Bloating, irritability, sleeplessness, food cravings, hot flashes, depression and more are common symptoms of PMS and menopause, experienced by many, many women in our reproductive years. You’d be hard pressed to find someone - male or female - who says there is no connection between a woman’s cycling hormones and her physical and emotional health
A woman may spend the majority of her life riding the waves of hormones – from PMS in her teens to the whirlwind of menopause in her 50’s. Yet our experts agree that the impact of hormones on mood is very individual – running the gamut from negligible to dramatic. And the good news? There is help for those who need it.
The monthly cycling of hormones that prepares a woman’s body for pregnancy doesn’t just impact the ovaries and uterus. Ask any women with cravings, fluid retention and a sudden lack of patience with the most minor irritation. Judith Mikacich, MD, an OB/GYN with Sutter Independent Physicians in Sacramento, has a special interest in reproductive mood disorders. She notes that it may be a relief for a teen girl to learn that her sudden moodiness can have its roots in her menstrual cycle. “If a girl hasn’t experienced it before, the changes in mood can be frightening. It’s sometimes helpful to know that hormones can be the cause – and that the mood will change.”
Dr. Mikacich notes that there is garden-variety premenstrual syndrome (PMS) experienced by many women whose bodies and moods change during the month. Other women may suffer from a more serious condition called premenstrual dysphoric disorder (PMDD.) Women with PMDD have disabling mood swings that impact their ability to function, in work or relationships.
To help with a diagnosis, she has patients complete a mood diary that charts their experience during at least two menstrual cycles. This helps to pinpoint if mood and other symptoms are truly hormonally related. If so, they peak in the days just before a period, and ease as the period begins.
Treatment can range from lifestyle changes to medication. “For some women, just knowing what to expect can help them cope, says Dr. Mikacich. “They can take extra care during this time to eat well, exercise more, and be aware that their mood may be exaggerated.”
For others whose life and relationships are severely impacted, medications can help. Some women do well with anti-anxiety and anti-depression medications like SSRIs, which can be taken just during the second half of the menstrual cycle, or all month, if warranted. For women with PMDD (not simple PMS), a birth control pill called YAZ can also really help with the severe mood swings.
Even if a woman has coped well with her monthly cycle or breezed right through without a single complaint, entering menopause can bring new challenges. Before a women’s hormones decline and fade, they often fluctuate wildly. This years-long phase is referred to as “perimenopause” and the bad news is that it can begin in a woman’s early and mid-40s and extend for almost a decade.
Dr. Risa Kagan, a Gynecologist with Sutter East Bay Medical Foundation, has worked and has done research in the field of menopause for much of her career. Dr. Kagan is on the Board of Trustees of The North American Menopause Society (NAMS) which has a helpful website for patients and professionals, at www.menopause.orgOpens new window, which provides the latest information on this stage of life.
“I work with what I call my ‘hormonally sensitive women,’” notes Dr. Kagan. “Some women are simply more influenced by the estrogen and progesterone in their bodies. We don’t understand why some are more sensitive, but it’s clear that they are.” That sensitivity impacts the body in many ways, but also influences the neurotransmitters in the brain. “Mood changes are not ‘all in the woman’s head’or imaginary” says Dr. Kagan. “It is a true physiological change in the brain brought on by hormonal shifts.”
How is perimenopause different from PMS? “A woman may have had cyclical PMS, with uncomfortable symptoms for a week or two, and then relief until the next cycle. When perimenopause hits, the spells of relief may disappear,” says Dr. Kagan. These changes can happen even before a woman’s actual periods begin to change. PMS symptoms may be exaggerated – the bloating, breast tenderness, difficulty in sleeping, and mood swings may become more severe. In addition, the changes in estrogen and progesterone can bring one of the hallmarks of menopause: hot flashes.
“Menopause is only defined by looking backward,” says Dr. Kagan. “Once a woman’s periods have stopped for a year, she is defined as completing menopause. However, the rough part of menopause occurs before the periods stop, during the time hormones are changing.”
Dr. Kagan also notes that not all women suffer through menopause. For many, this stage of life brings great freedom, as kids are grown, careers are in full swing and maturity helps women cope with many issues. But the aging process does bring its own physical challenges and menopausal women should be aware of the options they have. See our companion article on The Latest Thoughts about Hormone Therapy.
The good news about menopause symptoms is the variety of treatment choices. Some women will choose to face menopausal symptoms without medical intervention, using exercise, diet and their own coping skills to get by. Knowing that this common experience will come to an end can be comforting.
Other may choose medications to ease them through the roughest waters. Dr. Kagan notes that low-dose birth control pills can be a great option for women entering menopause. “Using birth control pills can override the body’s fluctuating hormones, providing a steady dose of female hormones throughout the perimenopausal years,” she says. Birth control pills will also smooth out the heavy periods that some women experience as the body shuts off its own production of hormones – and will provide contraception, which is still needed up to the cessation of all periods. As with any medication, however, the woman should consult with her doctor to see if the hormones in birth control pills are right for her. Smokers, and those with a tendency toward blood clots, are not candidates for birth control pills.
For other women, low-dose hormone therapy may be started during perimenopause to smooth out the worst of the symptoms. Dr. Mikacich notes that the best recommendation is to take the smallest effective dose for the shortest possible time to reach your treatment goals. See our companion article on The Latest Thoughts about Hormone Therapy.
Dr. Kagan notes that women who are already taking medications for mood disorders, such as bipolar disease, depression or anxiety, may need to be alert as they enter menopause. “The hormone shifts of menopause can require an adjustment of medication,” she notes. “A dose that has worked well for years may no longer be helping. Be alert.”
Sometimes the common symptoms of menopause – problems sleeping, weight gain, thinning hair or even hot flashes – can come from other causes. Marcia Peck, MD, an Endocrinologist with Sutter East Bay Medical Foundation, notes that the thyroid hormone can also cause a multitude of symptoms. Both elevated thyroid hormones (hyperthyroidism) and low thyroid function (hypothyroidism) can have quite noticeable effects. As with all physical or emotional changes, a visit to your health care provider can provide the right diagnosis for you and your body.