~ An overview of what's been (or will be) happening to you

The basic realities of Menopause are the material of legends. We all know them, we've all heard them, from our grandmothers, mothers, sisters, cousins, teachers, and friends. We know about the hot flashes, night sweats, memory loss, ridiculously reduced sex drive, incredibly increased sex drive, fatigue, mood swings, heart palpitations, bone loss, insomnia, depression, the absolute surety that you are losing your mind! All that fun stuff. Not to mention that, if you are lucky enough to share your life with a partner or family, you get to look forward to subjecting them to it all (is that what passes for luck these days?).

Now that you know the words... the song is almost over

For many of us, our grandmothers (and maybe even our mothers) thought their lives were over... "all downhill from here." There were a lot of reasons for this, but mostly it had to do with the fact that, for our mothers and grandmothers, a great deal (perhaps all) of their personal identity and sense of value was based in their child bearing abilities. In the U.S. women have only had the VOTE since the Nineteenth Amendment was ratified in 1920. Women's roles were tightly restricted and a woman's identity, more often than not, came from birthing and raising children. The symptoms of menopause were like a big iron door SLAMMING shut on womanhood. The other side of the Great Divide was uncharted territory, a literal no man's land where life simply wound it's way toward the end. Not a lot to look forward to there.

Not an ending but a BEginning

We may be our mothers' daughters, but this is not our mothers' menopause. For today's woman, between the age of 35 and 65, even with all the discomfort, weirdness and chaos, in the midst of hot flashes and forgetfulness, we are coming into our own. Sure menopause is an ending, but it is not the end. In fact, if played right, it just might be the biggest beginning of your whole life.

While your physical ability to conceive and bear children is waning (actually its been on the wane from the very beginning), your ability to conceive and bear new ideas, enterprises, hopes and dreams is coming into its own.

What's in a word?

The term "menopause" literally refers to a woman's last period but the catch is that this is something that is determined a year after the fact. There are so many ups and downs along the way, so many false-stops and re-starts that when you finally know for sure that you have passed through menopause it's a bit anti-climactic.

On the other hand, perimenopause - the period leading up to menopause - is the time, lasting anywhere from 2 to 10 years - when we experience the primary symptoms that we have come to identify as "menopause."

So how do you know if you've entered perimenopause? That one's actually easy. Pretty much, if you're asking the question, you probably have.

Exit... Stage Left

The girl who came on stage in fear and splendor and chaos back when you were 12, or 13, or 14 is preparing to exit the same way she came in, but you have to admit, she put on quite a show along the way. The amazing thing that we found upon embarking on our own menopausal journeys was the way all the symptoms we were experiencing seemed to be telling us something. The key to it all is in the act of listening; opening your heart, your ears and your mind (what's left of it) and paying attention. The girl you were (and are) has some things to tell you before she leaves the stage.

It's not like you want all these, often debilitating, symptoms, and in subsequent postings we'll be discussing how to mitigate their effects, but for now, let's take a look at some of the more common manifestations of perimenopause and ask what's going on. If they are going to be here anyway we might as well find out what they're trying to tell us.

When I said I wanted to look hot, I didn't mean it literally!

Hot flashes are the most common, and most outwardly obvious perimenopausal symptom in the American culture. It occurs in from 70 to 85 percent of all perimenopausal women. They can range from mildly warm feelings to raging wildfires that will have you peeling off clothes like a Las Vegas stripper.

Hot flashes usually begin as a sudden feeling of warmth that can quickly rise to a feeling of intense heat over the face, scalp and chest. This may be accompanied by redness, perspiration (oh come on... it's SWEAT!) and in severe cases, increased heart rate, tingling in the hands and feet, a creepy "skin crawling" sensation and nausea. Even with cute little fans and mint juleps for relief, this is no family picnic (except for the humidity and bugs).

No Sweat...

Close on the heels of the raging fires of hot flashes comes her evil twin, night sweats. Usually occurring in the early morning hours (between 2 and 4 am) night sweats are hot flashes with the added feature of waking you up in sheets so wet that your first reaction is to ask, "How did I get in the swimming pool? I don't even have a swimming pool."

Both of these symptoms are affected by the hormonal changes beginning in your body, but they can also be triggered by outside factors including spicy foods, hot drinks and emotional reactions to tension, anxiety and stress. The intensity and frequency of hot flashes and night sweats can be significantly reduced with diet changes, herbal treatments, and various estrogen treatments (more on all of this in future postings), but relaxation techniques and meditation have proven effective for a vast number of women with no additional treatments at all. This is because meditation and relaxation lowers your level of stress hormones. Turn down the stress... turn down the heat.

