Perimenopause and the Emotional Rollercoaster

Very often when women are in perimenopause they are bewildered and mystified by what appears to be a sudden and unexpected onset of symptoms.  Night sweats, hot flashes, raging mood swings, uncontrollable crying, depression and anxiety seem to come out of nowhere.

That is because despite the obvious symptoms of hormonal changes, they are likely still experiencing relatively normal and regular menstrual cycles, which leads them to believe they are not in perimenopause.

What they may not realize, however, is that the shift in hormones which sets perimenopause in motion has likely occurred years before they even began to notice the symptoms.  For most women, changes in their hormone levels begin as early as their mid to late thirties, though they may not be noticeably symptomatic until their early to mid forties.

What is Perimenopause?

The Greek prefix “peri” means around.  It is used to describe something that is marginally close or on the edge of, like the word perimeter or peripheral.  Perimenopause then, literally means “around the time of menopause.”  Menopause occurs once a woman has gone twelve consecutive months without a menstrual period. Until that time, she is in perimenopause, experiencing the hormonal changes that bring about actual menopause.

During the perimenopause phase, a woman’s body is producing less progesterone with each passing year.  In addition, her estrogen levels are rising and falling erratically as well.  These hormonal changes bring about great physical and emotional discomfort for many women and can last anywhere from five to ten years or more.

What are the Symptoms of Perimenopause?

Perimenopause symptoms vary among women not only in intensity, but in the types of symptoms as well.  While each woman’s experience is different and unique to her, there are many symptoms that are relatively common, such as:

  • Irritability
  • Rage
  • Feeling overwhelmed
  • Feeling revved
  • Depression
  • Anxiety
  • Mood swings
  • Reduced self-esteem
  • Hot flashes & night sweats
  • Insomnia
  • Fatigue
  • Crying easily
  • Shorter cycles, closer together
  • Heavy bleeding with blood clots

Perimenopause or PMS?

Due to the commonality of symptoms, many women confuse perimenopause with PMS and vice versa. Both PMS and perimenopause are the result of fluctuating progesterone levels. However, PMS symptoms are cyclical and directly correlate with a woman’s menstrual cycle.  They also disappear once a woman gets her period.  Not so with perimenopause.

Perimenopause symptoms typically continue throughout a woman’s monthly cycle and do not disappear once she gets her period. They are also much more erratic, unpredictable and intense. So much so that many women feel they are losing control or as if they are going crazy.

Meet Brenda

Brenda is forty-three-years-old mom with a thirteen-year-old daughter and sixteen-year-old son. Until a few months ago, she had regular twenty-eight day menstrual cycles. In the past, she suffered from PMS symptoms (feeling angry and out of control) a couple of days before her period began, but as soon as she flowed she felt normal again.

Now her periods are coming a little closer together (23 to 25 days instead of 28), are heavy with some clotting, and she is bleeding more days than before. She complains of intermittent night sweats and hot flashes. Her breasts are tender much of the time and she feels that her PMS symptoms are more intense, and are accompanied by rage and irritability.

She emphasizes that when her period starts she does not get the kind of relief from her symptoms that she used to. Now she suffers from crying spells, insomnia, and extreme fatigue during her menses and a week after. Brenda lives in an irrational and erratic zone, swinging from crying to rage to guilt.

Her gynecologist did not diagnose her as perimenopausal, but said a hysterectomy may be in order if her periods become much heavier. He also thought her emotional problems might be from depression or bipolar disorder, and he referred her to a psychiatrist for evaluation. Brenda began taking an antidepressant, but claimed her anxiety and insomnia actually increased. There was no change in her menstrual cycle.

The Hormone-Brain Chemistry Connection

I spoke with Brenda about her symptoms and performed an exam. Based on her recent history of heavy clotty periods, shorter cycles, and the lack of relief of symptoms once her period began, I determined she was perimenopausal. Although she was quite distraught, I knew from experience that I could normalize her cycle, and she would feel much better once she began her program of using bioidentical progesterone.

After only one month on her treatment plan, which also included nutritional supplements for her emotional type, Brenda returned to her follow-up visit with a smile on her face. She was amazed at how quickly she responded to the treatment. Her menstrual cycle was now back to twenty-eight days, her periods were normal, with no clotting, and her days were filled with less anxiety and more peace.

It’s important to understand that the relationship between Brenda’s hormones and her brain chemistry created her mood, and that treating her with progesterone alone would not take care of her discordant symptoms. In addition, she needed nutritional supplements to normalize her brain chemistry.

You are not going Crazy!

While the intensity, unpredictability and erratic nature of perimenopause symptoms is certainly disconcerting, the good news is you are not going crazy.  Like Brenda, by simply addressing the hormone imbalance, in addition to understanding the role of nutritional needs and the importance of reducing stress in your life, you will not only get relief from perimenopause symptoms, but you will bring a calming harmony and wellness back into your life!