Hey all,

LadyButterfly invited me to share my experiences so far with perimenopause. I feel like peri still isn’t talked about enough and sharing this kind of info might be helpful to others, so I’m happy to share! Quick disclaimer that this is just my experience and YMMV.

The Beginning

I had my tubes tied in my mid-twenties and hadn’t been on any kind of hormonal birth control since then.

In my late thirties, my periods started to vary from their usual predictable 29 day cycle, with some cycles being really short (22 days) and some pretty long (41 days). At the same time, my PMS, anxiety, and physical symptoms both the week before and the week of my period got much more severe. Normal irritability became rage, normal anxiety became crippling, normal cramps and back pain became much stronger, and my periods were now causing some pretty bad dizziness/lightheadedness. Roughly two weeks out of four, I was miserable and it was a real struggle to function. I was also waking up randomly coated in sweat at night - like soaking through my shirt, puddles of it under my breasts, despite keeping our bedroom at 64 degrees at night. My standard bloodwork was fine, so it wasn’t thyroid, anemia, etc. I saw a gynecologist (a man in his early sixties) and asked him if this could be the beginning of perimenopause. He said I was way too young for that, diagnosed me with Pre-Menstrual Dysphoric Disorder (PMDD), which is basically PMS on steroids, and put me on generic Yaz. He told me to take it continuously (skipping the placebo pills) to avoid having my period, and thus avoid those symptoms. It did help for a few years and it was fucking amazing not having a period. But it didn’t solve the anxiety, which just got steadily worse. I was also noticing problems with memory and was having a really hard time concentrating and thinking. The anxiety and cognitive problems got so bad that I retired from working, thinking maybe I was just burnt out.

The Tipping Point

About a year ago, I noticed a bunch of worsening symptoms that I couldn’t ignore. I was having night sweats again, plus insomnia. My anxiety was through the roof at almost all times, and I felt these sudden spikes of rage over things that should’ve been minor frustrations. I was sure this was related to peri, so I saw a different gynecologist (a woman in her early thirties) in January of this year and asked again if this could be perimenopause. She said it probably was, but at my age (43) there was nothing she could do for me - her standard approach would be to put me on birth control, which I already was on. The attitude was very much “yep, this sucks, but you’re just gonna have to deal with it.”

Well I couldn’t deal with it, and honestly I refused to take that as a final answer. After reading a lot of reddit threads about peri I decided to find a GYN who specialized in perimenopause and was female, and I specifically looked for one who was old enough to have been through it herself because I wanted someone who would have the compassion that comes from personal experience.

I was lucky to find someone who fit the bill, but I couldn’t see her until June of this year. In the meantime, my symptoms had gotten much more severe. I had extreme fatigue every day - most days I ended up needing a nap because I was just so exhausted. My brain fog had gotten so bad that I would lose track of what I was saying mid-sentence, I couldn’t reliably do simple arithmetic in my head anymore, and other things that made me feel like I was really losing my grip. For example, one time I showed up a full day early for a dentist appointment despite confirming the correct day and time were on my calendar. Or another time I ran the microwave without putting food in, staring at it the whole time without realizing it was empty. And my irritable bowel syndrome, which had always been mild and pretty manageable, was in overdrive. Sorry if this is too graphic but I was having liquid diarrhea every single day and I couldn’t get it under control.

Things Start Getting Better

In the spring of this year I ended up seeing a GI, who told me that my IBS worsening was a classic symptom of perimenopause. Ladies I was shooketh. Luckily the GI was a woman in her late forties who had already been through this and she got me sorted out with meds and a low-FODMAP diet. She also told me to see a GYN and ask for bioidentical estrogen.

Side note: at this point, anything new that happens to me I’m googling along with the term ‘perimenopause’ because you never know.

First Few Months on HRT

So in June of this year I saw the GYN for my first visit. She asked about my symptoms, and reassured me that this was all normal, and that HRT should be able to help alleviate a good amount of it. She takes a three-step approach: 1) start progesterone, 2) after 3 months, adjust progesterone as needed and add estrogen, 3) after 3 more months, adjust progesterone and estrogen as needed and add testosterone if needed. I had to stop taking birth control in order to start HRT. She also got a full blood panel plus tested for some additional things like testosterone and sex hormone binding globulin.

In June I started oral progesterone at 100mg nightly, but increased to 200mg pretty quickly since 100mg was ineffective. Since then I’ve noticed about a 70% improvement in brain fog which is HUGE! My anxiety is more mild in general, and the night sweats are pretty much eliminated. I do have sore nipples - they feel like bruises! - which is apparently pretty common with progesterone.

Since I stopped taking birth control in June, I’ve had one period, and it was awful. Heavier bleeding (I filled a cup in 8 hours whereas I used to be able to go 12), way more intense anxiety, and it left me feeling extremely physically weak - my workouts were so much harder.

I’ve also started shedding some hair, which is really upsetting. My temples have gotten a little thin and I’m considering trying minoxidil to reverse it. The hair loss is from stopping the birth control, not from starting HRT - apparently Yaz has a version of progesterone that helps prevent hair loss.

A couple of weeks ago was my follow-up appointment. Since the insomnia was still pretty severe on 200mg progesterone, she increased me to 300mg nightly. This seems to be helping a lot with sleep quality and duration, but hasn’t made a big impact on daytime fatigue. She also prescribed me the estradiol patch at 0.025mg to start with. I change it every 3.5 days and it’s tinier than I expected - about the size of the nail on my pointer finger. (In the early 2000s I was on Ortho Evra and that patch was huge in comparison!) I think it’s too soon to notice any difference on the estrogen patch but I’m hopeful it’ll help.

Final Thoughts

Sorry that this is an actual novel guys, but I hope it’s helpful. Everyone’s experience with peri is different - when it begins, which symptoms you have and how severe they are, and how easy or difficult it is to get a damn doctor to pay attention and offer you the help that you deserve. We do not need to suffer in silence like a lot of our mothers did. My own mother had never even heard of perimenopause (and so of course she doesn’t think it’s real, insert all my eyerolls here). I think it’s so important that we talk about all stages of menopause, that we make sure women know what to expect during this time of life, and that we offer those in the trenches our compassion and support. I’m so proud of all the late Gen X / early Millennial women who said “fuck that shit, I deserve better!” Because we absolutely do.

Please let me know if you have any questions, I’m happy to answer them!

PS - ladies, keep an eye on your LDLs! Estrogen helps the liver metabolize cholesterol, and as our estrogen production decreases our LDL and triglyceride levels tend to rise. Cardiovascular disease is the top killer of postmenopausal women!