​I recently had the privilege of being featured on Menopause Coach Kitty Anderson’s YouTube Channel, Create a Menopause Recovery in the video titled “Keisha Is a Black Woman Using HRT in the United States: Perimenopause Was Traumatic Without HRT!”

I responded to Kitty’s call for women of color to come forward and share their experiences of recovery from perimenopausal or menopausal symptoms, especially those who are using hormone replacement therapy (HRT). I actually encountered Kitty Anderson before; I enlisted her help to coach me through some continued challenges I was facing after I had started HRT months before. I even featured her on The Real Peri Meno blog in the post “Kitty Anderson: Menopause As a Social Justice Issue,”profiling her own journey as a menopausal woman who uses HRT herself and her experiences in becoming an expert on the topic.

My journey, from the process of realizing I was perimenopausal and not suffering from some other malady, and the maze I went through in navigating the medical system, is here on my blog on the post titled “Shocked By Perimenopause? I Was, Too.”

I wish more Black women (and women in general) would go public about their perimenopausal woes and the solutions that are working for them. While I am using HRT, I don’t expect ALL women to do so. But I do explore the reasons why Black women seem less likely to pursue HRT in “Why It Seems Like Black Women Don’t Use HRT.”  Using HRT is a highly personal decision, just like choosing to use any prescription medication is.

Please watch / listen to the interview in depth. Here are a few points I considered after the fact that I want to state for the record:

Choose the medical practitioner, healthcare professional or physician who works for and with you! Regardless of color, too. That healthcare advocate who opts to partner with you in your care may not look like you, sound like you or any in way be like you, but they may be exactly what you need at that moment – and as a permanent ally in your long-term care. The best doctors in this journey for me have been an older (60+) white woman and a younger white man. It was a Black gynecologist who really let me down, along with a slew of others.

Be prepared to pivot. No day in perimenopause is guaranteed to be the same. Your symptoms may be well controlled and absent one day, and then they might pipe up the next. That may not necessarily mean that you need to reinvent the wheel, but it does mean that a versatile mindset is more important now than perhaps it has ever been. As symptoms change during perimenopause, and as hormones choose to cause a commotion every now and again (even while on HRT), realize that dosages may change, you may need to add in new medications and you may need to drop things that no longer work for you.
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If you speak out about perimenopause, be prepared for . . . silence. When I went public about my perimenopause experience, I knew it was going to require being vulnerable. I didn’t know how people would react or what they would say. So far, in terms of my personal sphere, the response has largely been one of silence. No one I know personally is really asking any questions or sharing any of their experiences, but I know they are reading the material here, taking notes and considering options. I started this blog to help others, even as I continue to help myself in the background.

“Oh, I’m so sorry; you should’ve been born with testicles. It’s probably going to make you pretty bitchy, too.”

Can you imagine someone telling you this? Let alone, hearing it from a healthcare professional, a doctor?

Well, one woman didn’t have to imagine; it actually happened to her. This was what Jennifer, a Washington State-based YouTuber, and meditation and pilates instructor was told by a male gynecologist when she went to him for help with her perimenopause symptoms.

“This is lonely. You struggle. I’m still struggling. That was where my calling came from,” says the military wife and mother of four. “Why didn’t anyone tell me this was going to happen?”

Jennifer, like so many other women, struggled to understand what was happening to her body – and mind – as she progressed through her 40s, the era when the hormonal swings that eventually build up to menopause start to manifest. Now 49 years old, Jennifer recalls her first perimenopausal symptoms beginning around the age of 43 or 44.

“What is wrong with this picture? It’s not right that we have to struggle so much before we get some answers. We’ve come so far in this world, but we’re so far behind in some ways. This should be taught in sex ed, and we should have many options when we go through it,” she recounts with frustration.

One of Jennifer’s first wake-up calls was her poor sleep.

“Sleep was my first indicator. I woke up one day and said, ‘Shit, I haven’t slept great in four years. But I connected it to my children. I always had children in my bed. I had a baby at 40. I thought I wasn’t sleeping because I always had a baby in my bed,” she explains.

The next tell-tale sign were changes with her menstruation. What was once like clockwork began to feel like a broken watch.

“My cycle go wonky. One would be heavy, like from hell. And the next one would be light,” Jennifer says. “The cycles became very short, like 17 days or 19 days – that happened from ages 43-45.”

The cycles became not only unpredictable, but the bleeding was like a levee had been breached and toppled over. So profuse was the flow that it bound her to the house, zapped her of energy and landed her in the ER.

