Menopause has gotten a bad rap. Women in their 40s and 50s who have any symptoms – from moodiness to insomnia and headaches – may believe that it’s a normal part of aging and there’s not much they can do about it.
Fluctuating hormones caused by the normal decline of ovarian function can trigger the typical symptoms associated with menopause. One approach is to give the body a drug that mimics ovarian function, such as estrogen or hormone replacement therapy. This was a common treatment, until multiple studies showed increased risk of urinary incontinence, stroke, dementia and breast cancer from using menopausal hormone therapy.
Fortunately, there is another approach to improving the body’s ability to adjust to hormone fluctuations that doesn’t increase the risk of breast cancer and dementia. This approach looks at the other organ systems that are involved in addition to the ovaries. For instance, hot flashes will be greatly exaggerated in a woman who has blood-sugar problems – even if those don’t show up on a standard blood test.
Some women use bioidentical hormones instead. While they appear to have fewer immediate side effects, there is no evidence that they have fewer long-term risks.
At a recent functional medicine conference I attended, there were several discussions on how to address hormone “saturation” – the experience many women have after being on bioidentical hormones for several years and then having a return of their previous symptoms. We’re learning that underlying imbalances in gut function, adrenal hormones and blood sugar can have a major effect on a woman’s experience of her perimenopausal years.
IT’S NOT JUST THE OVARIES
Technically, menopause occurs when a woman hasn’t had a period for 12 consecutive months. The symptoms that can occur for years before that are due to the ovaries becoming less predictable in their hormone production. This means that estrogen levels can spike and fall like a roller coaster.
Unfortunately, once a woman knows that her hormones are fluctuating, she is likely to explain away all her symptoms as perimenopausal. But ovaries are not the only glands affected by hormone changes. The pancreas, thyroid and adrenal glands play key roles in determining how easy or difficult the perimenopausal years will be.
The most common, end-stage effect of pancreas dysfunction is diabetes. But long before the body reaches a disease state, there are more subtle effects. For instance, a woman with low blood sugar or insulin resistance will experience more severe hot flashes than a woman with normal blood-sugar regulation.
Following are common symptoms associated with perimenopause and factors that can determine the severity of those symptoms.
• Heavy or frequent periods. These can be worsened by blood-sugar and thyroid imbalances that don’t show up on routine blood work. Checking free and total levels of T3 and T4 as well as thyroid antibodies can be helpful.
• Hot flashes or low libido. Underlying adrenal stress can result in cortisol levels that are too high or too low, or reduced DHEA (precursor to several hormones). Cortisol levels are best tested with multiple saliva samples over a 24-hour period.
• Insomnia. With or without hot flashes, insomnia is often due to chronic stress, which causes the adrenals to produce excess cortisol.
• Mood changes and brain fog. Moods can be affected by the stress hormone cortisol as well as imbalanced neurotransmitters. Neurotransmitters such as serotonin are made primarily in the gut and can be evaluated with a urine test. Low levels of serotonin can also increase overall pain levels.
• Hair loss and weight gain. There may be underlying thyroid stress that doesn’t show up on routine blood work but requires a more detailed look at free and total levels of T3 and T4 and thyroid antibodies.
Once these underlying issues are identified, they can be addressed through food choices, lifestyle factors and specific supplements.
Marina Rose, D.C., is a functional medicine practitioner, certified clinical nutritionist and chiropractor with an office at 4546 El Camino Real in Los Altos. For more information, visit DrMarinaRose.com.
From 10 Ways Perimenopause Is Destroying My Life – The Mid.
1. My Period Is Trying to Kill Me
For years, I enjoyed a regular and uneventful menstrual cycle. Now, I never know when I’m going to get my period. It could be in the next six weeks causing a panicked pregnancy scare, or it could decide to come every two weeks (and always when I’m not expecting it at all, and wearing white pants). How long it will last is also a mystery. Once, I had my period for two days, and another time it lasted a full 12. Cramps, heavy bleeding—I’ve got all that in perimenopause. Last month, I passed something that resembled a London broil. It was as if my entire uterus was trying to escape through my vagina. I don’t like this. I want the boring periods I experienced in my 20s back.
