Since publishing Come Back Strong in 2017, I have had the opportunity to connect with women all over the globe. We discuss hormone health in Menopause Cafe‘s, Facebook groups, and at Virtual Summits. Menopause is a subject close to my heart and one that deserves more attention, more support, and more conversations.
It was through an international Menopause Cafe that I met Sandra Rice, MD. This month, I’m pleased to introduce you to her as my guest blogger.
Dr. Rice is a fellow author. While I write about self-help, lifestyle change, personal responsibility, and personal empowerment from a personal experience perspective, Dr. Rice gives you more of the science from a medical perspective.
Here’s the thing: you need and deserve BOTH perspectives. Especially as you seek answers and make decisions about your own personal health.
Women can be fierce competitors. I believe, they can also be powerful collaborators. I believe in an abundant Universe. I believe that a rising tide lifts all boats.
And since Sandra and I write about common topics—menopause, sleep, and athletics—I believe she fits right in here at my blog. Enjoy!
Whether you are a hard-core athlete or weekend warrior, you will notice that your physical and mental prowess declines as you age. This tends to happen gradually, but for many women entering their mid-to-late 40’s, things may spiral downward precipitously – making them wonder what on earth happened to their bodies. More than likely the culprit is perimenopause – the phase of life where the female body and brain go through hormonal changes that can have a significant effect on physical and mental performance. Why does this happen? And what can help ease this transition?
First of all, what is perimenopause?
Whereas menopause is defined as the final menstrual period, perimenopause refers to the five or more years prior to that point. During this time the ovaries slowly wind down. Ovulation becomes irregular and the levels of our two main female hormones, estrogen and progesterone, descend in an unpredictable and sea-saw-like fashion. This causes a change in the menstrual pattern and a number of symptoms that can range from mildly annoying to almost incapacitating.
Starting with the hot flashes
Hot flashes affect over 70% of women in perimenopause and menopause. For some women hot flashes are a minor nuisance, but for many they are life-altering. Suddenly feeling hot, sweaty, and uncomfortable at rest is bad enough, but during exertional activity a hot flash can be intolerable. The flushing can affect performance as well as make it more difficult to dissipate heat. In addition, hot flashes can be accompanied by heart palpitations and dizziness. In the middle of a soccer game or a bike ride, suddenly feeling this way can be downright scary!
It has also been shown that most women in perimenopause develop sleep problems – characterized by frequent awakening, poor quality of sleep, and reduced total sleep time. Much of this is due to hot flashes and night sweats, but the fall in hormone levels also directly interferes with the sleep center in the brain. Sleep deprivation is a killer. Feeling like a Zombie the next day is not going to allow you to perform any activity well, much less an athletic endeavor. Poor sleep not only causes fatigue but negatively affects the body’s energy balance and ability to regulate blood sugar– all factors that can make exercise more difficult.
The perimenopause is marked by changes in the menstrual pattern. Initially, periods come closer together – an unwelcome phenomenon especially when it comes to sports. Later in perimenopause, the interval between each period lengthens – causing missed periods. These cycles can be punctuated by erratic spotting, or episodes of heavy bleeding. Not infrequently this leads to be an excessive loss of iron which can cause fatigue and weakness and, in some cases, significant anemia. It goes without saying that these “female problems” interfere with all sorts of activities, especially sports.
Perimenopause and the brain
Another cardinal perimenopausal symptom is brain fog. This is not just a matter of forgetting the tennis score during a match; it can affect memory and cognitive function enough to interfere with day-to-day activities. In the past, not too much attention was paid to women with these complaints, but research is showing that the declining and fluctuating estrogen levels during perimenopause have a detrimental effect on the brain’s synapses and how the neurons communicate with each other. This is why it may seem more difficult to get your body to react and respond like it used to.
Another part of the brain affected by perimenopause is the area that governs mood. Over 50% of women experience mood changes during perimenopause. This occurs because estrogen plays a major role in supporting brain chemicals such as serotonin. Diminished serotonin activity is associated with anxiety, irritability, and depression. It is not difficult to understand why perimenopause would negatively impact someone’s interest and motivation to be active.