The Heart of the Matter

On the heels of night sweats and hot flashes, and pretty much related to them in both cause and effect, are heart palpitations that can range from slight to severe. Your heart skips a beat (not unlike those early feelings of falling in lust) or two and it can be scary as hell, but it's not likely to be truly dangerous. Such palpitations are generally the result of imbalances between the sympathetic and parasympathetic nervous systems and are triggered (as with hot flashes and night sweats) by the stress hormones generated by fear, anxiety and tension.

Again, there are a number of treatments that can be helpful to reducing these symptoms, but the first question to ask is "what is my heart trying to tell me?" Sit, wait, listen... rest. Much of the physical upheaval of menopause comes from the emotional upheaval of the life you have been living up to this point. Many times emotional experiences, even long passed, return with full emotional force at this time. Listen to these feelings, they may be offering you the opportunity to deal with issues you've kept at bay for a very long time.

Bang Bang... Maxwell's Silver Hammer

Another common effect of imbalanced hormone levels is the "menstrual migraine" that can occur during perimenopause. These headaches usually come before your period when both estrogen and progesterone levels are at their lowest point in your cycle. Such headaches can range from relatively mild, but very persistent, pain, to blinding, mind-numbing - often localized - agony that halts all ability to think and act for the duration of the pain. At their most severe, these headaches can leave you staring silently at the wall, while those around you wonder if you have suddenly been taken over by aliens, or a cult of mimes.

Herbs, acupuncture, and progesterone cream are all quite effective for treating these often debilitating symptoms. At the same time, it is important not to discount these experiences. A severe migraine can be an unmistakable warning sign - a bright flashing sign - saying "Bridge Out... Road Closed!" Often, the best treatment is to STOP. Lie down in a dark room, close your eyes, and rest until the pain passes.

If the pain is your husband tell him to take the dog for a walk... and call you in a month.

Not tonight honey... I've got a headache

Speaking of husbands (partners, lovers, a rose by any other name, etc.) and headaches, a number of perimenopausal symptoms have a clear impact on your sexual interactions. These changes can range from a simple drop in desire(low libido), to a complete turnoff to sex. At the same time, for some women it can lead to the exact opposite experience (your partner probably won't complain about that).

Vaginal dryness can make what was previously normal and pleasant intercourse unpleasant and even painful. Major drops in estrogen levels can make women who used to feel like Niagra Falls when they would even think about sex begin to feel more like the Gobi Desert. Sexual arousal can be slow to nonexistent. At its worst, the combination of reduced lubrication and the thinning of the tissue in the vaginal wall can lead to an increase in vaginal infections. A related collection of symptoms involves urinary tract issues like occasional incontinence and urinary tract infections. The reason for this is that like the vagina, the urethra is estrogen-dependent and as these levels drop in the body, urinary tract loses tone in the same was as the vaginal wall. It's important to discuss these symptoms with your doctor as they can become more serious and persistent with inattention. Kegel exercises can be of help with both vaginal and urinary tract issues and are simple to do.

As with other symptoms, listening to what your body is telling you goes a long way to addressing, and solving such sex related problems. Many women find that changing some of the ways they approach sex can solve many of these problems without any "pharmaceutical enhancement." As they say, the brain is the most important sexual organ, and conversation with your partner is a big first (second, third, fourth...) step to a full and satisfying sexual experience before, during and after menopause.

Could you PLEASE make up your mind!?

If it is indeed a "woman's prerogative" to change her mind, then the phrase applies to the physical symptoms of menopause as well... in spades.

As mentioned earlier, the term menopause specifically relates to a woman's last period. The problem with perimenopause, and its wide-ranging circus of symptoms, is that it's never really all that clear what's going on. This is especially true when it comes to your period.

Many women experience very heavy periods while others experience light, irregular, and intermittent periods that may stop for as many as several months at a time only to return by surprise just when you thought everything was under control.

If you can handle erratic periods accompanied by days and weeks of the various unpleasant feelings that seem to go along with them then the basic menopausal mantra that "this too shall pass" can be a great relief in and of itself. On the other hand, if the confusion and inconvenience of these ever-fluctuating symptoms is too much for you, it is time again to seek the advice of your doctor.

As if that weren't enough...

There is a whole laundry list of related perimenopausal symptoms that many women experience in various stages, and to varying degrees. Any one of them can leave you feeling like a shadow of your former self (or in severe cases, like the Creature from the Black Lagoon). Most of these are related to a fluctuating imbalance of hormones as the body attempts to cope with your system changing its metaphorical mind with the predictability and stability of Annie Hall.

Some of the more prominent symptoms include:

Breast swelling and tenderness - Even prior to the approach of menopause, many women have tender breasts just before their periods. During perimenopause this increases both in intensity and frequency. This tends to happen more often with "estrogen dominance," a hormonal imbalance in which there is a comparatively higher level of estrogen to progesterone. These symptoms can be mitigated with nutritional supplements and changes in diet as well as certain lifestyle changes like stopping caffeine.

