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What Your Doctor May Not Tell You About Premenopause
By Virginia Hopkins John R. Lee Jesse Hanley
Warner BooksCopyright © 1998 John R. Lee, M.D. and Virginia Hopkins
All right reserved.
Chapter OnePremenopause as a Life Cycle
You're only in your mid-thirties and you absolutely do not want to hear the word "menopause" applied to you, even if it is "pre" menopause. You're not there yet. You're still young, you haven't even had kids yet for heaven's sake, or your kids aren't even out of grade school. And yet you know something in your body isn't quite right. You haven't changed your eating or exercise habits, but you're gaining weight. Your breasts are sore and lumpy, especially premenstrually, and you've started to have irregular periods. Maybe you've lost some of your sex drive or your skin is dry or isn't as smooth as it used to be. You used to think of yourself as very even-tempered, but lately you're irritable and snappish, and you can't seem to get out of bed in the morning. You have friends your age who are struggling with infertility, uterine fibroids, and premenstrual syndrome (PMS) when they've never had it before. What's going on? It's premenopause syndrome, which is not a natural or inevitable part of life but rather one created by our culture, lifestyles, and environment.
Premenopause syndrome is a phenomenon that all women know about, but very few have a name for. Some fifty million women are going through premenopause right now, and most of them have experienced some form of this syndrome, which is a collection of symptoms experienced by women for ten to twenty years before menopause.
We call this pre-menopause rather than using the medical term perimenopause, because premenopause syndrome can begin as early as the mid-thirties whereas perimenopause technically means "right around menopause," meaning the year or two before, during, and after menstrual cycles end.
If you're a woman between the ages of thirty and fifty, you know a woman, maybe yourself, who has fibroids, tender or lumpy breasts, endometriosis, PMS, difficulty conceiving or carrying a pregnancy to term, sudden weight gain, fatigue, irritability and depression, foggy thinking, memory loss, migraine headaches, very heavy or light periods, bleeding between periods, or cold hands and feet. These symptoms are part of premenopause for a majority of today's women, and are the result of hormone imbalances, most of them caused by an excess of the hormone estrogen and a deficiency of the hormone progesterone. As you'll discover as you read on, natural progesterone is essential for maintaining hormone balance, and yet it has been largely overlooked by conventional medicine because of medical politics and pharmaceutical company profits.
However, premenopause symptoms are not just about biochemistry. They are also about women who are out of touch with the cycles and rhythms of their bodies, their feelings, and their souls. These are women who struggle to balance families and work, women who forget to take care of themselves, and women who aren't getting the help they need from their health maintenance organization (HMO).
There was a time when a woman's mother, grandmother, and aunts would quietly let her know what to expect during each phase of her life and help her through the rough patches with herbs and homespun, time-tested wisdom. These days the medical profession has taken over the role of a woman's extended family, but sadly, the advice they have to give out has more to do with dispensing drugs and scheduling surgery than with solutions that are healing-or that even work!
When women have premenopausal symptoms, estrogen is commonly prescribed. When that causes irregular bleeding or cervical dysplasia, or doesn't help their symptoms, their doctors often then resort to surgically induced menopause in the form of a hysterectomy, or they try personality-altering drugs such as Prozac and Zoloft to medicate them until they get through this particular phase of their lives. Or they are given more synthetic hormones-and the wrong hormones at that. None of these approaches really improves the quality of a woman's life, and they all have grave potential to cause illness and even to be life-threatening. In spite of what a conventional doctor will tell you, you can do something about the symptoms of premenopause besides antidepressant drugs, synthetic hormones, and surgery. We're not trying to say you will never have any symptoms as your hormones wind down or that you can live forever or that your skin will stay smooth and unwrinkled until you're ninety. But you definitely do not have to suffer from lumpy breasts, fibroids, and many of the other symptoms that show up anywhere from five to twenty years before menopause.
SO LOOKING FORWARD TO MENOPAUSE
One of the reasons that premenopausal women don't want to talk about menopause is that they dread this hallmark of aging. This attitude is sad and contributes heavily to the emotional causes of premenopause symptoms. This attitude is particularly true of the many women who have postponed having children and who wonder if they're going to be able to have children before their biological alarm clock goes off.
