Changelings

By: Tammy Ellingson

It’s 3:00 a.m.; I’m awake and sweating like Albert Brooks in Broadcast News. Now I have to go to the bathroom and am feeling a wee bit cranky and tired. I am not alone. In fact, if I log onto Facebook at this minute, I will find plenty of friends awake for the same reasons. Welcome to perimenopause.

What is Perimenopause?

Perimenopause is the phase leading up to menopause – the complete cessation of menses. It can begin in your 30s, but is most noticeable in your 40s. During perimenopause the levels of estrogen, progesterone and testosterone in a woman’s body fluctuate as her fertility comes to an end. How long will it last? Well, it varies from a couple of years to a maximum of 15, with the average around five or six years.

No matter how long it lasts, a woman will likely fall into one of two camps: The 50% who sail through, or the other 50%, whose sails need a bit of adjusting. For this half, the symptoms range from irritating to disruptive and debilitating. Arlene, a busy wife and mother in Washington, sums it up, “I have a pretty good sense of humor, but this just wasn’t that funny.”

Feeling Hot and Bothered

The most common complaint, the hot flash, which varies in intensity, duration and frequency, is also the most outwardly bothersome. Who among us hasn’t asked, “Is it hot in here?” when surrounded by folks in sweaters? While they remain comfortably clothed, we’re peeling off every layer we can without being arrested for indecent exposure. And depending on the intensity of the flash, our definition of indecent becomes pretty darn elastic.

For some, these flashes are brief and easily tolerated, but as Kathleen, a wife and mother in Phoenix, can attest, they leave others drenched. “Often I have to change my clothing twice a day,” she says. How long a woman will experience hot flashes is anyone’s guess. They often continue long after a woman has stopped her menses, but eventually they do stop.

While the hot flash might be the star of the perimenopausal cabaret, its backstage nuisance, irregular menstrual cycles, can be challenging. Most women experience heavier and longer cycles, followed by skipping a cycle or two. Just when you think you can safely avoid the feminine hygiene aisle; your period returns with a voracity suggesting heavy iron supplementation might be in your future. Kathleen wearily shares, “I have had my period non-stop for over six months.” Teresa in Hillsboro adds, “My period came every 12 to 15  days, and lasted up to 10 days!” This is both tedious and inconvenient.

As if hot flashes and unpredictable periods weren’t enough, women also report trouble sleeping, irritability and sudden changes in mood or behavior. Although the stereotype exists of the cranky, emotional and moody perimenopausal woman, the extreme symptoms are mostly exhibited in women with a pre-disposition, or history of PMS, post-partum, or other types of depression. “This is where it gets a bit muddled for me” says Arlene. “In general, I am a very happy person, but one day I realized I had been crying all the time, about everything, for a very long while.” She goes on to say, “My mom and sister have struggled with depression forever, so I’m not sure if it was related to specific life stressors, perimenopause or all of it together.”

The hormonal dance can cause emotional swings with symptoms similar to pre-menstrual dysphoric disorder. Estrogen impacts how chemicals affect your brain, and in roughly 10% of women, this dip in estrogen causes extra sensitivity. However, Doctor Ledbetter suggests that irritability, moodiness, mild depression, fatigue, inertia, emotional sensitivity, memory lapses and weight gain might also be related to sleep problems.

All of this impacts the relationship a woman has with her partner. “Having one long period definitely affects our life,” states Kathleen. Whether due to an unceasing cycle, or other physical and emotional changes, a couple’s intimate life experiences a shift. A decline in libido – perhaps also due to feeling overwhelmed, fatigue and depression is common. The decrease in hormones also means a lack of moisture and the thinning vaginal walls, which may cause discomfort and doesn’t do a thing for a woman’s desire. A smorgasbord of lubricants and topical estrogen may bring relief.

Don’t be afraid to discuss these issues with your doctor. After all, a lack of intimacy can add to one’s crankiness. Doctor Ledbetter maintains if a woman engages in sex with regularity, it will improve her vaginal health and “the friction will diminish and sex becomes more comfortable. Use it or lose it.” On the flip side, a few women report no decrease in libido or even an increase. Hey, it could happen.