Fibroids - Approximately 40 percent of perimenopausal women develop benign fibroid growths in the uterus. These are almost universally benign (less than one-tenth of one percent of fibroids are malignant). They are stimulated by estrogen and while most remain relatively small, they can in fact grow as big as a grapefruit. If you don't mind looking a little bit pregnant (or you consider moo moos to be a highly evolved fashion statement) and you're not experiencing pain you can generally count on fibroids to shrink as you move closer to menopause and treat them like Little Bo Peep's sheep.

There are a number of surgical and non-surgical treatments for fibroids, so if you do experience pain, extremely heavy bleeding (some fibroids cause exceptionally heavy periods) you should speak with your doctor about these alternatives.

Many women take the manifestation of fibroids as an opportunity to learn something from the body. There is even a sense that your body is seeking to "give birth" during this time and paying attention to the thoughts and feelings that fibroids raise in your consciousness may provide an exceptionally fertile opportunity for personal growth. Once again, paying attention to what your whole body is telling you will go along way to helping you find your way through the menopausal maze.

Skin Problems - Bone Loss - Do you ever look in the mirror and wonder who the heck drew a London Tube map on your face while you were sleeping? Do you affectionately refer to the lines on your neck as the Tigres and Euphrates?

As estrogen, progesterone, and androgen levels in your body begin to fluctuate and drop, the collagen in your body drops as well. This means that the elasticity of our skin, as well as the strength of your bones, is being reduced. For your skin there are three recommendations...

Moisturize... Moisturize... Moisturize

Of course these are the same three things you've been told (and have probably been telling yourself) since you started your period all those years ago. The thing is, right now the advice is even more important than all that time before. There are also skin, diet, and both natural and pharmaceutical treatments that can help keep your skin supple and effectively reduce lines and wrinkles in the skin.

Bone loss, and the risk of osteoporosis is also a concern with dropping collagen levels and, unfortunately, many bone loss issues are the result of lifestyle decisions (undereating, anorexia, over-exercise, and lack of proper nutrition among them) that go back many years. That is not to say that the book has already been written and there's nothing more to do. You can maintain, and even build, the collagen matrix in your bones through a combination of proper diet, vitamin D (from good old sunshine) and by doing weight-bearing exercise. We're not saying you have to look like Arnold Schwarzenegger (even Arnold Schwarzenegger doesn't look like Arnold Schwarzenegger any more) or lie on the beach for weeks at a time (though, come to think of it, that would probably be a pretty good treatment!). What you need is balance. Once again, the best place to start is to listen to what your body is telling you it needs.

Mood Swings - Brain Freeze - Forgetfulness and fuzzy thinking, mood swings and unpredictable emotions are not the exclusive territory of women approaching menopause, though at times you may feel like you should win a prize for raising these experiences to the level of high art - surrealist art! As with everything on this list, hormone shifts play a big part in the way your brain is working (and not working) at this time. In addition, and especially with the chaos of wide-ranging emotional states, it's really very important to pay attention to why you are having the feelings you are having.

Your body is not just changing physically, but you are changing mentally, emotionally, and spiritually as well. Your fear, anger, and confusion are a part of this change and it's important to ask yourself not only what is causing this, but why. Like Ebeneezer Scrooge, your strange experiences and emotional visitations may indeed be caused by "a bit of underdone potato" or they may represent ways in which your inner wisdom is attempting to get your attention so that you can change your life.

Insomnia - If you weren't already having trouble sleeping you probably are after reading all of this.

The fact is, the causes of perimenopausal insomnia are about as diverse as the women who experience them. Many women would sleep just fine if they weren't inundated by night sweats waking them up believing they just ran a marathon in their dreams. Some women are simply kept awake by the fears and anxieties that arise in the night. Diet is another big factor, along with caffeine and alcohol consumption and, as if all that wasn't enough, your body's hormone shifts can also be playing havoc with your normal sleep patterns. You may find that right now you need more, or you need less, sleep. This will continue to change throughout perimenopause and most likely get better after menopause. In the meantime you can use some of the same techniques we have mentioned earlier to center yourself, rest and relax. Less tension almost always means more sleep.

Bring It On!

For all of these, and many more, symptoms there are many conventional and non-conventional treatments that can help "normalize" your system (and we will cover many of them in future publications). At the same time, its important to remember that even when you feel like an alien baby is about to come exploding out of your chest and everyone is staring at you like the men in little white coats have already been called, all of these symptoms are, in fact, totally "normal."

As you move through this stage you can take heart in the fact that these often debilitating symptoms are, by definition, temporary. Things will indeed get better.

You aren't dying... You are being re-born!