Women have been taught in countless ways that their value lies in their ability to be sexually attractive to and unconditionally supportive of men, as well as being unselfishly maternal and unconditionally loving of their children. While these are truly positive feminine traits, they are also one-sided. A woman who has only developed these traits without developing her sense of self will be terrified at the prospect of aging. When her children have left the house, her breasts are sagging, and her skin is wrinkling, what does she have left?
Women who only develop this side of themselves also tend not to have good boundaries. They have spent so many years making themselves totally and selflessly available to their husbands and children that they don't know where their families end and they begin. They have trouble saying no and would be hard pressed to tell you when they last had an hour to themselves-or what they'd most like to do with an hour if they had one. It's no wonder that the process of becoming a more individualized and free woman can be a frightening one. These women are craving self-definition: Who am I? What's important to me? What really matters? What am I teaching my kids? What values do I stand for in my work? What are my personal creative gifts? They have to relearn their right to say, "No, I won't do that"; "No, I don't have time"; and "No, I'm not available right now."
Once a woman passes over the threshold of menopause and begins to redefine herself, she has the potential to discover the richest time of her life. She can look back on the energy and enthusiasm of youth as a thrilling and exciting time. Childbirth and parenting were magical and rewarding. A career was creative and empowering. Now her first fifty years of life are digested and integrated into wisdom and freedom. If you talk to menopausal women you will find that once a woman comes across the fifty threshold and gets a year or two over it, very few would go back for anything other than a tight butt and fewer wrinkles. Menopause was once called the "dangerous age" because so many women begin speaking their minds at that time of life. What the world needs more than anything is for a woman to have the courage to speak her mind.
Menopause is a life cycle to be respected and looked forward to. In the future, menopausal women will once again be cherished and appreciated for the experience they bring to the rest of us and looked upon as role models by younger women for their sense of individuality.
CREATING A POSITIVE PREMENOPAUSE CYCLE
Before puberty, you had the freedom of living without hormonal cycles and the relatively steady physical and emotional balance of that freedom. During puberty, you rode the ups and downs of a body getting used to the surges of sex hormones and menstrual cycles as well as the growth of pubic hair, breasts, and a libido. In your twenties and early thirties, if you were lucky, you experienced a remarkable period of high energy, clear thinking and all the excitement, privileges, and challenges of being an adult and building your adult life. This is also a time when your hormones reach their maximum hum. There's a rhythm working that is so genetically empowered that it's harder for all the spiritual, psychological, and environmental challenges you have to knock it off balance.
Sometime between your mid-thirties and mid-forties this strong, vibrant cycle becomes more easily influenced by outside factors and lifestyle choices. You notice things are changing again. Your periods aren't as regular as they once were, and your breasts get painfully lumpy when you're premenstrual. Sometimes your periods are heavier or lighter than usual. You're at least a little moodier than you used to be, and you tire more easily. You don't recover as quickly from a long trip or a late night out. You need more sleep, or you aren't sleeping as well. You strain your muscles more easily when you exercise and find yourself grunting a little when you stand up. If you eat poorly or miss a meal, you notice it. Those onion rings you used to scarf down without consequences now give you heartburn, and just one too many glasses of wine gives you a headache. You aren't quite the sexual tigress you used to be, and sometimes you notice you're not as lubricated during intercourse. You used to have mild PMS, but now it's distracting and unpleasant. Even though your diet and exercise are the same, you've gained a little weight, and no matter what you do it doesn't come off and stay off. You're sprouting more than a few gray hairs, and if you're over forty, chances are good that you need reading glasses, at least for the fine print.
* * *
These are the signs of a midcycle of life when everything is changing again. It's not as short, intense, and dramatic as puberty for most women, but once again your hormones are fluctuating up and down, with a gradual and overall direction of winding down (see figure 1.1).
