These first few entries are copied from Facebook and emails in an effort to keep the thought stream together. I've left the comments that I think specifically add to the discussion, and substituted initials for names. If you recognize a comment of yours and don't want it here, please let me know and I'll remove it asap.
I've gotten a lot of feedback and advice following my last few menopause-related posts. I loved the reach-out from people, but realized that there are different rides women take, depending how things go in their bodies, and I thought that instead of writing each of you back to say 'yes that would work for me' or 'that wouldn't work for me because' or 'doc and I already talked about that' or whatever, I'd put together a post with what I've been told about what's going on, and specifically what I'm doing for it, for those interested. Some of this I may have covered already, but I assume if you do read all the way through this then you're likely someone who will forgive me for it.
Here is what I came away with from my Doctor:
The doctor drew me a little graph showing how both estrogen and progesterone levels go up and back down during a woman's normal cycle, each having their own time that they peak and drop. Eventually peri-menopause starts, and a woman's body starts to produce less and less of these hormones. However nothing ties their production together, so production of one may start to taper off prior to the other.
When a woman's estrogen production starts to drop, that lets us know that the ovaries are heading towards retirement, and the big obvious sign of that is our menstruation schedule gets wonky.
When a woman's progesterone production start to drop, there is no sign as obvious as a late period, however there are signs if you know what to look for, and that has to do with how progesterone and estrogen interact. One of the things most noticeable to us is that it calms down the emotional rollercoasters that come with lots of estrogen. So when a woman's estrogen levels are still in normal production but progesterone isn't being produced in the same amounts, its like being a 13 year old girl again - all the crazy emotional energy and anxiety washing over our brain but without enough progesterone to balance it out and help us feel the way we've been used to feeling in our brains since we finally kicked puberty.
So, that's my personal issue - progesterone production is dropping but my estrogen levels are still what they've been. So I still get my period every month like clockwork, but my brain often feels out of control emotionally because I'm awash in estrogen without the progesterone to keep it in check.
[slight tangent - The doctor actually went into a bit of detail about estrogen that I appreciated. He said that estrogen makes us feel like EVERYthing is connected, and EVERYthing means something. EVERYTHING. Progesterone balances out that feeling and helps our brains filter out what is actually connected and what isn't. Women have higher levels of estrogen than men, and one of the ways our brains learn to deal with that essentially shows itself as 'women's intuition'. So at that dinner party you went to where you, the wife, noticed that 2 people were giving each other eyes all night and then made excuses to leave at the same time and that lead you to likely rightly conclude that they're enjoying some boom-boom together, yet your husband noticed none of it - that's the woman's higher levels of estrogen, helping her notice and put stuff together that her male counterpart is less likely to notice. Unfortunately it can also lead us to assume things mean stuff that they don't, assigning meaning and connection where none lies.]
As for what my doc and I have done about it and how it's working:
On top of exercise, mediation, a high dose of vitamin D, and instructions to eat foods that help with progesterone production and limit foods that stimulate estrogen production, I started on a low dose of progesterone cream, and did that for 1 month to see how an entire cycle was on this dose. Then I went back to the doc and reported on how much better I felt. I said, "about 50% back to normal." So, he upped the dose from 1 pump of cream a night to 2 and added folic acid.
I've now had about a month and a half on this higher dose, and I'd say 90% of the time I feel myself again, and most of that other 10% of the time I'm mostly ok.
But I will say, even when I say I feel ok, sometimes I can still feel or hear the anxiety, but like its in the next room talking loudly but muffled instead of in this room with me and in charge. Its a very strange sensation.
So my anxiety and emotional roller coaster ride were the main things that needed and got some control. As for other symptoms, I do occasionally get hot flashes, but not often now. I don't sleep as well as I did when I was younger, and find myself a lot more often seeking the comfort and safety of my own home, small social things, and the peace of solitude vs. going out or to big parties. I've not yet identified any one thing that triggers any of it; though I know that some women find alcohol or caffeine or such can make symptoms much worse. I will say that exercise is really great. It doesn't make the hot flashes go away (I had one a few weeks ago that started in the pool and didn't stop until I was out and most the way through my weight machine routine) however the endorphins do rock as a weapon against the anxiety.
As for the future, what I believe to be true is that I'll just keep watching my body closely, discuss with my doc and adjust the progesterone cream as needed if needed, and then reformulate a plan once my ovaries decide to retire and my estrogen starts to go down too. I'm guessing as that happens I'll get to wean off the progesterone cream.
But then comes the other stuff - my body dealing with not having the estrogen it is used to, and based on what things hit me I decide if I put some estrogen back into me. Shiny hair, smooth skin, no dark facial hair, a vagina that easily gets moist and is nice and elastic inside, a clit that stands up to be counted when it matters - all those things can go away with lack of estrogen.
So there you have it. Them's the details of my trip so far.
For you still-menstruating women reading this, I remind you that we each get to go on our own trip. I do however think it is very important for us to talk about it and share our experiences, simply so that we're more aware of what is going on with each other and with our own selves, and it serves as a reminder to be gentle and forgiving with ourselves. This does happen, is happening, it is real, and I can't stop it or turn it off. I can only look for ways to survive the ride.
- J.A.: Is there alternatives to mares urine when it comes t hormone cream? i'm not there yet so i haven't done the research.
- N.E.: I was taking "bio-identical" estradiol combined with testosterone in pill form, which seemed to work fine with few issues, but then was discontinued in the US so I took just estradiol. I tried testosterone cream which didn't do anything, but that may have been because I didn't have a conscientious doctor like Susanne does.
- I discontinued HRT a few years ago; still get hot flashes but they've subsided quite a bit. I recently had a scary emotional/physical situation which turned out to be a really low thyroid level, so make sure to get that checked too. There's some disagreement about what the normal ranges are, so do the research, try treatment, listen to your body and decide for yourself what works. best.
- I.B.: How have your energy levels been? You mention that exercise has been effective for making you feel better, but is it harder? Or harder to begin exercise (maybe even as a result of wanting to be more at home)? Do you have the same strength and stamina as before? Curious minds want to know...
- Susanne: Physical strength and stamina, not really a problem. However I don't sleep as well (wake up very early in the morning and can't get back to sleep right away) and almost any moment of the day I'd happily shut my eyes and head straight to nap land. If I could sleep from 8pm till 3 am, then from 5am till 8am, that would rock. So it's more a matter of regular lack of sleep teamed with less mental energy for life-stuff and the social anxiety that can come with it all equalling a kind of fatigue. But not in a physically weak way like I think you mean.
- M.S.: My perimenopause is going differently than Susanne's - I'm not having the emotional upheaval but the hot flashes have been extremely annoying. I'm now on progesterone cream and it seems to (finally) be kicking in. I totally agree on the exercise portion of this advice. I've been going to a gym several times a week and its been helping me focus on better health, but more importantly it tires me out enough to sleep through most of night. Normally I'm wakiing up 3-5 times due to hot flashes.
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