PERIMENOPAUSE AND INSOMNIA

 

 

Imagine if you are a woman, early forties to late forties or so, and can’t remember the last time you had a good night’s sleep. Dr Steven R. Goldstein, a Perimenopause Specialist NYC has seen women come into his office with a range of symptoms that appear to have nothing to do with their menses or gynecological health. They have been to allergists, psychologists, psychiatrists and other specialists but never thought their issue was related to their gynecological health.

 

Perimenopause is the transition into menopause when a woman begins to slow the production of hormones. Some of the symptoms are irregular periods, hot flashes, and generally one of the least understood and most misdiagnosed stages of a woman’s life. One of the symptoms of Perimenopause is insomnia, the ability to sleep.

 

Insomnia generally gets worse as one gets closer to the last period. This is because night sweats – hot flashes that occur when you are sleeping – trouble many women when their bodies stop making estrogen.

 

While night sweats are a signal that you are close to actual menopause, many women complain about waking up in a sweat years before menopause happens. Or they complain that they wake up for no reason in the middle of the night and can’t go back to sleep.

 

Sleeping poorly is a big complaint for people, regardless of their age. For millions of people, bedtime is an invitation to hours of worry. Small annoyances like a truck driving by or a humidifier turning on interrupts sleep. Then come the worries of the day: Did I pay the gas bill or didn’t I?

 

If this is happening to you and you are a woman late thirties to late forties, then rule out stimulants such as the ones in cold medicines, some of the “natural” health pills, and diet sodas can keep you awake. Alcohol can send you to sleep only to wake up three hours later – for the rest of the night. A sedentary lifestyle and sleeping late can also be culprits.

 

Insomnia alone is not an indicator of Perimenopause. The stress of having subtle symptoms you’ve never experienced before can keep you up at night. Insomnia can exacerbate every other symptom of Perimenopause, so it’s important that if you’re having trouble sleeping, you talk to your doctor about it and formulate a plan for improving your sleep. The quality of your sleep is a major part of your sense of well being.

 

 Dr Steven R. Goldstein is a past president of the International Menopause Society, a Certified Menopause Practitioner and co author of the book “Could it be….Perimenopause?”. If you suspect you have Perimenopause, Dr Goldstein, a Perimenopause doctor in NYC  is available for consultation at his office in Manhattan

 

TESTS FOR PERIMENOPAUSE

 

 

How exactly does a doctor determine that a woman’s symptoms are due to unopposed estrogen instead of something else? Dr Steven R. Goldstein,  a Perimenopause Specialist in NYC, and past President of the International Menopause Society and a Certified Menopause Practitioner says that the first place to begin is with menstrual history, which is why it is very important for women to keep a good calendar.

 

In addition, the doctor inquires about subtle symptoms such as mood changes (depression), free-floating anxiety, sleep disturbances, forgetfulness, changes in libido, difficulty concentrating etc.

 

Doctors can also do blood tests to verify this transition. One test measures the level of estradiol in the blood. Estrogen isn’t really one hormone, but three – estrone, estradiol, and estriol. Estradiol is the predominant estrogen in terms of potency. Estradiol comes mainly from the ovaries, which is why this is the type of estrogen your gynecologist is most interested in.

 

The second test is for FSH (follicle stimulating hormone) level. FSH is the hormone that tells the ovary to release an egg. It will also appear in your blood.

 

Sometimes, however, these blood tests can give confusing results. Many patients have estrogen levels that are not in the menopausal range (in other words they are still making estrogen), but their FSH levels have started to rise (greater than 30, which is typical for post menopausal women), and their interpretation when given the laboratory’s norms will be in the menopausal status. It appears paradoxical, because the patient’s estrogen level is premenopausal, but the patient’s FSH level is post menopausal.

 

How does this happen? In Perimenopause sometimes an ovary responds and sometimes it doesn’t. Sometimes it responds only given a high level of FSH. The ovaries do not turn themselves off like a light switch. They often “sputter”. What this means to you is that a single measurement of FSH or estradiol may be insufficient in telling you whether you are perimenopausal or menopausal. It also means that you’d be wise to request these tests more than once if your fertility is an issue or if you’ve been told that you’re in menopause.

 

If a doctor measures only estradiol, he or she may conclude that you are not menopausal if you still make some estrogen. If FSH is the only thing tested, and the reading is high, a doctor might conclude that you are menopausal and recommend hormone replacement therapy (HRT), when in fact it isn’t necessary yet.

 

Dr Steven R. Goldstein, a  Perimenopause Specialist in NYC , says that any diagnosis he makes is aided greatly by the use of transvaginal ultrasound as part of the overall pelvic exam. Transvaginal ultrasounds show if a patient is indeed having episodes of anovulation (not ovulating or releasing an egg), and unopposed estrogen, the gynecologist will expect to see a nonsecretory endometrium and not to find a corpus luteum in either ovary on ultrasound. He or she expects to see multiple follicles present and a relatively homogenous uterine lining suggestive of unopposed estrogen.

 

Dr Steven R. Goldstein is a Perimenopause Doctor in NYC and co-author of the book “Could it be….Perimenopause?”

 

PERIMENOPAUSE - IT’S NOT ALL IN YOUR HEAD

 

Dr Steven R. Goldstein is a Perimenopause Specialist in NYC and co-author of the book “Could it be….Perimenopause?” Perimenopause is a stage of life which a woman enters into right before menopause and experienced by women in anywhere from the late thirties to mid to late forties. Perimenopause is a stage of life with symptoms and realities of its own that responds to specialized healthcare strategies. Perimenopause begins about a decade before the actual onset of menopause. Yet, even though every woman will go through Perimenopause, it is one of the least understood, most misdiagnosed, and most confounding stages in a woman life.

 When it first starts to happen to you, the symptoms are so subtle that by the time you start to worry, they’re often gone. You mention your anxiety, your fatigue, your bouts of forgetfulness to your friends. They nod knowingly, they’ve had them too.

 But still, there are these differences in the way you feel, these annoying symptoms. You think about making an appointment to see your doctor, but what will you say? That you feel vaguely anxious? That you’re suddenly having trouble putting names with faces? That you’ve taken going to bed an hour before your husband when you aren’t even tired, to avoid having another argument over sex? You wonder “maybe it’s all in my head”.

 A word of caution about these symptoms. There are a myriad of medical conditions that can cause you to feel tired and/or forgetful, anxious, etc. It’s when doctors see a “family” of symptoms that occur following a specific pattern of events that we make preliminary diagnosis. Not all of these symptoms are hormonally mediated. The last thing you may attribute such symptoms to is subtle changes in your menstrual cycle, but they are related. Irregular is regular at this time of your life. Shorter, longer, lighter, heavier, the character of your period can change so much during perimenopause that you wonder – is this normal?

 If what you’ve read so far sounds like you, then maybe a consultation with Dr Steven R. Goldstein, a  Perimenopause Specialist in NYC  may be appropriate.