the migration of endometrial tissue to other pelvic structures, both are fueled by estrogen and may become more troublesome.
Hot flashes can last up to five minutes. Some women have more than 10 per day, and they’re never convenient. The sudden blaze of heat that can leave you soaking with your own sweat is the result of your hormones confusing the temperature regulator in your brain. The hypothalamus misreads the body’s signals and puts its cool-down system in high gear. Your skin gets hot so the body’s core temperature can return to “normal,” and perspiration pours out to help regulate the heat.
An estimated 35%–50% of Perimenopause women suffer sudden waves of body heat with sweating and flushing that last 5–10 minutes, often at night as well as during the day. They typically begin in the scalp, face, neck, or chest and can differ dramatically among women who have them. Some women feel only slightly warm, while others end up wringing wet. Research has also found that hot flashes are associated with greater body weight, smoking, and stress.
When you’re really tired, getting through the day is enough of an effort to warrant at least a small trophy. And if you haven’t been sleeping well for days — or weeks or months — you might feel like you’re operating in full-on zombie mode. Unfortunately, sleeplessness is one of the most common symptoms of Perimenopause. With the withdrawal of estrogen, the brain sometimes releases the chemicals responsible for the fight-or-flight response. That rush is necessary for escaping mountain lions, but less helpful for remaining blissfully asleep.
Late-night prowling around the house can be calmed with hormone replacement therapy (HRT) — but it’s not for everyone. Sleeping pills can help you nod off, but not all of them leave you feeling rested, either. Pick up some melatonin supplements, exercise daily and try meditation to see if you can get your snooze back.
Hormonal fluctuations in a woman’s body may cause mood swings. Any woman who’s experienced a bad bout of PMS knows the havoc it can create. Irrational anger, sudden irritability, long crying spells — hormones can make you little nuts. Some women report mood swings and irritability during Perimenopause, but it’s hard to tell if it’s hormones that are causing it or side effects of other symptoms, like a lack of sleep (which can make anyone cranky).
There is quite a bit of controversy in the medical community about whether depression is more common in Perimenopause and menopausal women. Some studies have linked estrogen to depression during the menopausal transition, but there’s no proof that depression in women at midlife reflects declining hormone levels. Menopause-related hormone changes are also unlikely to make women anxious or chronically irritable, although the unpredictability of Perimenopause can be stressful and provoke some episodes of irritability. Some studies have shown a mood upswing in response to hormonal treatment of depression in Perimenopause women, suggesting that there’s a link between this phase in life and the development of an affective disorder.
This one is a common symptom of Perimenopause you may not have heard much about. Some women may be too embarrassed to discuss their leaks, but it’s not unusual to experience some bladder changes during this transitional phase. Just like it helps keep vaginal tissue in shape, estrogen is partly responsible for the health of the bladder. It also makes sure pelvic muscles are in good condition. So when estrogen is reduced, bladder control may weaken.
Whether it is a little pee escaping when you sneeze or the sudden urge to “go” when you’re at the bank, talk to a doctor. Urinary incontinence is a problem for more people than you think, and there are exercises, medications and behavioral techniques that can retrain those weakened muscles.
Transitioning to menopause isn’t the same for every woman. With the possibility of pregnancy removed and monthly periods a thing of the past, some women feel sexual freedom. Others, knowing that their time of fertility is over, feel they are less desirable. And for women who don’t consider sex a priority, it may be a relief.
It’s generally accepted that women’s libido is more complicated than men’s, whether that assumption is fair or not. Getting in the mood isn’t necessarily solved by a dose of hormones, although testosterone has worked wonders for some Perimenopause women who miss their sexual appetite. But stress, lack of sleep and your own feelings about the onset of menopause can also affect how excited you are about sex, as can a partner’s actions and attitude. Lowered libido can also be caused by vaginal dryness, which we will discuss next.
When estrogen levels reduce, it takes a lot of moisture with it. That hormone is responsible for a surprising number of jobs, and one of them is helping with the production of oil and sealing moisture in the skin. And while women in Perimenopause could already be using a rich face cream to counter the problem of dry skin, they may not have been expecting dryness in more intimate areas.
Vaginal dryness isn’t a sign of sexual inadequacy or dysfunction on a woman or her partner’s part. It’s simply biological fact, the result of thinner, drier vaginal tissue. The problem is that it can make sex painful. There are plenty of options to try for a woman who’s looking to regain some of that lubrication – in pill, cream, ring, and tablet or gel form — whatever you need. A gynecologist can help you find a treatment that works for you.
Tender breasts can signal periods and pregnancy. And then there’s the other – Perimenopause. Hormone changes can cause water retention, as anyone with a case of period bloat who can’t fit into her favorite jeans can attest. Your breasts can retain fluid too; swelling up the tissue and making them feel heavy and sore.
