Hi Friend!
Recently, I conducted a social media survey. It asked women to share whether they have ever been embarrassed to ask their gynecologist a question. I wish I could say I was surprised by the results, but unfortunately, I am not. 64% of the women who responded to the questionnaire had been too embarrassed to ask their provider a question and kept quiet instead of speaking up. That’s over 6 in 10 women!
As I read the responses, I grew incensed. Why is there such a disconnect between patients and physicians regarding women’s health?! Not long ago, I read several studies from 2023 and 2024, and depending on which study you look at, Oklahoma is ranked last in the nation for women’s healthcare. At best, we are in the bottom three.
I’m not interested in pointing fingers and arguing about WHY we are ranked so low. We could talk in circles for days and never come to a definite conclusion. I am interested in being a change agent. My desire is to offer the women of Oklahoma the level of care they so desperately deserve.
Part of that care is helping to educate and empower you. This ensures you are an active participant in your health and wellness journey. I want to make decisions with you, not for you. I don’t want you to be embarrassed to ask anything. I very literally mean anything. My recent social media survey proved that you are not alone even when you think you have an off-the-wall question. Someone else wants to know the same thing!
Trusting me (or any physician) with your healthcare is not a decision to make lightly. If you are my patient and you don’t feel comfortable asking me why your libido is nonexistent, why you pee a little when you cough, or what might be causing the funky odor in your undies, then I’m doing something wrong.
I understand these topics are personal, and you may have some reticence about discussing such intimate details. I don’t want to disregard that. But, like a jigsaw puzzle, I can’t see the whole picture if a piece is missing. Trust and honesty are reciprocal things to me. And while you may prefer emptying the ocean with a bucket over asking me about vaginal rejuvenation options, please leave your bucket at home. Let’s talk.
A face-to-face visit at the clinic is invaluable, but I want this blog to be a piece of our care puzzle. This should be a spot where you can find information that’s easy to understand without all the complicated medical terms. We can also dive into the topics that really matter to us.
is it perimenopause?
Perimenopause was among the most mentioned subjects in the social media survey results. So, what is perimenopause, really? On the most basic level, perimenopause is the time when your body is making the transition to menopause. That clears it up, right?!
Perimenopause can begin at different ages, but it most commonly starts in your 40s. During this time, estrogen levels fluctuate, causing irregularities in your menstrual cycle, which may become longer than usual or even stop altogether. You might also experience symptoms commonly associated with menopause, such as vaginal dryness, fatigue, difficulty sleeping, mood swings, and hot flashes.
After a full year (12 months) without a menstrual period, you have officially (clinically) reached menopause, and the perimenopause phase is over.
Have I had patients go 10 months without a period, suddenly have one, and then start the twelve-month clock all over? Yes, it happens.
Our bodies have quite the sense of humor, don’t you think?
It’s important to remember that your perimenopause journey may not look like your mom’s, your sister’s, or your best friend’s journey. The individuality of this natural transition can cause some angst, to be sure. But I don’t want you to feel panicked if you are experiencing symptoms that someone else is not. Remember, it’s normal to have different symptoms.
Just think about how intricately our bodies are knitted together to make us exactly who we are. It would be unrealistic to believe that perimenopause (or any biological process, to be frank) will be the same for every woman. Each experience is as unique as a fingerprint.
A book called ‘How Doctors Think: Clinical Judgment and the Practice of Medicine’ has a great way of expressing the complexities of medicine: “In the world of physical sciences, there are absolute laws—of motion, of thermodynamics, of gravity; absolute laws from which deviance does not— cannot—exist. Medicine is almost the living antithesis of this. The biological variability of disease, human beings, and the human condition make such assured rationality almost laughable. Yes, there has been enough written about diabetes to sink a galleon, but there is no invariant law that will predict exactly what will transpire in my patient with his unique constellation of glucose control, pulmonary pathology, drug absorption, cultural expectations, financial constraints, and personality quirks.”1
I love how the author explains that even though medicine is intensely studied, quickly advancing, and perpetually evolving, our humanness (biological, social, or otherwise) will always play a pivotal role in our health and wellness experience.
It’s not just about finding a physician who knows about perimenopause. It’s critical to see a physician who understands the science of perimenopause and will apply that knowledge to a treatment plan tailored specifically to your needs.
tell me what’s happening.
Having said that, there are some common indicators you have reached the perimenopause level of womanhood.
Irregular Periods
Irregular periods, while a significant change, are a normal part of the perimenopause journey. Your estrogen and progesterone fluctuations can lead to these changes as your body prepares to transition out of its reproductive era. It’s like having an unpredictable house guest who shows up without an invitation on a whim, but rest assured, it’s all part of the process.
Hot Flashes
Have you ever lived in a house with an unreliable air conditioner where you discovered the coolant leak after waking up one night drenched in sweat? That is similar to what happens to your body when you have a hot flash.
When estrogen levels drop, the hypothalamus, the part of the brain that controls the body’s internal thermostat, can get a bit unhappy. This can lead to a rush of warmth, commonly known as a hot flash. While they can be intense, remember that they are usually short-lived.
While there is not one definitive cause, things like spicy foods, alcohol and caffeine, sugar, stress, nicotine, tight clothes, and hot weather can set a hot flash in motion.
Mood Swings
As if estrogen and progesterone haven’t caused enough chaos, they can create significant emotional turmoil and pull their buddy serotonin into the mix. Serotonin, often referred to as the “happiness hormone,” is a mood-balancing chemical that mimics the effects of estrogen. When estrogen decreases, serotonin can also drop, leading to a decline in mood. Progesterone, usually the more stable hormone, can also decrease. When that happens, you may experience anxiety and/or headaches. Additionally, sleep problems may arise, which can further impact mood.
