Hot Flashes and Mood Swings: Why Perimenopausal Symptoms Are Misdiagnosed – and How to Treat Them | Well actually

IIn her 40s, Karen Cummings began to notice a change in her menstrual cycle. The New Yorker’s typically mild, constant symptoms had been replaced by bloating, emotional swings and feelings of overwhelm before she entered menopause five years ago, at age 52.

She thought she might need to change her birth control method. His doctor suggested an antidepressant. But the symptoms seemed related to her menstrual cycle. “I’m not depressed,” she remembers thinking. “I’m on the wrong birth control.”

Dr. Brittanny Keeler, an obstetrician-gynecologist in Buffalo, New York, often sees patients presenting with menopausal symptoms and feeling hopeless. It can feel like “falling off a cliff,” she said. “They don’t understand what’s happening to them.” They are often told that they must wait until their period is over to start treatment.

In the United States, the average age of menopause, or the period of life when reproductive hormones decline and menstruation stops, is 51. Perimenopause can begin seven to ten years early. People who menstruate may begin to notice symptoms such as insomnia, hot flashes, and mood changes in their late 30s and early 40s. Added to this are other life pressures, including a busy career and family commitments. “The divorce rate is increasing for this group,” Keeler said. Perimenopause “is absolutely a contributing factor.”

Many doctors do not fully diagnose the cause of these symptoms. Keeler, who just received the designation of Certified Menopause Practitioner from the North American Menopause Society, said, “We see a massive increase in the amount of antidepressants prescribed around the mid-40s. Many women do not receive the treatment they really need.

Many people benefit from mental health medications. But it’s not the whole story when it comes to treating perimenopausal symptoms, nor does it adequately address hormonal fluctuations. It is extremely common to receive a dismissive diagnosis and subsequent prescription of SSRIs for depression and anxiety without any acknowledgment of perimenopause.

Cummings found a new doctor and shared the same information: her symptoms and her curiosity about other birth control options. Her doctor told her, “You need another method of birth control. You are not on the right one. Her doctor reassured her that they would keep trying until they found the right method of birth control for her current needs. Cummings said: “It was such a simple thing.”

What are common symptoms of perimenopause?

Menopausal symptoms can occur much earlier than you think. “Perimenopausal women are actually some of the most symptomatic people because of the wild fluctuations in their hormones,” Keeler said.

“When someone is in perimenopause, the ovaries are still functioning, but not in the same, very predictable, way as before, where you had your monthly cycles,” she said. “They send estrogen and don’t get the response they want, so they send even more.” This can result in no ovulation in some months or twice in others; the latter is known to experience an out-of-phase cycle.

Symptoms are different for everyone, but can include mood changes and irregular bleeding like shorter, lighter cycles or heavier, longer cycles. Hot flashes and night sweats may also occur as your period approaches. Insomnia is also very common. It may not be difficult to fall asleep, but staying asleep all night is a challenge.

Perimenopause is clinically defined by a seven-day variation in the menstrual cycle and typically lasts four years. “It’s a progressive change,” said Dr. Katie Unverferth, director of the Women’s Life Clinic at UCLA and a psychiatrist specializing in reproductive psychiatry and women’s mental health. But fluctuations in ovarian function can begin well before this level of variance.

“This hormonal dysregulation can lead to many mood symptoms,” Unverferth said. It’s quite common to experience mood changes, commonly called premenstrual symptoms, or PMS, during the luteal phase, which lasts longer as women age.

Patients may feel “all over the place.” Anxiety, depression, insomnia and cognitive problems such as memory problems may occur. “Many say they don’t feel well, and it’s really hard to pinpoint why,” Unverferth said.

“The greater the hormonal changes, the greater the risk of depression,” Unverferth said. These sharp hormonal fluctuations also appear in premenstrual dysphoric disorder (PMDD) as well as during pregnancy and postpartum. “But once you hit menopause and that change is made, the risk of depression goes down.”

ignore past newsletter promotion

after newsletter promotion

How to treat symptoms during perimenopause?

“Menopause is simpler to treat than perimenopause, because with menopause we’re just giving back to you what you’re not producing,” Keeler said. Menopausal hormone therapy (MHT), formerly called hormone replacement therapy (HRT), replaces progesterone and estrogen that decrease during menopause. This can help relieve symptoms like hot flashes, night sweats, brain fog, vaginal dryness, and mood swings. It also reduces the risk of heart disease, osteoporosis, diabetes and dementia.

But, in some circumstances, MHT is not a sufficient treatment for people in perimenopause. “Not only do we need to manage the symptoms, but we also need to support the uterine lining to prevent irregular bleeding caused by hormonal fluctuations, which can sometimes happen with menopause because it is too weak, and some women also still need “birth control,” Keeler said.

“Birth control pills are actually great for people who have (perimenopausal symptoms), especially mood fluctuations, because birth control pills will suppress ovulation,” she said, and the ovaries will no longer try to guide the body through the menstrual cycle.

But not everyone is a candidate for hormone treatments, such as those who have had a heart attack or blood clots. Treatment should be individualized and developed in consultation with a healthcare provider.

Additionally, people who have mental health issues or low tolerance for subtle health changes may really struggle with perimenopausal symptoms like hot flashes in public or trouble sleeping, and may believe they are “Embarrassing and shameful,” Unverferth said. “Cognitive behavioral therapy specifically for perimenopausal symptoms can be very helpful. »

Research has shown that antidepressants can be effective for emotional symptoms. According to Unverferth, a 2011 study found that, for example, the anti-anxiety and antidepressant medications Lexapro and hormone therapy helped reduce hot flashes, night sweats, sleep and quality of life. “Typically, antidepressants remain the first line for depression and perimenopause, but for someone who has treatment-resistant depression or very severe depression, or for someone who also has insomnia or sweating nighttime, we would definitely consider hormone therapy,” she said.

Awareness and access to treatment options are essential, but MMT, birth control, and non-hormonal options like antidepressants are not a panacea. “If you don’t take good care of yourself — eating well, prioritizing your sleep, exercising — you won’t get as many benefits as you hope,” Keeler said. . She emphasized strength training for people in their 30s and those in perimenopause and menopause because it can counteract the loss of muscle mass and decline in bone health during menopause.

Reproductive health, particularly in terms of perimenopause and menopause, is not solely the responsibility of obstetrician-gynecologists. “The entire healthcare system is broken. We simply don’t have enough time to focus on prevention with patients,” Keeler said. Not every doctor can specialize in everything, but they must recognize the symptoms of perimenopause and know where to send patients for care. Those entering this transition should consult their primary care physician and consider speaking to an endocrinologist and even an orthopedist. “This (transition) affects all organ systems, and so all physicians have a responsibility, regardless of specialty, to at least recognize the symptoms, even if they are not equipped to manage them,” Keeler said.