“All of a sudden they started getting really heavy, almost hemorrhaging. I was stuck in the house three or four months before I started figuring something out. I was anemic, tired, couldn’t get up. No sanitary product would work, not even Super Plus. I was literally homebound for weeks and weeks and weeks. I ended up in the hospital, and that at point, they gave me progesterone to help control the bleeding.”

This experience ignited a fire under Jennifer, prompting her to action. Little did she know it would be the beginning of a complex and convoluted journey with the medical system.

“That’s when the fun with the doctors began,” she says.

Her first doctor, a male primary care physician, said she was too young for it to be perimenopause, since she still had periods (yet women still menstruate throughout perimenopause). Then Jennifer remembers she started experiencing her third main symptom, an involuntary attitude shift that affected her relationships. She reported this to the doctor, too.

“Around this time, I also noticed the symptom of not liking my husband, and I felt something was going on. Normally, after my PMS passes, I like my husband again, but this time it was different. The doctor looked at me and said, ‘Well, you’re not in menopause because you’re still getting your period. I’m going to write you a prescription, and get you some Zoloft.’”

Studies show that about 25 percent of all American women in their 40s and 50s are on some sort of antidepressant. Not surprisingly, this uptick in antidepressant prescriptions at this stage of life coincides with the time women are beginning perimenopause and transitioning into full menopause. Jennifer felt intuitively that she wasn’t a textbook depression case and decided not to take the Zoloft. “I knew I wasn’t depressed, and I knew there was something to it.”

She continued to take progesterone to control the bleeding, but it didn’t work as well or for as long as she’d hoped. So another doctor – the fourth by this time – put her on birth control pills. Sometimes doctors prescribe birth pills in lieu of hormone replacement therapy (HRT) as a less expensive stop-gap, one that overrides natural hormones rather than augments them like HRT does. But those proved to be far from the optimal solution.

“Birth control made everything worse – I was more moody and irritable, though it did help with the bleeding and made my periods regular.”

After being on birth control pills for eight months, Jennifer starting feeling sick, with nausea that reminded her of the hyperemesis she endured during pregnancy. By now, she was offered an ablation, which would have presented a surgical remedy to stopping the bleeding, but she decided against that. And then Jennifer found a helpful OB/GYN who suggested the Mirena IUD, which she’s had inserted for about six months without any negative symptoms yet.

Soon after the IUD insertion, Jennifer wanted to address another common problem – her tanking libido. Her diminished sex drive was starting to cause marital friction, so she approached her primary care physician for some help, and she walked away with a prescription for Wellbutrin, an antidepressant now commonly prescribed off label for weight loss, smoking cessation and, yes, sex drive. Like many medications, antidepressants can be prescribed for all sorts of other reasons, including sleep, nerve pain, hot flashes and night sweats, anxiety and migraine headache relief, among others.

“I think Wellbutrin can be a life saver to get a woman back on track and help with the libido,” Jennifer says. “When I was on the birth control pills, I didn’t even want to be touched, by my husband or my children. I would literally be cringing. It was horribly upsetting. I knew I had to do this for my children. I have to be present.”

Still, Jennifer discontinued the Wellbutrin after about six months. She found the initial benefits to her sexual desire and mood declining as time went on, and she didn’t want to end up in a cycle of increasing the dose over and over again to maintain the same effect.

The journey for effective treatment and quality care continues for Jennifer, who plans to seek additional help for her symptoms, especially sex drive and feeling low at times.

“I still feel like we have to get to the root problem, which is imbalance of the hormones,” she says. “I may ask for testosterone supplementation. And I may pursue HRT.”

Though she’s still navigating the medical system and may end up trialing yet more options to treat her symptoms, that hasn’t extinguished the flame for progress in promoting understanding about perimenopause – a passion Jennifer now holds dear. She’s become quite the advocate – adding content that specifically addresses menopause to her YouTube audience of hundreds and educating her children about what this all means. In fact, her kids even help out with her YouTube video production.

“Let me tell you how educated my boys are. I am empowering and educating my boys,” she affirms. “They need to know, and as mothers, we should be teaching our sons and daughters that this is something that will come – just like we tell them puberty is coming.”
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Though some days are difficult, and she knows the road forward in her final destination to official menopause may be more years in the making, Jennifer finds moments of joy and humor in all this. For example, one day she overhead her 13-year-old son talking to his 8-year-old brother, saying, “Mom’s having a hard hormonal meno day. She’s going through puberty in reverse.”

Key Tips from Jennifer

Learn for yourself and advocate tirelessly.

“Our providers are not educated, and it’s not their fault. Unless they’re educated as a GYN or take steps to educate themselves, it’s not going to happen. Science hasn’t delved into it enough to figure it out for us.”

