Perimenopause – The Goal Posts Will Continue to Move: Go With It

​If there were ever anything to keep a woman on her toes, it will be perimenopause.

One thing is for sure when it comes to perimenopause and figuring out what works for you – the formula may periodically change, though the goal post never moves.

The goal post, or the “True North,” for most perimenopausal women, is to restore and sustain as high a quality of life as possible through this transition. A transition that lasts, on average, for 4 to 12 years. For most of us, that means remaining as functional as possible and with a sense of well-being that hearkens back to a feeling of normalcy, even as we navigate our “new normal.”

What we attempt and try during these oft-tumultuous years of symptoms is as varied as the millions of women gradually transitioning toward menopause themselves. As reported in Glamour magazine, 1.3 Million Women Enter Menopause Each Year, and at least 27 million women between the ages of 45-64 officially hit menopause annually. Plus, now Millennials – the generation that has gotten so much attention and analysis regarding youth trends – are no longer young whippersnappers, nor are younger members of the Generation X cohort (that’s me!). Many Millennial women are now in their mid-30s+, and are already in or about to hit their perimenopausal stride.

Each of these women has her own equation of what works for her symptoms. Yes, that means there could be millions of different approaches, methods and components involved in addressing those pesky perimenopausal symptoms.

I went through a lot to figure out what works for me. Once I finally landed on what seemed to be a magic formula, I felt golden. The sun was shining, the clouds had moved away, and I had a song in my heart! I felt like I had conducted a clinically proven process of self-discovery. My formula was repeatable; I’d tried it over the course of weeks and then months. And it worked well each and every time . . . for about eight months straight.

Until it didn’t.

The first alarm happened a couple of months ago when my breasts got so sore, they felt so sensitive, swollen and painful, it reminded me of post-partum engorgement. My boobs were so sore that it was difficult to get comfortable in bed or wear a bra, and even moving the wrong way disrupted me. I also found myself more alert than usual, making it harder to fall asleep.

I sought help from communities of strangers – strangers who in our times of perimenopausal challenge become more like confidants and trusted advisors, as so many of us lack real people in our real lives who are really equipped to empathize with us or offer reasonable guidance. On an HRT forum, I was met with multiple responses by women and clinicians who suggested that my estrogen was probably running high (“having a spike”), and that I needed to counteract it with a higher dose of progesterone. So that’s what I did. For about a week, I increased my progesterone by an additional 100mg nightly, and the problem soon subsided, and I was back to my trusted formula of what had been working for me for the previous eight consecutive months.

“Whew, dodged that bullet,” I thought.

Then, just recently, I hit another unforeseen hurdle.

I found myself awake at 4 a.m., feeling like I had slept all night. I tried to go back to sleep, but it proved to be an exercise in futility. I soon found myself thinking about all manner of things, especially my daughters and the random concerns I have about them. I am the mother of a high school senior who will soon be starting college and a high school freshman who, though nowhere near leaving the roost, still gives us enough parental angst to keep us on our toes. In the wee hours of the morning, the bed was no longer a sanctuary. So I arose, made some coffee, watched the news for half an hour, and then changed into my workout gear to get my morning exercise routine underway – much earlier than usual.

And so the day went.

That night, I found myself unable to switch off as I typically can. I found myself lying in bed awake, not thinking about anything in particular, not feeling concerned or on edge about anything at all. Just awake. I did not fall asleep until after 2 a.m., and I woke up by 7 a.m. Yes, I was kind of tired, but I got on with my day as usual – no harm, no foul.

The next night played out in much the same way – awake into the wee hours for no discernable reason at all, not worried or concerned about anything, not irritable or agitated either. Just up, wishing I were asleep instead, but comfortably lying in the darkness and silence.

But I knew this could be the beginning of a decline, a return to the old ways that landed me into the medical spiral that initiated me awareness of perimenopause itself. And I knew I had to take action. So, as I did before when my breasts got extremely sore, I decided to distance myself from my symptoms and my problem as much as possible, and to try to look at this objectively.

Here's what I knew: Nothing I was doing had changed. I was still on my combo of HRT and an ultra low maintenance dose of an antidepressant that had been prescribed off-label for sleep, mainly. My activities and lifestyle behaviors were the same – I wake up, make coffee, exercise for about an hour, work for a few hours, take an afternoon walk, work a bit more, then start planning dinner, cook and prepare for the evening. I may read, work on my blog or other interests, talk to some friends or family members, watch TV, read some more, take a shower and then go to bed.

Rinse. Repeat. This is the cadence of an average week day.

Nothing outside of myself had changed fundamentally either. There was no reason for me to feel more stressed, pressured or uptight about anything. By all indications, our lives are good.

But I knew something must be off, and whatever it was needed to be addressed, even if it wasn’t my “fault” and was totally out of my control.
So the next night, I brought out the bigger guns. I went up on my antidepressant dose, and even added a small dose of a prescription antihistamine to boot. I decided not to take any melatonin or magnesium (which I had been doing for months) because I wasn’t even sure those were helping me anyway. And guess what?

I slept fine and felt great in the morning.

However, I noticed I woke up in a wet nightshirt. So I had experienced a night sweat but slept through it. This was a signal to me that indicated a couple of things: 1) Just as I had experienced a hormonal switch-a-roo two months prior with the sore breasts, I was going through another one again, based on the night sweating; 2) Maybe my hormonal silliness is causing some funny business with my cortisol and serotonin levels, which antidepressants help to control and contain.

So here I am again, almost a year on HRT and about eight months into a formula that had worked beautifully until now.

I am not one to sit by passively and let a situation degrade or go off the rails without taking action. So I have scheduled an appointment with one member of my healthcare team to discuss options for now and the plan going forward. I also reached out to another member of my medical squad to report the issue and ask for input.

In my daily work, I help people with their careers. Doing so involves so much more than what is close at hand, like their resume, cover letters and LinkedIn profiles; it involves some make-it-plain conversations about concepts like getting comfortable with vulnerability and developing agility and adaptability. I give great guidance and advice that, honestly, has changed thousands of lives.

I now realize it’s time to apply the sample principles to myself.

In fact, perimenopause asks this of all of us. As our hormones shift, fluctuate and roller-coast, so will whatever works for us in dealing with the hot flashes, night sweats, migraine headaches, hormonal acne, body aches, sleep problems, sub-clinical depression and low-level anxiety (the most commonly reported symptoms among women).

I realized that I need to get more comfortable with the ambiguity and, frankly, the powerlessness I have in this situation. I know I am doing everything I can for the sake of my immediate and long-term health. I also know that I have researched extensively about perimenopause, medications, treatments and more, and I now possess a high degree of clinical knowledge.  

But there was something within myself that felt I had reached my personal Eureka, that I had found the panacea that would be my ally at least until the age of 50, over the next six years or so, until I am projected to reach official menopause. And knowing that I haven’t – that the goal posts have moved yet again – makes me kind of sad.

So as I mourn the loss of the assurance I thought I had, I am also working to embrace possibility. And finding solace and hope in the panoply of options available today for women like me.
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Perimenopause is the ultimate exercise in adaptation. No corporate master class on agility comes close. What helps us today may change every six months or every ear, but what will best serve us ultimately is a mindset that is fixed on nothing in particular, aside from the knowledge that, “This too shall pass,” and “God is in control.”

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