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What do you mean, you started hormones? I asked as we sat around the dining room table. There were three of us together that night, all humans with ovaries, all over 40, and all experiencing different levels of unexplainable oddities. However, one of us was not only looking amazing but feeling amazing too. And that one was not me. In fact, that night in October 2021, I was feeling anything but amazing.
This was the dinner party that opened my eyes to peri-menopause, it brought out all my subconscious biases, sent me down rabbit holes on all things hormones, and made me feel shame, disbelief, and anger equally because how could I, a registered nurse who considers herself intelligent and absolutely in tune with her body, not know any of the things that I would soon learn over multiple hours of consuming copious amounts of information on this topic.
SOME BASIC DEFINITIONS
Peri-menopause: The erratic ups and downs of hormones. Can start at any age 35 -50. Typically 8-10 years before menopause.
Menopause: Literally day 365 of not having a period (ovulation). That day is, by definition, menopause. The average age is 51. However, the term menopause is often used to cover the gamut of this whole period in a woman’s life.
Post-menopausal: Day 366 and after.
Estrogen, Progesterone, and Testosterone in perimenopause:
Another easily digestible graph from the website of Lara Briden, a naturopathic doctor and author.
Take a listen to this short 16min episode with Dr. Taz Bhatia - 7 Hormones Every Woman Should Know About
FMP: Final menstrual period
HRT: Hormone replacement therapy
Menopause diseases: The lack of hormones can lead to - osteoporosis, cardiovascular disease, and dementia. “These health concerns are greatest for women with a final menstrual period between ages 40-45” - Dr. Jen Gunter.
Also, from Dr. Jen Gunter and The Menopause Manifesto, “Weighing all these outcomes together, an earlier menopause has a greater association with an earlier death than a later menopause because cardiovascular disease is far more common than breast and endometrial cancer. For every year menopause is delayed after the age of thirty-nine the risk of death from cardiovascular disease decreases slightly”.
(**Remember this statement because this will and should come up when weighing the pros and cons of menopause treatment if one chooses to do so)
Is there a test to check if you are in perimenopause or menopause? Short answer, No. Generally speaking, if you are in your 40s and having symptoms (some listed below), you don’t necessarily need your hormones checked. There is no diagnosing test other than the lack of a menstrual cycle for 365 days. Dr. Jen Gunter, in her book The Menopause Manifesto, compares this inquiry to teenagers and puberty. If they are of a certain age and acting a certain way, we don’t need to check their hormones to confirm they are in puberty. This analogy made sense to me - but also, I am one who is always asking for hormone level checks (more on this later).
Of course, things can get complicated and confusing if we are dealing with other medical conditions, such as thyroid disorders or PCOS, which can cause menstrual irregularities. So know where you are starting from. This may require blood work and tests to rule out other possibilities.
Perimenopause signs and symptoms:
*To note, no two women will experience perimenopause the exact same way.
Fluctuating estrogen levels
Loss of memory
Hair loss
Sarcopenia (muscle loss)
Vaginal dryness (atrophy), inelasticity
Pain with sex
Bladder problems, frequent UTIs, cystitis
Hormonal imbalance
Decreasing fertility
Palpitations
Urinary incontinence/frequency
Changing cholesterol levels
Emotional Distress/Mood swings (depression and/or anxiety)
Low libido
Hot flashes/Cold flashes
Joint pain
Night sweats
Weight gain
Thinning/crepey skin
Sleep disturbances
Headaches
Dry eyes (dry mucosal in general)
Menstrual irregularities/changes (long, short, heavy, light)
The Greene Climacteric Scale: Aims to measure psychological symptoms divided into anxiety and depression, somatic and vasomotor symptoms with a total of 21 items. Data were analyzed by reliability, correlation and confirmatory factor analyses. - Source NIH National Library of Medicine.
Give it a go and fill it out. What’s your score?
My experience
Around 2014 I found myself in the ER for severe abdominal pain. After a ten-hour