2. I Can’t Sleep
Every day I tell myself that this will be the night that I will go to bed at a decent hour and get a full night’s sleep, but it never happens. My sleep patterns now resemble a newborn’s. I’m up every two hours. I’m hungry, I have to pee, I’m bored. I’ll toss and turn for hours each night, praying that my mind will shut off and let me go to sleep, but nope. Naturally, because of this, I’m exhausted all day long and have to drink a ton of coffee to stay awake. To further torture me, in the past year, my body has decided it doesn’t want to metabolize caffeine like it once used to. I’ve morphed into a hybrid of Lady Macbeth and Cornholio. If you ever see me furiously Irish step-dancing through the aisles of Walmart, I swear it’s not meth. I just had a cup of coffee, because I was tired, because I can’t sleep at night, because of perimenopause. Save me, please.
3. Unexplained Weight Gain
No, I’m not pregnant. I’m just cruelly bloated. They make mom jeans for women like me. Once a sworn enemy, elastic is now my greatest ally. I swear, I haven’t changed my diet at all. If anything, I eat healthier now than ever, but my metabolism is nonexistent these days. I used to be able to rip through nachos, Twix bars and Slurpees, and remain a size four, but now a single Cheeto will force me into a higher dress size.
4. My Body Is Growing Weird Hairs
I hate my teenage self who used to wonder why older ladies always had wiry hair on their chins. Now I know. It’s because those hairs can randomly sprout three inches in about two seconds. And also because we are so old that we can’t even see black whiskers shooting out of our faces. Yes, I’ve accepted it, I’m either turning into Witch Hazel from Looney Tunes, or a walrus.
And when I cough, laugh, or jump up and down. I’m an old house—quaint and charming on the outside, but my plumbing system is a leaky nightmare.
PMS is apparently having its last hurrah with me and is determined to go out with a bang. Irritable doesn’t begin to describe it. Little things set me off: going to IKEA, wanting tortilla chips but being out of them, if my daughter whines because, God forbid, I gave her the wrong plate at lunch, and when my clock ticks too loudly in the middle of the night. It’s awful. Whenever I see a woman on the news who’s had a road rage incident, I sigh knowingly and say that I bet she’s in perimenopause. Sometimes I have fantasies of getting a job at an amusement park haunted house just so I can chase people around with a chainsaw, because most of the time, that’s what I feel like doing anyway. I may as well get paid for it, right?
7. My Skin Is Freaking Me Out
I’m so dry and wrinkly that I think my vagina has cobwebs. I recently read somewhere that during perimenopause “breast tissue may reduce.” Great. That thing sputtering around the room? Not a deflating balloon. That’s my left boob. The skin on my arms and chest is so crepe-y that you could make streamers out of me. Yay! I love looking like a beige party decoration. I found an age spot on my hand the other day, and I also heard that you can get age spots on your nether regions, which is fabulous because I always wanted my crotch to look like a Chinese crested puppy. Said no woman ever.
8. I Can’t Remember Anything
What was I saying? You know that feeling when you’re trying to remember something, and it’s right on the tip of your tongue? That’s me 24/7 these days. They call this brain fog, and I feel like I’ve reached my brain’s natural storage capacity and now it’s malfunctioning from overload. I need an external hard drive for my mind. The number of times in a day when I find myself standing in the middle of a room and have no idea how I got there or what I’m supposed to be doing is staggering. Every time I open an app on my phone, I forget what I meant to look up, log or check. I’ve officially turned into the guy from Memento and am going to have to start writing notes on my skin to piece together my life.
9. Everything Makes Me Cry
Last week, I cried because I saw a high school marching band coming down the street playing Stevie Wonder. I cried at a puppet show, from watching children ride a carousel and over the grand finale of a fireworks display. Forget Idina Menzel. Before she even opens her mouth to sing, I’m weeping uncontrollably.
10. I’m Hot—NO, I’m Freezing
My internal temperature gauge has gone haywire. I wear cardigans in the summer, and bathing suits in the snow. Nothing makes sense anymore.
But that’s the nature of perimenopause—everything is different, it’s confusing, and most women don’t know what to expect. Now that I know I’m not insane, that this stuff is pretty normal, and that I’m not dying from a terrible illness that causes insomnia, vaginal dryness and ugly boobs, I can usually laugh off my symptoms. When I’m not hysterically sobbing, that is. Perimenopause is a sucky part of life, like puberty was, and when it’s over, the very second my last period ends, I’m throwing a huge party. Or, more than likely, just going to bed.