Crazy or Menopausal?
Fuzzy thinking, forgetfulness, depressed mood, and fatigue can be signs of perimenopause, which can appear as early as your mid-30s. Here’s what you need to know
When perimenopause hit Magnolia Miller at age 41, she thought she was going crazy. “I had raging mood swings where I felt out of control,” Miller says. “I would go into days of depression where I couldn’t get out of bed, then become this angry, screaming person, and then I would be fine.” For Miller, now 51 and a blogger who lives outside of Dayton, Ohio, the change from her normally can-do personality was frightening.
Perimenopause, a period of usually several years before women stop menstruating, is characterized by erratic and often heavier menstrual flows, night sweats, and hot flashes – all caused by hormones in flux due to declining fertility. But lesser-known changes in mood, concentration, and energy levels also accompany perimenopause for many women.
If you’re in perimenopause and just not feeling like yourself, you’re not alone. Here’s why, and what you can do about it.
© MSN Healthy Living
Hormonal Changes Wreak Havoc on Your Period
Your monthly cycle relies on the coordination of estrogen, progesterone, and other hormones to stimulate ovulation and menstruation. Ideally, all of the signals are in sync. Before she started perimenopause at about 37, Holly Osterman “could write on a calendar what day I would get my period,” says the 42-year-old homemaker and blogger who lives in Downers Grove, Ill. A graph of a regular cycle shows steady, predictable peaks and valleys in hormone levels. (After menopause, hormones also level out.)
Perimenopause sends hormones into chaos because aging ovaries can’t respond as well to prompts to ovulate. “Instead of smooth hills and valleys, you get sawtooth spikes of hormone variation, like an EKG,” says Julia Edelman, M.D., a certified menopause clinician practicing in Massachusetts and author of Menopause Matters (Johns Hopkins, 2010). Because hormonal timing is thrown off, suddenly your period may become unpredictable, with breakthrough bleeding, spotting, and lighter or heavier flow.
Flashback to Puberty: Mood Swings
Estrogen fluctuations can drastically affect mood. Estrogen has a relationship with serotonin, a neurotransmitter and “feel-good” hormone in the brain. “All of a sudden a woman is having anxiety or panic attacks for the first time in her life,” says Faina Novosolov, M.D., a psychiatrist and faculty member at the Women’s Mood and Hormone Clinic at the University of California-San Francisco. Women with past depression are five to ten times more likely to suffer depression in perimenopause, Novosolov says. Miller found some relief with antidepressants. Most women don’t get depressed, but they might notice significantly worse mood swings. “My PMS is magnified times 100,” says Lori McManus, 43, of Bloomington, Minn., who first noticed symptoms about two years ago. And some, like Osterman, just become uncomfortable in their own skin. “I was miserable with myself a lot of the time with no reason.”
Fuzzy … Oh Yes, Thinking
Studies show that estrogen levels also affect cognition. “The estrogen peak before ovulation is a woman’s most alert time,” Novosolov says. “It’s the height of verbal and mathematical performance for her.” So when estrogen plummets during perimenopause, some women complain of fuzzy thinking, an inability to concentrate, and trouble remembering things. “I would find myself re-reading things and thinking, ‘I should not be having this hard a time understanding,’” Osterman says.
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Where Has My Energy Gone?
Fatigue in perimenopause has several likely culprits. You may be getting too little sleep, Edelman says, especially if night sweats or hot flashes are waking you up. “It’s important to rule out anxiety, depression, and sleep apnea as causes,” she says. You could also be experiencing hypothyroidism. The thyroid, a gland in the neck, controls metabolism. Fatigue is a hallmark of hypothyroidism. Other symptoms mimic those of perimenopause -- depression, mood swings, sleep disturbances and even heavy, irregular bleeding. Women are more likely to develop thyroid abnormalities and sleep apnea as they age.
Diagnosis: How Your Gynecologist Can Help
There is no test to confirm perimenopause. You may be offered blood tests of estrogen or follicle-stimulating hormone (FSH) levels, but doctors are divided over how useful they are. “There are too many spikes in estrogen and FSH to make that a helpful measure,” Edelman says. “The best gauge we have is clinical diagnosis. Eighty percent of women will have irregular bleeding and hot flashes five to 10 years before menopause.”
To discuss with your gynecologist:
- How often you’re bleeding or spotting, and in what amounts. Your doctor may biopsy your uterine lining to rule out other causes of bleeding, such as polyps.
- How often you’re experiencing hot flashes, night sweats, or vaginal dryness. Discuss the pros and cons of lifestyle changes, alternative therapies and hormone therapy.
- Changes in mood, energy levels, sleep, and libido. Ask your doctor to check your thyroid hormone level. Discuss the above, plus whether to consider antidepressants and/or therapy.
What to Know About Hormone Therapy and the Mind
Hormone therapy may turn out to be as effective in treating depression in women with perimenopause as for easing hot flashes and other physical symptoms. Past studies have shown that estrogen increases a positive response to antidepressant medication. In the wake of the Women’s Health Initiative, which was halted in 2002 after estrogen therapy raised risks of heart disease and breast cancer in postmenopausal women, many investigators wanted to know the risks for younger women. Studies of hormone therapy, depression, and heart disease are currently underway now in perimenopausal women.
Other studies are examining the links between estrogen, cognition, memory, and the prevention of Alzheimer’s. Since the health risks to younger women are murkier, hormone therapy will be up to you and your doctor. Nonsmokers can consider taking a low-dose birth control pill, which contains estrogen (estradiol) and progesterone levels that mimic your own. “I don’t go with an estrogen patch for perimenopausal women because they’re still cycling, Edelman says. “That can give them too much estrogen and make them feel worse.”
Women who walk or do other daily exercise report fewer hot flashes. Exercise is also a top recommendation for anyone dealing with low mood or depression. Eat a primarily vegetarian diet and try adding flaxseed: A small Mayo Clinic study found that four tablespoons a day halved the number of hot flashes for those women, and greatly reduced their intensity. Maintain your weight, avoid alcohol and cut back on caffeine. Try to keep the same bedtime, and dim the lights about an hour before you plan to go to bed. Slow-breathing exercises, meditation, and yoga can also help. “Yoga has really helped me to calm myself down when I feel moody or a hot flash about to take over,” Osterman says.
“Peri-what?” is still a common response to perimenopause – that’s why Osterman and Miller started blogging. “It’s one of those areas of health care that’s still sort of neglected,” Osterman says. “Many women feel so isolated.” Talking about your symptoms honestly and asking for help is the most important thing you can do. “A lot of women keep saying, ‘What is wrong with me,’ for awhile before they figure it out,” Miller says. “Women feel so validated when they can talk to others who are also going through this, to help them understand that there’s nothing wrong with them.”
Sara Aase is freelance writer specializing in health and family issues. Her work has appeared in Parenting, American Baby, Pregnancy and other publications.