Breast pain, also known as Mastalgia, is a very common complaint among women, Perimenopausal or no. While most people agree that cyclic breast pain is hormone-related, one interesting theory posits a fatty acid imbalance in breast tissue cells is to blame.
Weight gain in the Perimenopausal years is a well-documented symptom. The frustrating thing is that the weight doesn’t distribute itself evenly: It settles right on your belly and hence increases chances of insulin resistance, which leads to a greater chance of heart disease.
It doesn’t seem to be the onset of menopause that causes the weight gain, though. It’s aging. As you get older, it’s easier to gain weight and harder to get rid of it. Part of that is because our activity decreases. Whether you’re on your feet or at a desk all day, it’s hard to get excited about jumping around after work. But the simple truth is that in midlife and beyond, you have to stay active to win the battle of the bulge.
We know that abnormal brain activity causes migraines, but beyond that, the causes of these headaches are a mystery. Certain foods can trigger a migraine attack, as can certain odors, missed meals, stress, exercise — the list goes on. The factor these triggers have in common is change. A change in the usual, like less caffeine or too much noise, can set off a neurological alarm that may result in a debilitating headache. And what’s more changeable than a woman’s hormones during Perimenopause?
It has long been believed that hormones have a great deal to do with migraines, since the majority of their victims are women. The withdrawal of estrogen during a certain phase of a woman’s menstrual cycle often precipitates a migraine in women who are prone to them. This same estrogen withdrawal may be what prompts migraines during Perimenopause in women who have never had them.
It could be better to achieve good health and hormone balance nutritionally and naturally first. But then, sometimes that’s not enough. Sometimes, hormone replacement therapy becomes your only choice. But sometimes, there are other more natural solutions that could show remarkable results too.
Since no two women experience the exact same symptoms of Perimenopause, it helps to know all your options to find relief.
Solution #1: Medications
Currently, two kinds of medications are prescribed normally to counteract the symptoms of Perimenopause. The Pill and Anti-depressants.
The Pill has been used for decades to help women in their 30s and 40s have easier periods. The Pill will suppress the hormones in your body that are affecting the brain. It may help even out the rollercoaster ride, and curb the highs and lows of your emotions. There are many types as well as new formulas to consider with your provider. If you didn’t like the pill 20 years ago, you should know that there are many different types today – and your experience could be much different this time around.
Women in crisis may need to use anti-depressants if they really feel they are “falling apart.” These medicines can support the brain chemistry and help stabilize mood despite the hormone changes that are happening. With this support, your brain might better handle any wild hormone fluctuations that are wreaking havoc on your emotions during Perimenopause, and how you might be reacting to the triggers that result in rage.
A healthy diet, high-quality multivitamin, essential trace minerals and omega-3 fish oil all have the ability to enhance results of using an antidepressant as well.
Solution #2: Progesterone Cream
Progesterone is one of the hormones that affect the brain chemistry and it is also one that changes in the Perimenopause years. It is not a one-size-fits-all sort of option, but it is one easy thing to try, and it works for many women.
You can get the low-dose, over-the-counter formulas at most health food stores, or from many holistic practitioners’ offices. It’s important to look for “USP progesterone” on the ingredient list; that’s the active ingredient you want. Progesterone creams are also made to order at compounding pharmacies by prescription, which might be ideal (if this option is available to you) to ensure potency and quality.
There are few side effects or serious concerns with natural progesterone, especially when taken in these low doses. Most of the risks in hormone use are linked to oral estrogens. If you have concerns about risks, you should certainly talk about them with your health-care provider, or choose another path altogether.
Solution #3: Eliminate or Reduce Caffeine, Alcohol and Sugar
This natural and nutritional approach is one of the best. Truth is that sugar, caffeine, alcohol and stress will exaggerate any hormonal symptoms that are occurring. Unstable blood sugar and an over-activated stress response – on top of hormone fluctuations – create a perfect storm for emotional outbursts and Perimenopause rage.
If you can curb these dietary triggers, and pay more attention to what you put into your body, then your brain may be better able to cope with the hormone imbalances of Perimenopause. Alcohol may calm your nerves while you’re drinking it, but if you don’t drink in moderation, or if you use it nightly, then you may find it actually feeds your rage the next day!
There are so many benefits to the natural and nutritional support you get with a healthy balanced diet, and the basic foundation provided by certain key supplements that they can’t be ignored. This strong foundational is built by:
– High-quality multivitamin and mineral formula rich in B-complex vitamins and vitamin D
– Omega-3 fish oil
– Calcium and magnesium
A woman’s personal experience during Perimenopause is very much her own. Some women feel irritable, anxious or depressed. Others feel just fine. If you’re in the former group, talk to someone who can help you evaluate your health and manage stress. In general, women older than 45 are less likely to be depressed during Perimenopause than women who are reproductively younger, according to data found by Harvard Women’s Health Watch. It’s important to know that depression is not a natural part of the aging process.
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