Feeling burnt out? Why you could be going through the perimenopause
Hormonal changes start years before the menopause arrives — yet many women aren’t familiar with the perimenopause and its telltale symptoms, writes Katie Byrne
Six months after she gave birth to her second child, fitness entrepreneur Orla Hopkins began to feel out of sorts. She was chronically tired, irritable and weepy - and she couldn't understand why.
"Initially, I just accepted it," she explains. "I had a newborn baby and I wasn't getting enough sleep. But then it got to the point that I was feeling overwhelmed by the smallest incident. I'd kind of well up - and that just wasn't me."
The mum-of-two eventually went to her GP who, after reviewing her symptoms, suggested that she was suffering from post-natal depression. But Orla (38) wasn't convinced.
"Obviously, if I had continued going the way I was going then, I probably would have hit post-natal depression," she says. "But I didn't feel I was at that stage."
She decided to get a second opinion and this time the doctor had a different viewpoint.
"She said, 'I don't think you're suffering from post-natal depression. I think you're lacking in nutrients'. She said she knew even by looking at my skin because it was dry and washed-out looking," adds Orla.
The doctor asked about her diet. Working in the fitness industry, Orla had always prided herself on eating well. However, when she took the time to write down her daily intake, she realised that the doctor might have had a point.
"I was literally surviving on coffee because I didn't have the time to eat. I didn't have time to stop and look after myself," she says. "I'm very lucky - my husband prepares a lot of our food and he prepares the boys' food. But I just wasn't taking that moment to sit down and eat. I was having one meal a day along with coffee and energy drinks. And that just wasn't me."
The doctor ordered blood tests which later revealed a Vitamin B deficiency. In the meantime, she recommended a supplement designed to give extra nutritional support to perimenopausal and menopausal women.
Orla hadn't considered the possibility of perimenopause - the transitional period before menopause - but the more she researched, the more her symptoms began to make sense. And the longer she took the supplement, the better she felt.
"Looking back, I was getting very irregular, heavy periods; I was sweating at night-time and I was having these moments of anxiety," she says.
"When I said it to other women, they said it was quite normal. The attitude was, 'You're over 35. You've had two children. This is life now'. But I now know that's not the case. As women, we can become aware of what's going on in our bodies, and we can do things to deal with it."
The perimenopause varies greatly from one woman to the next, although it usually starts in the mid-40s and lasts for three to four years. An unpredictable menstrual cycle is one of the earliest indicators. Levels of follicle stimulating hormone (FSH) rise as the body struggles to mature eggs from a diminished pool.
This in turn stimulates breast receptors and womb receptors, leading to breast pain and heavier, longer periods. In other cases, periods can become lighter and less frequent.
In the later stages of perimenopause, the decline of progesterone can lead to changes in sleep and mood. Women may notice they can't cope in stressful situations and become flustered more easily, or they may wake up during the night and have trouble getting back to sleep.
Dwindling oestrogen levels brings its own set of problems, including increased sweat production (especially at night-time), itchy skin and vaginal dryness. The decline of oestrogen also leads to increased fat mass and decreased bone mass density and muscle mass.
"The women I see with perimenopause are absolutely exhausted," says endocrinologist Dr Mary Ryan.
"By the time they come to me, they're pretty shattered because they've gone to their GP first. They have body aches and pains. They're bloated and not sleeping. They tell me that their energy levels are 2/10.
"They can have poor memory - and they're often worried that they have dementia. And the exhaustion is the other thing - they all think they are depressed and they're not.
"Irritable Bowel Syndrome is part of it too," she adds. "Everyone forgets that the bowel is a muscle, so if the hormones are down, you're going to get bloating, wind, etc."
The perimenopause is inevitable, continues Dr Ryan, but the symptoms tend to be more severe among women who push themselves too hard.
In rarer cases, women who overextend themselves can experience an earlier perimenopause when stress-related burnout triggers autoimmune disease, which in turn leads to secondary ovarian failure.