The premenopause life cycle is an extremely potent and empowering time of life. A balanced premenopausal woman is confident, knows herself, and has enough experience to be moving around in the world with self-assurance. She realizes that Prince Charming is not going to gallop up and rescue her, so she is no longer looking outside of herself for security. She has achieved a level of competence in the home and the workplace, as well as familiarity with her own strengths and weaknesses. One of the keys to a healthy premenopause cycle is to make it not just okay but wonderful to be moving into a time of life when we're becoming less physically powerful but more emotionally and spiritually powerful.
Anne is a forty-four-year-old schoolteacher who went to her doctor a year ago complaining of weight gain, depression, and headaches She had also been having irregular periods for about six months. The depression and headaches were very difficult for her to cope with while teaching a class of energetic junior high schoolers. On many occasions she had found herself uncharacteristically snapping at her students or on the verge of tears.
She and her husband didn't have any children, but they were avid weekend hikers and loved to travel the world to beautiful hiking spots. Anne's weight gain had made it difficult for her to keep up on the hikes, and her depression made it hard just to get out of bed on weekends. Anne was nearly thirty pounds overweight, and her face was flushed, as if she had a permanent blush.
When Anne went to her HMO's doctor, he told her she was going into menopause, and gave her a prescription for Premarin, a synthetic estrogen and Provera, a synthetic progesterone. She dutifully took them, and for about two weeks she felt better. Then her symptoms started to become worse than before she had begun taking the synthetic hormones, and every time she took the Provera in the middle of her cycle her depression became dramatically worse. When she called her doctor to tell him, he called in a stronger dose of estrogen to the pharmacy, which Anne began taking. Within two weeks of the new regimen she had gained six pounds and was almost constantly weepy. She was calling in sick to work because her headaches had become so severe.
After six months of enduring these symptoms and on the verge of losing her job, Anne returned to her doctor for a pap smear and it came back positive for cervical dysplasia, a potentially precancerous condition. He told her that although they could take a wait-and-see approach for six months, he recommended a hysterectomy. He promised her that after the hysterectomy all her symptoms would disappear and she would be a much happier woman.
At this point Anne went to see Dr. Hanley, weeping through most of the appointment. She confessed that she thought some of her depression was caused by the realization that at this late stage of her life she wanted a child, even though her husband was adamantly against it, to the point of not wanting to have sex for fear of pregnancy. Anne said with a sad laugh that her sex drive had disappeared since she had started taking the synthetic hormones, so she didn't really mind that her husband didn't want to have sex.
Dr. Hanley suggested to Anne that she keep a daily journal of her feelings, including her feelings about not having a baby. She explained that while Anne's symptoms were no doubt partly related to her conflict over having a baby, the severity of her headaches, depression, and weight gain, as well as her cervical dysplasia, had probably been caused by the high doses of estrogen she had been taking, as well as the synthetic progestins. Dr. Hanley did hormone tests, which revealed that Anne's level of follicle-stimulating hormone (FSH) was still normal, but her estrogen level was way too high, an indication that she was not in menopause yet. She suggested that they gradually ease her off the synthetic hormones, replacing them with natural progesterone. Dr. Hanley asked Anne to take the vitamin Colic acid along with sublingual vitamin B12 and vitamin A to help heal the cervical dysplasia. She was asked to return in eight weeks for another pap smear.
Dr. Hanley also asked Anne to take up a gentle but regular weight-lifting program at the gym to bring her metabolism back to normal and help her reduce weight. Anne added twenty minutes on the treadmill and said the workout immediately picked up her energy and she felt more hopeful and cheerful.]
Six months later, Anne had lost twenty pounds, and her last pap smear came back normal. She said that within days of beginning on the natural progesterone it felt as if her body was giving a huge sigh of relief, and her symptoms began to get better. She was bubbling over with energy and enthusiasm for a hike in the Peruvian Andes she and her husband were going on in a few weeks. She still felt sad about not having a child, but after many months of writing in her journal, she decided that her marriage was more important.
Excerpted from What Your Doctor May Not Tell You About Premenopause by Virginia Hopkins John R. Lee Jesse Hanley Copyright © 1998 by John R. Lee, M.D. and Virginia Hopkins . Excerpted by permission.
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