Decreased Libido
You may be head over heels in love with your partner, but you still might not be feeling it. Like at all. Hear me when I say this: there is nothing wrong with you because you’re not feeling it. As your ovaries prepare to go on a permanent hiatus, they decrease levels of estrogen production. These ever-changing hormone levels can also cause vaginal dryness or tightness, which makes sex painful and something you may want to avoid.
Beyond the biological changes (as if that’s not enough) happening within your body, there are social and psychological stressors during this time. These stressors can contribute to a lower libido, too.
Increasing Cholesterol
Cholesterol doesn’t follow the leader, so when estrogen dips, cholesterol will rise. Oh, how we love an independent thinker.
Still, higher cholesterol levels mean more fatty deposits develop in your blood vessels, which is bad news for your heart. Even if your cholesterol has been nearly perfect your entire life, perimenopause can quickly affect your high-density lipoprotein (HDL) levels. HDL is also known as the ‘good’ cholesterol. Once HDL levels decrease, your risk for cardiovascular disease increases.
This doesn’t mean perimenopause will increase every woman’s risk of heart disease, but being proactive with screenings and labs is essential because the possibility is definitely real.
the unusual suspects.
Perimenopause is the gift that keeps giving; sometimes, those gifts are in the form of lesser-known symptoms.
Electric Shock Sensation
If you grew up in the country, you learned never to touch the wire fence because it would shock you. The sensation known as Electric Shock Sensation (ESS) can feel similar—like a brief zap in your brain. These episodes usually last only a couple of seconds and don’t leave any lasting side effects. While brain zaps are not typically concerning on their own, mentioning them to your physician for documentation is essential.
Joint or Muscle Pain
Estrogen is crucial in ensuring the proper function of joints and tissues. When estrogen levels fluctuate unpredictably, it can lead to increased pain in our joints and tissues, often due to inflammation. Additionally, bone density is dependent on balanced estrogen levels. Consequently, it’s not surprising that the risk of developing brittle bones or osteoporosis rises during perimenopause.
Burning Mouth Syndrome
It sounds made up, I know. But it’s a real thing. Burning Mouth Syndrome (BMS) can affect your whole mouth but usually affects the tip of the tongue. Symptoms often manifest as a tingle or a more painful burning sensation. A wrecking ball of fire, if you will. The intensity of BMS varies from person to person; some people may only have mild discomfort upon waking in the morning. Others may endure intermittent pain throughout the day.
For some people, though, the pain can be constant and unrelenting, significantly impacting their quality of life. Paying attention to your diet and avoiding foods that exacerbate the pain can effectively manage symptoms.
Dizzy Spells
Feeling dizzy or unbalanced can be alarming, especially when it occurs unexpectedly. Hormonal imbalances, particularly fluctuations in estrogen, can affect the inner ear or the autonomic nervous system, leading to sensations of lightheadedness or instability while standing. Additionally, if your menstrual periods are heavier than usual, this can contribute to anemia, which is another common cause of dizziness. Although these episodes can be concerning, they typically last only a few seconds.
Changing Body Odor
If you catch a little whiff of something and wonder, ‘Omg, is that me?!’ It just might be. Sweat, skin bacteria, stress, and hormones, the chemical messengers in our body, play a significant role in our body odor. As hormones run wild, your body’s chemistry changes. Sometimes, these changes can include a more substantial body odor. Your scent may change because of the new chemistry inside your body, but you may also just think you smell stronger.
Aging can cause a condition known as presbyosmia, which affects the way you perceive scents. Some women experience dysosmia (a distorted sense of smell) or phantosmia (smelling things that aren’t there). It’s easy to see how either condition would make someone more aware of or even imagine changes in their body odor. As if moms don’t already have a sense of super smell, we get to look forward to this!
I know what you’re thinking: perimenopause sounds like the party of the century, and you’re just waiting for your invitation.
Well, fear not, sister, your invitation will arrive in due time.
why it all matters.
All joking aside, perimenopause can wreak havoc on your physical, mental, and emotional well-being. It can look so different from one person to another, so it’s vital to establish care with a physician before you’re in the thick of it. Getting a baseline for labs and other information gives you a head start on noticing and proactively managing changes.
Or, if you’re already knee-deep in hot flashes and night sweats, find a physician specifically trained to treat menopause. Doing so can be the difference maker in how your perimenopause to menopause story is written.
I am one among only twelve Oklahoma physicians certified by the North American Menopause Society. I don’t say that to brag. I say that to illustrate just how few resources women have during this season of life.
I want to normalize talking about the changes our bodies and minds experience during this transition.
I want to inform and empower you so that you feel confident in your treatment decisions. Speaking of treatment, you might be wondering what treatment is even available for consideration. Various medical and non-medical interventions can help you manage symptoms during perimenopause. Hormone replacement therapy (HRT) is one medical option. Non-hormone prescriptions and more naturopathic treatments (focusing on nutrition, lifestyle, supplements, etc.) are also options.
One size does not fit all, and, as I’ve said before, I want to work with you, not for you.
It is your body.
Your well-being.
Your life.
I’m just honored to be part of it.
If any of this resonates with you, please call the office at 405-701-6717 to schedule a time to come see us.
Please share this blog, too. You never know who may be going through it.
And remember, you’re not alone.
With love,
Dr. Ronni Farris
- How Doctors Think: Clinical Judgment and the Practice of Medicine, Kathryn Montgomery, Pp 256. ↩︎
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