"Women tend to have an awful habit of keeping going when they are tired and that exacerbates the fatigue," she explains. "And of course, the more tired you are, the more adrenaline you release and that exacerbates the flushing and the sweating."
Dr Ryan always prescribes lifestyle changes (see panel) to promote hormone harmony.
"I don't want to give medication unless it's absolutely necessary," she says. The endocrinologist also advises women to explore why they might be feeling overburdened. "The most successful women tend to have low self-esteem," she says. "These women are running the whole time. And they don't have the self-worth or self-respect to ask for help from their partners or even from their children.
"Men are much better at taking rest when they are tired - that's how we rear boys. And I'm seeing it at the coal face. I have women coming into me with infertility, burnout and hormone imbalance, and all of it is related to the fact that they have low self-esteem because of the way we are rearing them."
Dr Ryan tells her clients they need to learn to say no, and to remember that lifestyle changes can make a world of difference. In fact, good nutrition alone can help delay the onset of perimenopause by a few years.
"Because us professional women are having our children later, it gives us an opportunity," she says. "It's lovely to think that we're pushing perimenopause and menopause on a bit."
As for Orla, she's back to her old self. "So many women just put up with hormonal symptoms," she says. "So it's time we got the message out there that hormonal change happens 100% - but we can do something about it."
Orla Hopkins is an ambassador for Cleanmarine. Visit cleanmarinekrill.co.uk or cleanmarine.ie
The main female hormone produced by the ovaries from around day 5-7 of the monthly cycle. Oestrogen peaks at day 14 when it initiates ovulation and then gently falls throughout the second half of the cycle. Eventually this depletion triggers the start of a period.
Produced after ovulation and helps the body support pregnancy. This nurturing hormone has a 'calming' effect and helps keep the stimulating effects of oestrogen in check. It helps calm the mind, mood and nervous system.
Associated with male health, it's natural for women to produce small quantities of testosterone too. Benefits include healthy sex drive, lean muscle mass, body hair, ambition and focus, plus energy and healthy metabolism.
Follicle stimulating hormone (FSH) is produced by the pituitary gland, helps promote puberty and kickstarts the monthly female hormone cycle. It stimulates the growth of ovarian follicles each month so that a healthy egg can be released at ovulation time.
How to naturally promote hormone harmony
1. Serotonin is the hormone responsible for happy feelings. Oestrogen makes serotonin more effective, so when oestrogen drops below the base-line needed to maintain adequate 'active' serotonin, the emotions, mind, co-ordination and memory can all be affected. Exercise, a healthy diet and mindfulness all help with mood and serotonin balance. Make sure your diet contains adequate Biotin, Vitamins B1, B6 and B12, which all contribute to normal psychological function.
2. Nature cleverly provides us with many solutions for improving health and vitality at all life stages - and the perimenopause is no exception! Many plants contain natural compounds called phyto-oestrogens, which have a similar structure to the oestrogen that the body produces. They can be found in soy sauce (tamari), fresh miso and soya yoghurt.
3. Don't let crashing energy levels and random days of fatigue steel your zest for life. It's good to know that these 'crash' days are simply a reflection of your female hormones dropping below the threshold that is required to keep your energy, metabolism and mood buoyant. The key is to use strategies that help keep your female hormones from dipping below this threshold. Cutting back on caffeine, sugar, refined carbs and alcohol can help smooth over energy highs and lows.
4. Be kind to yourself, take time out to rest and rejuvenate. Pushing yourself on crash days is counterproductive. Your body is struggling to switch off a hormone cycle it's been pre-programmed to run for the last two-three decades. It's hardly surprising there will be days when you need to take time out.
5. Bouts of worry, anxiety and insomnia can leave you feeling overwhelmed, tired and wired. With a strung-out nervous system, it's hard to wind-down. Avoiding stimulants such as caffeine and sugar helps. You may feel like a glass of wine at the end of the day takes the edge off, but alcohol is a mood suppressant, so it's best to avoid using it to unwind.
Tips Extracted from The Essential Guide To Female Hormones by Cleanmarine