Find an outlet for self-care, emotional release and mental clarity.

“Meditation is my saving grace. I’m trying to really share with women that meditation can do wonders as well. To meditate, you don’t need to be spiritual or religious. It’s more about the breathing, the silence and being able to become still, and just focus on yourself – it is self-care. It’s your gift that you can do for yourself.”

Discover the right doctor or care team for you.

“I’ve been through six doctors. Find the doctor who is going to advocate for you, give you that support and help you find what you need. I do think it should be a woman and, more importantly, a woman who has gone through menopause. I am for you firing your doctor and finding one that works for you.”

Jennifer’s Perimenopause and Menopause Videos on her DivineThreeFold YouTube Channel
Symptoms of Menopause: Update on IF and ‘Are You Serious’? Vertigo
The 3 Most Important Tips to Help You Get through Menopause
Symptoms of Menopause – Diet and Exercise
Symptoms of Menopause – IUD for Perimenopause?
Pilates Strength and Stretch for Menopause Symptoms
Symptoms of Menopause: Can You Believe He Said That?
Meditation for Acceptance: For Help with Peri/Post/Menopause Symptoms
Menopause Weight Gain Full Body Workout  
Symptoms of Menopause: Why Is No One Talking About It?
 

If you are in midlife (typically between 35-50 years old), your melatonin production has already gone down substantially. By the time you’re in your 40s and beyond, your melatonin will never return to what it was in your younger days. Melatonin is associated with the circadian rhythm, that is, the sleep-wake cycle.

One study shows that the drop in melatonin production coincides with the onset of perimenopause, even if women are still having regular cycles and may be years from menopause. In “Decrease in melatonin precedes follicle-stimulating hormone increase during perimenopause,” researchers studied 77 healthy female volunteers, ages 30-75 years old. They found that, within the study group, those ages 30-39 had the highest levels of melatonin, but women in the next age bracket (40-44) excreted 41 percent less melatonin! Older women also experienced another sharp drop in melatonin production, going down by another 35 percent between ages 50-59.

This means that melatonin and follicle stimulating hormone, or FSH, have an inverse relationship as it pertains to the onset of perimenopause. Melatonin levels sink way before FSH levels (a measure commonly used to determine if a woman is in menopause) rise. High FSH levels are a sign of impending or completed menopause. That melatonin production declines before FSH climbs is yet another signal that a woman is in perimenopause. Since most doctors don’t test patients’ melatonin levels, there are some signs that a woman in midlife may be experiencing a reduction in natural melatonin, such as:

• Experiencing more difficulty getting to sleep
• Having nighttime awakenings
• Waking up too early

Not so coincidentally, these are the very same type of sleep problems perimenopausal women commonly experience. Sometimes these sleep disruptions occur in tandem with other perimenopausal symptoms like night sweats or anxiety, but often they exist in isolation. Sleep issues as a midlife perimenopausal woman, then, are not dependent on perspiring while asleep or having a mood disturbance, such as depression or anxiety.

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Nighttime melatonin levels by age, Source: Cultura Pierpaoli
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Multiple melatonin studies on perimenopausal and menopausal women show that it may be beneficial to supplement melatonin. In one study, subjects receiving melatonin at a nightly 3 mg dose reported sleeping and feeling better. Another study found that the time it took to go to sleep lessened in a group being treated with melatonin, and participants did not develop a tolerance to melatonin or experience a return of insomnia when melatonin administration was discontinued.

Overall, some researchers say that “short-term usage of melatonin is a rational therapeutic approach for the alleviation of insomnia or circadian phase disorders of peri- and post-menopausal women, as these periods of life are characterized by changes in sleep quality and circadian rhythms.”

What “short-term” usage means has not been clearly defined, as studies on melatonin have yet to define precise guardrails around its use. It is generally well tolerated and deemed safe. For those who take supplemental melatonin, experts suggest taking it between 8-10 p.m., as that helps it coincide with its natural peak in the body between 2-4 a.m. Also, doses up to 5 mg have been most studied, with general current guidance suggesting that doses over 5 mg are not necessarily more helpful.

Melatonin is available over the counter (OTC) in the U.S. in a variety of forms – gummies, liquid, capsules, caplets and extended-release versions. Though OTC medicines and supplements don’t require a prescription to purchase, since supplements and vitamins are not regulated like prescription drugs, it is advised to consider using a third-party source to evaluate the safety of supplements. ConsumerLabs is a paid site that performs research-based quality checks of various vitamins and supplements, often by brand.