Melbourne Functional Medicine
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The quintessential symptoms of menopause: hot flushes, night sweats, being moody - are often mocked and the subject of comedy. (P.S. not that funny). But the lesser publicised effects of menopause: chronic lack of sleep and fatigue, poor cognitive processing, lousy memory, depression and anxiety are not necessarily linked with the hormonal changes of menopause and can leave women bewildered as to what is happening to their body and their minds.. AKA, crazy-making!
“Perimenopause” denotes the journey into menopause, whilst a woman is still ovulating or cycling. Once there has been no menstruation for 12 months, a woman is described as menopausal or post-menopausal. However often the terms perimenopause and menopause are used interchangeably.
I'm a functional medicine practitioner and a woman who's going through perimenopause, so I can speak both personally and clinically about this part of life.
Personally, I’d like to know why the heck did sex education start and end with how to avoid pregnancy and STDs! What about the rest? A heads up on this 5-10 year hormonal roller-coaster, and how to prepare myself, would have been handy.
The female human being has a finite period of time in which to reproduce and create children. And as that capacity declines, the hormonal environment changes, bringing with it a myriad of effects on mind and body.
The hormonal environment is actually changing from our teens all the way through to our 50s. In our late teens and early 20s women are typically the most fertile they will ever be in their lifetime. They have high oestrogen and high progesterone which is great because the progesterone curbs the effects of the high oestrogen (think moody teenager). Progesterone happens as a result of ovulation in the middle of the cycle, and it's very calming and useful for sleep. That’s why the time during and immediately after ovulation - the third week of the menstrual cycle - is often the best for women. (I know what you’re thinking…just one good week? Don’t worry, when I’m queen of the universe there will be system upgrades).
As we age, oestrogen tends to become more dominant relative to progesterone and that's because our ovulatory response diminishes in strength.
And as we move into the middle of life, mother nature makes a last-ditch effort for us to reproduce, by creating high but fluctuating high oestrogen levels. This, coupled with low progesterone, is responsible for many perimenopausal symptoms, in particular, sleep and mood changes.
Oestrogen and progesterone actually affect how the human brain develops and functions. Just as in adolescence, pregnancy and the postpartum period, the function and structure of women’s brains are radically and rapidly changing during perimenopause, increasing the susceptibility to mood disorders and directly impacting cognition and memory.
As a result, women experience big (and sometimes terrible) feelings. It’s distressing (and confusing) to experience amplified feelings that are beyond your conscious regulation. Women might be afraid to express what’s happening for fear of being shamed, judged, misunderstood, mocked, patronised, dismissed or medicated. These perceived fears can become real if they've already received negative feedback from family members, friends or colleagues about their behaviour.
My patients say things like “I’m afraid that I’m losing my mind” or, “ I’m out of control”. Some women experience sudden and tremendous psychological changes, putting them at great risk. The effects of the changing hormonal environment on mental health are explored in population-based and experimental studies. The most alarming statistic relates to suicidality. This evidence suggests that a woman in perimenopause is seven times more likely to experience suicidal thoughts than at any other time in her life. Why is this not a conversation in primary health care or in the community?
Feeling irritable, angry, teary, depressed, highly anxious, panic attacks, are all perfectly normal responses to a chaotic and changing hormonal environment. It’s valid to feel like you’re going crazy, and you are not alone. But it sure does feel that way.
Importantly, it’s not okay to endure feeling this way. This is not something you should ignore. It’s your health and you’re important. Get whatever help you need and don’t let anyone else’s opinions about your choices get to you. Whether it’s psychology, acupuncture, functional medicine, a mental health day, HRT, a rage cage, a holiday away from family, or an Elizabeth Gilbert moment - just do what you’ve got to do to take care of yourself. And take the time you need.
The hormonal changes also affect cognition function and performance (e.g. memory, learning, processing). You’re probably aware of the poor recall phenomenon. Yep, you’re in a conversation about “the thing….you know…the thing that washes the clothes” because you can’t recall the term for it at that moment. Sounds funny when I write it. Gets less funny when I’m in front of a patient and can’t string a sensible sentence together.
A recent UK study indicated that 44% said their ability to work had been affected by menopause, and 52% had lost confidence in their ability to perform at work; 10% have left work due to menopause symptoms, whilst 14% of women had reduced their hours at work or gone part-time.
That all seems pretty bleak, but the attitudes toward menopause are changing (albeit slowly) with more workplaces developing policies for leave related to menstruation and menopause. In the interim, if you’re feeling it, you could be an agent for change, a champion for what you and other women need.
These brain chemical changes can also impact sleep quality and duration. Anyone that has experienced prolonged sleep deprivation in their life, for whatever reason, will understand that their tolerance levels for life and other people are substantially reduced.
It’s not a coincidence that sleep deprivation is used as a form of torture.
The high fluctuating oestrogen levels are responsible for the rising thermostat which prevents the drop into a deep sleep and pulls women out of sleep in the middle of the night (with or without flushes). There are many herbal medicines that can help to modulate this effect, as well as, supplements and medications to directly affect sleep.
Unfortunately the decline in progesterone (which has calming effects) adds to this situation.
Naturally, fatigue goes hand in hand with poor sleep, and reduces cognitive function and emotional resilience. It is the perfect storm.
While I’ve focused a lot on the physical/biological effects. I feel like there’s a broader sociological narrative to consider. Sometimes big health challenges cause us to focus on what really matters, and what we might have been neglecting/tolerating. My personal take is, if you’re going through menopause, caring for yourself, has never been more important. Right now, you are the most important person. These can be hard words to digest, given the social scripting of what it is to be female in many societies.
Maybe there’s space for a different perspective of this time of great flux. Perhaps perimenopause could be your own personal metamorphisis, a catalyst for transformation in all aspects of life. This might be the time to do that life drawing class you’ve always wanted to do, change career, travel, go back to school, re-evaluate relationships, create boundaries, grow, reinvent your life and discover yourself, newly.
The symptoms of perimenopause will wax and wane, sometimes unexplainedly. What I want you to hold onto is that, over time, the symptoms will lessen and eventually pass. On the other side of all this, it's a steady state. I’ve never been there before, but I’m really looking forward to it!