Can I Get a Little Help Here?

So, what’s a gal to do? You’ve got options; the key is finding what works for you. If you need help controlling hot flashes, black cohosh, isoflavones (in soy products) and acupuncture have proven to be helpful for some. Several herbal supplements on the market claim to ease symptoms, and while there isn’t specific independent research to verify all claims, plants don’t have estrogens, so herbs, used wisely, are unlikely to cause much harm. Dr. Ledbetter recommends Estroven to control hot flashes for some, but adds “acupuncture helps a lot of patients.”

To control unruly periods, treatment options include the birth control pill to regulate flow patterns, or reducing the amount of flow with an IUD. However, the pill is not recommended for women with a history of heart attacks, blood clots, breast cancer or for women on anti-coagulants. The good news is that 95% of women stop bleeding by age 55, which is also when doctors recommend stopping the use of the pill.

For sleep issues, progesterone can help calm the body and improve sleep, as can melatonin and exercise. Yes, exercise! If there is one thing all women can do that will improve their quality of life, it is exercise. “If only I could get women to do it,” says Dr. Ledbetter. “It helps with weight gain, stress, moodiness, fatigue and sleep.” Ledbetter recommends incorporating 30-60 minutes of activity, five to seven days a week, to improve overall well-being.

While women readily seek help from their doctor for physical symptoms, they aren’t sure where to turn for emotional assistance. Ask your doctor if hormone replacement therapy or anti-depressants might help in your situation, or find a naturopath who can recommend alternative therapies. In addition, discussing concerns with a therapist, counselor or clergy person can be helpful.

While you might be inclined to stay home, pour a cocktail and cocoon, it’s best to fight that urge. Socialize, nurture connections and surround yourself with friends and family who support you. Do things that fill you up, and avoid tranquilizers and alcohol.

Another thing women can do is to add to their stress management toolbox. Learn to relax, take yoga and meditate. For perimenopausal women, who are dealing with many mid-life challenges, learning to relax and manage stress levels helps ease several symptoms and is good for the heart – another concern during mid-life. The best defense is to eat well, rest well and play well.

For those who seek assistance from their physician, it is frustrating to be met with a less than sympathetic ear. As Teresa describes, “just finding a doctor you feel comfortable with is not easy. My last doctor was not interested in talking, or very helpful.” It’s important to find a practitioner you can talk to who is also interested in talking to you.

Yes, perimenopause does mark a change in a woman’s life. Things will be different. “It’s hard for me to know my time to bring life into the world is coming to an end. Even if I don’t want another child, it makes me sad,” says Teresa with mixed emotions.

It might be the close of your baby-making years, but it is the opening of your self-making years. With change, comes opportunity.

SIDEBAR

On the North American Menopause Web site, (menopause.org) you will find practitioners who specialize in the science of menopause. They are constantly searching for ways to improve women’s lives.

To contact Dr. Randi Ledbetter, or to find out more about the Menopause Center of Portland, visit docrandi.com.

To improve your stress management skills, check out The Relaxation & Stress Reduction Workbook (New Harbinger Self-Help Workbook) by Martha Davis, Elizabeth Robbins Eshelman, Matthew McKay and Patrick Fanning.

The Oregon College of Oriental Medicine’s Web site (ocom.edu) or the National College of Natural Medicine (ncnm.edu) can enlighten you about the benefits of acupuncture or assist you in finding an alternative practioner.

To find an acupuncture practitioner near you, visit acufinder.com.

Most employee assistance programs have a counseling benefit, call your EAP to check what benefits are available to you, or use a Web site like goodtherapy.org to find a therapist or counselor in your area.

While Tammy has loved writing ever since she had a poem published in her grade school newsletter, she has mostly written notes in class, Valentine cards for her kid and long-winded e-mails to friends. Visit her blog at mamacandance.blogspot.com.