Random thoughts about perimenopause
from the mind of a pelvic floor pt
I’ve been thinking quite a bit about perimenoapuse lately. As a pelvic floor PT, I work with women across the entire spectrum of womanhood. I’ve worked with young girls with chronic constipation and bedwetting issues and women in their mid to late 80s, trying to avoid residency in a nursing home. Most of the women I worked with were postpartum. From abdominal separation to pain during intimacy, I’ve seen all the conditions. Not so ironically, most of the postpartum women I worked with were also perimenopausal. They just didn’t know it.
I suspected this and struggled with the idea, as nobody spoke about this. Perimenopause wasn’t even a trendy hashtag yet. Menopause was hardly ever discussed, and the women who came to me with very obvious signs of perimenopause were often dismissed by their doctors, leaving them to feel hopeless and broken. I might refer them back to their GYN to discuss hormonal therapy, only to learn they had already seen their GYN. It was as if they didn’t know what to do with them. And then the millennial GYNs started speaking up on social media.
My hunch was indeed correct. Western doctors didn’t know what to do with menopausal women. It was a stage in life ignored by medical professionals. No shade at GYNs, but when women stopped having babies and transitioned towards menopause, they also transitioned out of those doctors’ care. It took a generation of women doctors, some of them GYNs themselves, experiencing symptoms and frustration, to finally seek the knowledge on how to actually care for their patients, each other, and themselves. This is when perimenopause became trendy.
I’ve seen millennials create funny, entertaining, and real content highlighting the reality of perimenopause (like “we do not care club, #WDNC). It’s normalized the conversation, and I am very happy to see this. And as I have seen more and more women come for pelvic floor PT for perimenopausal symptoms, I’ve also done more research to best help these women. And as time would have it, as my friends and I entered the window of perimenopause in our early 40’s, we’ve all benefited from my gained knowledge and expertise.
And so, as the deep thinker, researcher, and wellness enthusiast that I am, I’ve gathered a few unfiltered, random thoughts about perimenopause I am happy to share with you. What I share is adapted from a video series I shared on YouTube and Instagram called “Thoughts from a pelvic floor PT.”
A friend shared that her mom stopped having her period at 40-years-old. That’s a whole 10 years before the average woman. For some context around this, perimenopause can last somewhere between 7 and 14 yrs. That means that at 30 years old, or worse in her 20’s, where she was barely a grown woman, she was already having hot flashes, phantom bug crawling on your body type sensations, and shrinking of her lady lips. In her 20’s and 30’s! And still, she is within the what’s considered normal range for reaching menopause.
Everybody talks about the decrease in estrogen during perimenopause but I’m glad to see progesterone is finally getting some of the spotlight, too. Turns out a decrease in progesterone can cause a buttload (pun intended) of symptoms from restlessness, anxiety, trouble falling asleep and staying asleep, headaches, irritability, dry vagina, hair and skin, itchy ears, and heavy periods. Isn’t it supposed to be going away?
I fully expect surprise or a brush off when I tell women that stress management is going to be a major part of our work together. Listen, your body cannot focus on both stress and sex at the same time. And you would know because you’ve likely never been turned on and pissed the hell off at the same time…or maybe you have. Listen, no jugelment. The body has to choose between reproduction and stress. And if you’re chronically stressed, baby, you’re already choosing! This is why I’m so big on a mindfulness or meditation practice to build your resilience to stress and gracefully crash out when it’s appropriate. If you’re in perimenopause or identify as a woman living on Earth, I’m going to need you to listen. You know, they say women who are conditioned to hold back their emotions and to be the good girl are more likely to develop autoimmune disorders. Don’t hold back ma’am. Let Chad know how you really feel and then do some deep breathing after. Woo Sah!
Metabolic disorders like insulin sensitivity or resistance are severely misdiagnosed in women. PCOS is now PMOS to reflect that it’s a metabolic condition and not an ovarian problem. Ovary is still in the name but maybe they’ll address that at some point. We have to accept the small wins. Anyway, did you know that a drop in estrogen can cause a drop in blood sugar as well? This might explain the brain fog, irritability and afternoon crash after lunch. And here I am thinking I have the -itis. Anywho, try adding protein to see if it helps with the after lunch crashes.
As we age, it’s easy to lose bone density as we become less active and our cells aren’t as efficient at making bone tissue. This is especially true for women as a drop in estrogen significantly increases our risk of developing osteopenia and osteoporosis. This is why strength training is recommended. Don’t feel like you have to go hard or go home every day! Please, go hard for 2-3 days and then go home for the rest of the week, and walk or do Pilates, yoga or qi gong, whatever floats your boat. Balance is key, girlfriend! While you’re at it, take some creatine as it does your muscles, bones, and brain some good too.
Your body practiced for menopause during the postpartum period and that most “eventful” week leading up to your period. Your symptoms then are just the preview. So when you laughed and peed a little bit, but it went away once your hormones settled back in, that can come back and stay for breakfast, lunch, and dinner. Best to get it under control now. And before you even ask, pelvic floor exercises, which we will not call kegel exercises because they were named after a man, even though not 1 but 2 women were teaching these exercises long before he published them, are just part of the solution. Most of you need to learn coordination, relaxation, and integration exercises. I mean, when was the first or last time someone actually evaluated your ability to squeeze, lift, relax, and lengthen those muscles?
If you didn’t have a pill box before, get one and bedazzle it because supplements to help during perimenopause number in the few. There’s magnesium glycinate for sleep and muscle relaxation, citrate for constipation, vitamins D and K for bone and immune health, vitamins c for antioxidants, omega 3’s for brain health and inflammation, ashwaghanda and b-complex for nervous system regulation and energy, maca for hormonal regulation, creatine for muscle, bone, and brain health, and slippery elm for your goody good, you know what I’m talking about. Listen, I am not your doctor so make sure to check with yours before trying anything new. This is the wild, wild internet!
Perimenopause is more than your ability to make babies. Sex hormones affect the entire body, all the systems. This is especially true for your nervous system. I know you feel crazy when little things that didn’t bother you are sending you in a rage now. One of my favorite ways to manage stress is with breathing. An easy technique I like to teach is to breathe deep but quiet, through your nose and with an exhale longer than the inhale from your mouth. Go ahead and try it out right now…So next time that boy chews with his mouth open, try that breath before you wake up the whole neighborhood. Ok?
Nobody is handed more antidepressants and antianxiety medications more than a woman in perimenopause. It’s not depression or anxiety, it’s perimenopause. And it’s a normal biological thing. We are 1 of only a handful of animals on this planet, and I do mean a handful, and most of which are matriarchal, just saying that experience menopause. You know what might actually be helpful, because antidepressants don’t help most women, hormone replacement therapy. I know some of you don’t like the idea of hormones, but it beats feeling batshit crazy most of the time. And sometimes it helps to find other women who can relate.
There are about 1 billion (yeah that’s a big number) women navigating the perimenopausal space right now. That’s a lot of women in the age range of mid 30’s to 50’s. I highly recommend you gather some friends who are also on the peribus because perimenopause is more fun when we do it together.
Please do me a huge favor and share this article with your peri-bestie because this is one of those experiences when the more is actually merrier. Let’s normalize these discussions and normalize getting help when needed. We are no longer doing the “let’s just tough it out” mentality. I promise you that some of what you are experiencing can be improved or even eliminated altogether. If you’re not sure, ask your primary care or GYN. And if they can’t help or are they are not easily accessible, I’m literally a message or phone call away.
❤️ Dr. Kenael
P.S. If you are a member of the WDNC, please share what you are not caring about anymore.
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