Managing Peri-Menopausal Symptoms
Did you know that menopause symptoms can start up to ten years before you actually stop menstruating? Yup, that’s right! The “peri-menopausal” period is up to a decade long. Most women start experiencing symptoms in their forties, entering menopause in there early fifties.
As I head into my 50th year, I’ve been noticing many of these symptoms myself. So, I decided to dive into some of the available research and resources. The good news is, there are a lot more options out there than there were a decade or two ago. Not as many options as there are for erectile dysfunction but progress!
I won’t cover the entirety of symptoms that occur during menopause but will touch on a lot of the common ones (and in full disclosure, those that I have first-hand experience with).
Periods Come MORE Frequently
I incorrectly assumed that “irregular” periods during the perimenopausal phase meant LESS periods. Oh no! I currently get mine every 2-3 weeks. Which means, there is maybe a week or so in the month when I’m not feeling PMS symptoms. While we can’t change the frequency of our periods, there are some things we can do to manage the PMS that accompanies it. This includes, exercising regularly, eating foods high in calcium (or supplementing), getting adequate sleep, minimizing alcohol and caffeine intake and drinking plenty of water. Engaging in relaxing activities such as yoga and meditation and managing stress is found to help too. Calcium, vitamin D, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking. You can talk to your OB, primary care doctor or health practitioner to see if supplementation could be helpful. Acupuncture or acupressure can also help symptoms such as cramps and bloating. I’ve found this book to be a great resource for managing a lot of common ailments.
“Brain Fog” and Cognitive Decline
I can be looking directly at someone I know and blank on their name. It’s as if my brain freezes. It’s very discouraging as I’ve always prided myself on remembering peoples’ names. Interestingly, I learned through an NPR episode interviewing Lisa Mosconi, a prominent physician focused on menopause, that there is a link between estrogen levels and dementia. Changes in estrogen levels leads to cognitive shifts in women’s brains. We’ve always known that women had a greater incidence of dementia and Alzheimer’s but it was always assumed it was due to the fact that we live longer. Newer research reveals that there are shifts around menopause that put us at greater risk for dementia. Lisa’s book, The Menopause Brain is a great resource for learning more about this and navigating options. Of course, stress management, exercise, eating a healthy diet and using your brain regularly are all helpful pieces of the puzzle.
Body Changes and Body Image
There is a reason menopause has been coined the “second adolescence”. The body changes A LOT during menopause and the period leading up to it. Skeletal muscle mass decreases as fat storage increases. We also tend to retain more fluid. Do puffy eyes, swollen hands or feet sound familiar? Lines on your legs from pants? These are all signs of fluid retention. The kidneys play a central role in fluid balance in the body. Estrogen impacts how the kidney regulates fluid. Shifts in estrogen during perimenopause lead to retention of sodium and water. These changes, while natural, can contribute to challenges related to body image.
Decreases in muscle can contribute to decreased strength and stamina which also impacts how women feel about their bodies and their level of energy. Strength training can help restore and maintain muscle mass and has been demonstrated to help with body image. It also helps boost energy. Moreover, women in menopause are at increased risk for bone loss and maintaining muscle mass helps support bones.
Sensory Sensitivity, Moodiness and Irritability
Can I tell you how validating it was when, at a cookout over the summer, another woman my age shared how irritated she gets when her husband taps his foot to the music while driving? I felt so seen! I’d have this exact same experience. It’s amazing how irritating the simplest things can be – the windshield wipers being on too long, the sound of my husband chewing or drinking coffee, the hum of the dishwasher, florescent lighting or LED headlights behind me. And I’m like a bloodhound with smells! It’s extremely annoying and contributes to a great deal of irritability. And, my frustration tolerance is baseline very low these days. However, I will say that meditation and yoga help a lot.
In addition to sensitivity to light, odor and noise, many women may also experience increased tactile sensitivity and changes in spatial awareness and balance during perimenopause. Why does this happen? Estrogen plays an important part in the neurological regulation of brain chemicals such as serotonin and dopamine. Serotonin and dopamine help you enhance your mood. They also help with cognitive function and sensory perception. When estrogen starts to fall, it alters the way that your brain perceives these sensory inputs, so you reach a threshold much quicker than you would have done normally. It’s helpful to understand this so you can be compassionate and find ways to minimize or decrease the environmental stimuli you find particularly triggering.
Similarly, these hormonal shifts can contribute to changes in mood, increasing symptoms of depression and anxiety. This can be particularly concerning if you already struggle with mood issues. It can be helpful to seek guidance from a psychopharmacologist and/or OB who specializes in medication management of mood during menopause. Thankfully, we have a couple great resources right near us in Boston at MGH and BWH. I’ve shared these below.
Bloating and Digestive Issues
I’ve already discussed the reason we retain more fluid during menopause. This is usually experienced throughout the body. Many woman also experience and increase in stomach bloating and discomfort which is also a result of hormonal shifts. Although hormone levels eventually decline, during perimenopause, hormone levels are in a state of flux. In addition to shifts in estrogen contributing to fluid retention, increases in estrogen and progesterone contribute to slowing of the digestive muscles. This can lead to gas, bloating, constipation and stomach discomfort. There are some things that can help. Eating regularly throughout the day (not going long periods between meals and snacks) and getting fiber through whole grains, fruits and vegetables are a start. Avoiding carbonated beverages and chewing gum also helps prevent air from getting trapped in the gastrointestinal tract. Mint or ginger in tea or in foods can help ease stomach discomfort as well.
While it may seem intuitive to reduce fluid intake when the body is retaining more, the opposite is true. You want to drink more water. This not only helps with digestion, it regulates body temperature which can help reduce incidence and/or intensity of hot flashes. Dehydration can also lead to mood instability and fatigue. Plus, when the body doesn’t get enough water, it actually sends a signal to the kidneys to retain more in the body. So, drink your water (or fluids in whatever way you prefer them!)
In addition to the suggestions I’ve already shared, there are a number of hormone therapies, medications and supplements (DHEA, pregnenolone, herbal remedies) that can help ease menopausal symptoms. If this is something you’re interested in exploring, you can discuss it with your doctor.
Resources:
“Menopause Brain is a Real Thing” with Lisa Mosconi
‘The Menopause Brain’ by Dr. Lisa Mosconi (disclaimer: there is weight-centric language in this book)
Midlife Women’s Health Center at MGH
‘Midlife Eating Disorders: Your Journey to Recovery’ by Cynthia M. Bulik, Ph. D
Fish Center for Women’s Health: Menopause and Midlife Clinic at BWH
‘The Longest Match: Rallying to Defeat an Eating Disorder in Midlife’ by Betsy Brenner
‘What Fresh Hell is This?: Perimenopause, Menopause, Other Indignities and You’ by Heather Corinna