Muscle and joint problems
Another common complaint during perimenopause is joint pain. The exact reason for this is somewhat unclear, but likely has to do with the fact that estrogen supports connective tissue – the backbone ingredient of cartilage, which makes up our joints and tendons. Joint problems affect performance; plus sore shoulders, hips, and knees are sure ways to take some of the enjoyment out of playing sports.
Finally, estrogen is very important for energy production in the muscle cells. As estrogen levels drift downward, muscle function declines and there is a loss of muscle mass, a condition known as sarcopenia. This loss of muscle activity progresses slowly throughout perimenopause and menopause leading to a gradual decrease in strength and stamina.
The bottom line
…being aware of what aging brings can be empowering.
Each woman will go through perimenopause differently – some women will have more problems than others. But the loss of our female hormones in mid-life will have noticeable effects. Reading about these changes that may be in your future is no doubt unsettling, but being aware of what aging brings can be empowering. We can’t stop the process, but we can be proactive in dealing with it, with the right attitude and tools. Understanding that changes in our bodies and brains may appear fairly acutely during perimenopause is the first step. Here are some other suggestions that may make the transition go more smoothly.
- Don’t put up with hot flashes. Estrogen replacement is the most effective treatment to combat hot flashes. Today, most experts in menopause agree that estrogen therapy is very safe and that the benefits outweigh the risks when they are taken around the time of menopause. If you don’t want to consider hormones, there are other options that can offer some relief, such as antidepressant medications.
- Get adequate sleep. During perimenopause, 7 to 8 hours is strongly advisable to allow your brain and body to stay healthy. Sometimes it’s a matter of following simple measures such as prioritizing time for sleep, putting away electronic devices, avoiding evening alcohol, and heeding other well-described sleep hygiene advice. Since hot flashes and night sweats greatly interfere with sleep, estrogen treatment is extremely beneficial. Cognitive-behavioral therapy can also help. A consultation with a sleep specialist may be in order if you feel you have a more significant sleep disorder
- If your menstrual cycles are extremely heavy, see your doctor for an evaluation. Make sure your iron level is normal. There are multiple treatment options to deal with irregular cycles and heavy bleeding. Low-dose birth control pills can help regulate your cycles as well as lighten the level of bleeding and they also have the added benefit of relieving hot flashes. Other procedures such as hormone-based IUDs and endometrial ablation are sometimes recommended to deal with bleeding.
- Continue regular exercise, ideally a minimum of 30 minutes of aerobic activity 5 days a week. This, along with weight training three days a week has been shown to improve muscle function and strength as well as help prevent bone loss – another issue that begins in perimenopause.
Finally, take things in stride. Our bodies and brains are not the same at age 45 as they were at age 25, so don’t expect that you can do everything as well as you did back then. But that doesn’t mean turning into a couch potato; it means that you need to pace yourself and work within your limitations and set realistic goals and expectations. Making adjustments to accommodate the way your body changes through perimenopause will allow you to continue to enjoy your athletic and recreational activities.
About Dr. Rice
Dr. Sandra Rice is a board-certified internal medicine specialist with over 35 years experience taking care of women in menopause and beyond. She is the author of The Estrogen Question: Know Before You Say “No” to HRT, a book she wrote to educate women about the benefits and risks of hormone replacement therapy. She continues her quest to inform women about how perimenopause and menopause impact their health through her website, www.yourestrogenquestions.com and her social media accounts @SandraRiceMD1. She is a strong proponent of preventative medicine and encourages women to adopt a consistent exercise routine from cradle to grave.
From my blog:
- Your Menopause Perspective: Sign of Aging or Second Spring?
- Choosing Faith Over Fear During Menopause
- Sleep, Menopause and Learning to Say No
BUY NOW: The Estrogen Question: Know Before You Say “No” to HRT, by Sandra Rice, MD
Thank you for reading, thank you for your support!