Weather Alert – If perimenopause is sending signals that your body is changing, get ready to ride out the storm.
"What's wrong with me? Am I going crazy?"
At 43, Magnolia Miller couldn't help but ask these questions as she faced mounting changes that proved something strange was happening to her.
The only way the stay-at-home mother of three knew how to cope was to pencil in the words “hell week” across her calendar on that dreaded week before her menstrual cycle. Like clockwork, she was hit by crazy mood swings; heart palpitations and vertigo; and deep, debilitating bouts of depression.
Then the storm cleared as abruptly as it had arrived, "and I'd feel normal again," she says. "It was just insane." Like so many women in the prime of their lives, Miller was too busy with life's responsibilities to pay attention to perimenopause's first signals.
With perimenopause in every woman's forecast—that transitional phase before periods end for good—it's time to decode the signals and discover how they can interrupt day-to-day life, along with exploring practical strategies for weathering the storm.
Signal: Your menstrual cycle's droughts and floods
Storm advisory: Miller says she had very regular periods until age 41, when a "phantom period" mid-cycle turned her life upside down. The disruption in her normal menstrual cycle led to an unexpected pregnancy, and after the birth of her third child, "I started having heavy menstrual cycles to the point that I could not leave my bedroom," Miller says.
How to weather it: Margery L.S. Gass, MD, executive director of the North American Menopause Society (NAMS) and a certified menopause practitioner, says a change in your menstrual cycle is one of the first clues you're in perimenopause. “In the beginning, your periods may come a week early or a week late. The more common that pattern becomes, the greater the likelihood that a woman is entering perimenopause," Gass says. "The peculiar thing is a characteristic of perimenopause is to have irregular bleeding. But irregular bleeding can also be a sign of problems such as endometrial cancer or hyperplasia. So breakthrough bleeding throughout the month or cycles that have gotten noticeably heavier or longer could be normal but are definitely things to check out with your physician."
Gass says a woman may choose to stabilize her erratic periods by taking birth control pills (if she doesn't smoke, have high blood pressure or a history of blood clots) or progestin, the synthetic form of the hormone progesterone.
Signal: The hormonal heat wave known as "hot flashes"
Storm advisory: As Miller discovered, hot flashes can hit when you least expect them.
Miller recalls a road trip to her husband's 20th high school reunion during an icy winter. She was sweating and asked her husband to crank up the car's air conditioner.
"I was sitting there in short sleeves, no coat, with my arms raised up over the vent to get cool air," she says. "Meanwhile, my husband was wearing a hoodie, a scarf and a big heavy jacket, and he was just freezing.”
How to weather it: Perimenopausal women may get occasional hot flashes when their estrogen levels drop, usually around the time of their period, says Gass, who offers simple coping strategies.
"First, try to stay cool—both physically and emotionally. Having emotional reactions can trigger hot flashes, as can letting your body get a bit too warm.” Gass suggests layered clothing to allow for flexibility and to keep the temperature around you lower. Low-speed fans can do the trick, along with clothing made of fabric that can wick moisture away from your body.
Signal: Night skies with a slight chance of sleep
Storm advisory: Miller can never forget her sleepless nights. "During the warring part of menopause, I had horrendous insomnia, and I took [the prescription sleep aid] Ambien for about three years because I just couldn't sleep at all," Miller recalls.
How to weather it: Some women experience menopause-related sleep disturbances, especially if hormone changes provoke hot flashes (or "night sweats") during the night, North American Menopause Society reports. To get more adequate shut-eye, women should first focus on improving their evening routines, including avoiding heavy meals and adjusting levels of light, noise and temperature.
"As people get older, having caffeine and chocolate, especially dark chocolate, may be a stimulant that prevents falling asleep easily, so they should be avoided after late afternoon," Gass recommends.
To minimize night sweats, she suggests avoiding comforters that trap heat and opting instead for lightly woven bed linens that breathe. Also, keep the air circulating in your bedroom by setting an overhead fan on low.
Signal: Dark moods and widely scattered emotions
Storm advisory: Miller called it PMS on steroids or simply hell week—the week before her period when she felt fragile and furious.
"The mood swings and rages where I'd lose complete control were probably what freaked me out the most," she recalls. "I would scream so loud I would lose my voice and start shaking. It was just rage. Then I would swing over to depression so dark and heavy I'd cry for two or three days. And then it was like a switch would go off and it would pass, and I'd feel completely normal."
How to weather it: Gass compares the moodiness and irritability that many women feel during perimenopause to premenstrual syndrome or postpartum depression. "It's good if women can realize it's a phase; it's not going to last forever," she says.
Emotional health during this pivotal time of life requires a healthy balance between self-nurturing and the obligations of work and caring for others. It's an important time to get enough sleep, and exercise, as well as to stay active, engaged and get out of the house to do things you find rewarding and enjoyable. When lifestyle changes aren't enough, hormone drugs (such as oral contraceptives or estrogen therapy) may help stabilize moods. Other women may benefit from selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft or Celexa. The important thing to realize is that the need for hormones or SSRIs is temporary.
Sunny Skies Ahead
It has been 12 years since Miller was first jostled by hormonal whims. She entered menopause a few years ago and has now reclaimed her happy—and healthy—life as an active blogger ("The Perimenopause Blog," theperimenopauseblog.com) and a graduate student pursuing a master's degree in health and human development with a focus on healthcare consumer advocacy for women's health.
"I've discovered there's a real need to blog about this topic, from the perspective of a woman who has 'been there, done that' and who can empathize, have compassion and reach out to women to say, 'Yes, it's real. And no, you're not going crazy.' "
Better yet, as Miller has realized, perimenopause is just a passageway to a new part of life when many women feel more confident, empowered and energized than ever before.
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