By Allison Koch, CNM

Worsening PMS, and all the suffering associated with it, is your early warning system that something big is happening to you. Your hormones are changing. This is usually the first symptom that women experience in perimenopause, even though they are still having regular menstrual cycles. Progesterone, the hormone that is in dynamic opposition to estrogen your body, has been gradually decreasing since you were about 30. In a normal cycle, the PMS symptoms caused by estrogen – edginess, impatience, headaches, food cravings – are balanced by the surge of progesterone that occurs when an egg is released. In our thirties, we begin to have the occasional anovulatory cycle. The ovaries pour out more and more follicle-stimulating hormone, attempting to get an egg released. When no egg is released, there will be no corresponding progesterone surge. No progesterone surge, no “softening” effect to balance out the edginess of all that estrogen which helped mature the follicle to release the egg. After a number of cycles without the progesterone surge, estrogen begins to dominate. The result is an increase in the estrogen-driven symptoms of PMS. Most women start feeling better once their period starts. In the days leading up to it, though, they can feel a range of heightened emotions from anxiety to anger, even rage.

Estrogen has the effect on the brain of enhancing alertness/awareness and making us more sensitive to stimuli. But, estrogen is also involved in creating serotonin and serotonin receptors in the brain. But despite research, it is not yet understood why many women experience improvement in their mood after menopause. Perhaps the stabilizing of the hormonal rhythms of the perimenopausal years? Perhaps some other mechanism is at work? In the meantime…

What can you do about it? Manage your stress. Exercise and physical activities that release endorphins are helpful. Your grandmother’s advice: get plenty of sleep and drink lots of water- that’s true. Make sure you’re eating regularly and well – if your blood sugar is stable, your insulin will be more stable, and avoiding those peaks and valleys of blood sugar will help stabilize mood. Avoid skipping meals and eat less simple sugars and carbs. One exception to that advice is dark chocolate, which is known to affect serotonin levels in the brain and lead to a feeling of well-being and even joy (for some of us!)

There are several herbs (Lemon Balm, Passionflower, St Johns Wort, and Kava kava are some examples) and homeopathic remedies (Sepia, Pulsatilla, Ignatia) that can help with depression and anxiety. Some women may find the most relief from prescription antidepressants.

Many women respond well to Acupuncture treatments as well as Chinese Medicine approaches to healing, as they rebalance your particular hormonal energy system. Ayurveda is another ancient system of health that has much to offer us during menopause and times of transition or change.

We are all women, and some experiences are universal. However, we are all different, too, and an individualized approach is what offers the best outcomes. That is what we want for you when you seek your care with us at WBWC. We understand that you are uniquely YOU and we can help you sift through all the options to find works best for YOU.

Your Life. Your Health. Our Commitment.