The Change Before 'The Change'
Hot Flashes, Infertility, Happen Earlier Than You'd Expect
It's All About Estrogen
Recognizing perimenopause isn't easy for doctors: "Patients
will complain of hot flashes, but hormone levels will be normal, so the patient
isn't really taken seriously," says Bill Meyer, MD, associate professor of
obstetrics and gynecology and a reproductive endocrinologist at the University
of North Carolina Hospital in Chapel Hill.
It's not all in your head, he says. "We know that these
symptoms do occur," Meyer tells WebMD. "There are some huge and wide
fluctuations in estrogen levels that cause these symptoms -- the irregular
uterine bleeding, vaginal dryness."
Wild-flying estrogen levels also wreak havoc on your mood.
"When estrogen levels are high, more mood-elevating chemicals -- like
serotonin, dopamine, norepinephrine, and opiates -- are free to circulate in
your bloodstream," writes Corio. "Low levels of these chemicals cause
However, perimenopausal mood swings are often mistaken for
depression, says Corio. "A woman suffering insomnia, fatigue, weight gain,
problems in concentrating, and loss of interest in sex might be diagnosed as
mildly depressive whereas she's in perimenopause."
In other cases, low estrogen levels can make existing
depression worse, adds Meyer. Thyroid problems may cause depression-like
symptoms as well as irregular bleeding.
That's why it's important that your doctor look at the big
picture -- testing your hormone levels rather than just handing you a
prescription for an antidepressant, says Corio. Estrogen could help your
antidepressants work better, adds McGee.
Taking Stock of Life, Lifestyle
As her estrogen declines, the 40ish woman is at increasingly
higher risk of certain health disorders. Her bones, reproductive organs,
breasts, and heart all become vulnerable.
"During this period, bones start changing because you're
losing estrogen and progesterone," Corio tells WebMD. "Dwindling
estrogen puts women at higher risk for uterine cancer, breast cancer, ovarian
cancer, heart disease, diabetes."
It's a time to consider your lifestyle -- and your level of
stress, says McGee. "Perimenopause is a time of life, not a condition,
something to be diagnosed," she tells WebMD. "Women are going through a
lot of changes, and some of those are society pressures -- they have parents,
grandparents to take care of. Women in their 40s and 50s have a lot of
If you have symptoms, talk to your doctor, someone who takes
you seriously, who is sympathetic, says Meyer. "Go to another doctor if
that's not happening."
You don't have to put up with the symptoms, says Corio.
"There's no need to be a martyr," she writes. "Practically every
week new studies are showing that simply incorporating particular vitamins,
minerals, herbs, and foods into your diet and making certainly lifestyle
adjustments can counter many of the annoying, uncomfortable, and sometimes
painful effects of perimenopause."
There are also numerous synthetic and natural
"bioidentical" estrogen products to help stabilize your hormone levels,
including mini pills and patches, she adds.