Have you noticed that EVERYTHING you are feeling seems to be blamed on perimenopause? Or is that just my algorithm? The frustrating truth is that for most women, their hormone “levels” do not accurately reflect the hormonal imbalance they may feel. While hormone level testing can give some insight, how you feel depends more on your body’s ability to utilize and regulate your ever-fluctuating hormonal symphony rather than treating a static hormone level.
The best way to “manage” the hormonal chaos is to look through a personalized lifestyle approach that can help your body modulate its hormones more effectively.
Let’s look at this hormonal chaos a step further assessing the typical hormonal stages in a woman’s life and recognizing where there may be opportunities to improve insight into hormones at each stage. Everybody’s journey is different. I’m writing this based on my experiences working with professional women and mothers (and as one, myself), recognizing it won’t apply to everyone.
Let’s start by looking at our hormones as far back as adolescence, the hormonal roller coaster admission ticket. Are there any other student athletes out there? Perhaps, like me, you had parents who, wonderful as they were, were terrified of discussing anything related to sexuality? Many young female athletes are training so hard, they drive suppressed or unpredictable periods, and so cultivate resentment of their cycle, as something that interferes with life, training, and competition. Others go on the pill or an IUD, to help control or even remove their periods, but never learn the insight the menstrual cycle can offer into one’s health, much less how to “go with the flow” rather than fight against it. So many learn just the bare minimum and spend most of their time praying they don’t get their period at a swim meet or competition. This can lead to a rocky foundation to kick off their hormonal future.
** Opportunity: We need to support parents and girls to understand and even respect the wisdom of the menstrual cycle and the insights it can offer as a guide to our body’s needs and health.
** Lifestyle Tip: The first half of the cycle is estrogen dominant, and the second half (post ovulation) is progesterone dominant, with overall higher hormone levels. Many women struggle with cramping, pain, worse performance, headaches, and/or PMS as hormone/progesterone levels rise. A supportive lifestyle approach may be to prioritize sleep, self-care, magnesium and anti-inflammatory foods in the week preceding the period.
Next Stage: Upper Education (college, grad school/med school/residency and professional entry)
These women, usually in their 20s, a time when our hormones are supposed to finally be “normal” or even optimal, the professional woman is generally in a state of pervasive sleep deprivation and high stress. Could this state support “normal” hormonal balance? Consider cortisol “the stress hormone” as the uber hormone regulator. In states of persistent or extreme high stress, cortisol down-regulates (reduces) reproductive capability, making “hormone balance” often unachievable. So many professional women delay or forego fertility and continue to deny or suppress their cycles in efforts to keep up with (and maybe surpass) their male counterparts. If they decide to pursue fertility or cycle awareness, many are stunned to discover the intricacies of their own bodies.
**Opportunity: Support women in school and/or climbing the career ladder to recognize the negative impact that high stress and insufficient sleep can have on health and hormone balance. Create a culture that nudges better self-care. Continue teaching them how to “go with the flow” and how to shift their lifestyle habits to nourish their body’s needs rather than further deplete it.
**Lifestyle Tip: Sleep deprivation reduces our cognitive capacity to learn and remember. If we create “bookends” on the day that support the circadian rhythm (such as, natural sunlight in the morning, and avoiding screens before an ideally regular (ish) bedtime, we can cultivate better sleep, more productivity, and better resilience.
Next stage: Reproduction (optional)
If fertility is a woman’s goal, and the professional woman adds “mother” to her CV, she adds another HUGE chunk of celebrated hormonal imbalance that is accompanied by sleep deprivation, possibly adding breast feeding/pumping to her work schedule, a second full-time job as mother, and a whole different type of stress- one that is often internalized and challenges her identity. That is, the inevitable perception of inadequacy a professional woman feels as a mother and in the workplace. I hope my experience of work-home imbalance was unique, but I have worked with enough women to know that it is pervasive. Women tend to internalize and feel alone in their stress. This perceived loneliness exacerbates the risk of physical and mental health conditions. The self-care of women tends to take a backseat to the needs of family and work. Yet, women statistically direct health habits, nutrition and medical care in the home. This divergence adds additional struggle to an already fragile state.
** Opportunity: We need to build community in the workplace for working mothers to recognize they are not alone in this journey. (There are massive additional opportunities to support better maternity and paternity leave, breastfeeding, and parenting support, needless to say).
** Lifestyle Tip: Creating workplace parenting groups or finding other support groups helps women feel a sense of belonging and more enjoyment in the working-mother journey.
Next Stage: Perimenopause and Menopause
Here we are. The kids are older. We finally have a routine, a firm grasp on our job and purpose, and maybe even thriving at work, and then. . . . PERIMENOPAUSE! Or is it new, weird palpitations, anxiety, fatigue, headaches, joint pain, thyroid symptoms, weight gain, sleeplessness, hot flashes, brain fog, you name it- it fits. In the UK, a recent survey said that 23% of women considered resigning due to perimenopausal symptoms. Mayo researchers estimate $1.8 billion dollars lost every year related to menopause-related missed opportunities (sick days, unpaid leave, etc). Many of these women are in leadership roles, but unable to sustain the demands when they feel their bodies are leading a mutiny. Most women and clinicians were not educated in the symptoms of perimenopause and menopause, and certainly not equipped to effectively support this pivotal part of the workforce. Once the hormonal rollercoaster of perimenopause flattens out, post-menopause might just be the most “normal” (or certainly stable) that women’s hormones will ever be! We know that post- menopausal women are the most empathetic population in existence. They tend to have better life satisfaction, independence, mood, personal growth, and better relationships. If a woman leaves the workforce due to perimenopause symptoms (rather than a desired retirement), the world loses another leader.
**Opportunity: Continue the small, but growing awareness that EVERYONE (not just perimenopausal and menopausal women) needs to be educated, supported, and united with evidence-based information to help champion women through this often-difficult transition. There is hope! I’m getting more and more requests to empower workplaces with Lifestyle Medicine education around women’s health and supporting healthy hormones. Let’s continue to be this much needed change.
Lifestyle Tip: This is a great time to prioritize nutrition that helps you utilize estrogen more effectively by supporting your ESTROBOLOME (the subset of the microbiome that helps you modulate estrogen). Adding in ground flax, cruciferous veggies (like arugula, kale, broccoli sprouts), and minimally processed soy (like ½ cup of soybeans daily) along with minimizing processed foods, saturated fat sources (especially red and processed meats and whole fat dairy) can be a game changer to reduce perimenopausal symptoms AND chronic disease risk.
