The Mysteries of Being Female – Your 5 Common Questions Answered

Sometimes being a woman can be challenging.  Hormones go up and down then come and go.  We have this amazing ability to become pregnant and deliver a baby out of an area that starts small and grows to 10 centimeters when fully dilated.  We crave, we cry, we cramp, we clean and we console often all in the same day (sometimes in the same hour). We can carry on four conversations at once while updating our Facebook status, cooking dinner and prepping tomorrow’s suit which makes us wonder why we are tired at the end of the day.  We do all this and yet there are times when our body just does not seem to want to cooperate or suddenly veers off course.  Here are some answers to 5 common medical mystery questions about the female body.

1.       Why do I have vaginal dryness (sometimes or all the time)? There are many reasons to consider but the big ones include: not fully aroused, stressed, other things on your mind, on the birth control pill, on clomid (or other fertility medications known to dry up mucus), history of a LEEP procedure on the cervix due to an abnormal pap smear, decongestants (they do not just dry up the nose), dehydration, and hormone changes.

2.       Why are some periods unlike other periods?  Some women have the “fluke” where their period comes early or late (not pregnant), is really heavy, really light, no cramps, severe cramps…etc and this is different from the normal.  Some women alternate months in that one month is an easier period then the next month is a more symptom heavy period. Remember (as I tell my patient’s), your ovaries are sisters not twins therefore “righty” and “lefty” may produce different hormone levels and create different symptoms. Some months may be a “righty” month and others a “lefty” month.  In addition, high stress, grief, flying, major transition, heavy exercise, weight loss, and hormone changes can all affect how your cycle rolls. 

3.       Am I too young for hormone changes?  Nope.  Hormone changes and imbalance can occur at any age from puberty all the way through menopause.  You may be too young for menopause but that does not mean there are not issues with hormone production.  Women who do not ovulate do not make progesterone and progesterone is typically known as the calming, soothing, anti-PMS, pro-pregnancy hormone.   High estrogen contributes to more PMS-type symptoms, heavier periods, weight gain and tender breasts.  Higher testosterone or testosterone sensitivity may create more acne and increased hair growth on the chin, neck, and around the nipples.

4.       Why are my periods irregular or why do I spot and bleed more than seems normal?  First of all, if you are fully menopausal and have not had a period in 12 months and suddenly you start bleeding, please contact your health care provider as you will need additional work up.  If you are peri-menopausal then expect your once regular periods to become very erratic and unpredictable due to the nature of the ovaries changing.  Other reasons for most all ages include hormone imbalances, fibroids, polyps, pregnancy, thyroid problems, being low in iron, having Polycystic Ovarian Syndrome (PCOS) and being on the wrong birth control pill dose.

5.       Where did my sex drive go?  This is tricky.  Some women do not start out with a thriving sex drive and as they go through hormone changes it begins to wane even more.  Those who are used to a higher drive find themselves perplexed when their mojo is gone.  Sex drive for women is rather complicated as it takes into account hormone balance, arousal, stressors, how many things are on their brain, attraction, confidence…and more.  Certain medications are known to lower drive such as the birth control pill and anti-depressants.  Men typically have an “on/off” switch while women have an entire control panel.  Talk with your health care provider about testing for hormones, thyroid, and energy zappers like iron, Vitamin B12 and Vitamin D.  Focus on your stress response, eliminating what is not a priority, communicating with your partner about what you need (A dinner out? The laundry done? Compliments? Forplay?) and do not be afraid to explore and change things up within your comfort zone.  Perhaps this means new lingerie, the addition of sex toys, erotic readings (grey ties anyone?), more date nights, or a mini-couples vacation.

While being a woman is wonderful and empowering (empowher!), please talk to your health care provider if you recognize some of the symptoms above and suspect your particular symptom is more than just a “fluke.”  There may be some true imbalances that require a little tweaking in order to help you feel your healthiest.

References:

1)      Bachmnan, G., and Santen, R. Treatment of Vaginal Atrophy.  Web.  8 June, 2013.

http://www.uptodate.com/contents/treatment-of-vaginal-atrophy

2)      Shifren, J.  Sexual dysfunction in women: Epidemiology, risk factors, and evaluation.  Web. 8 June, 2013.

http://www.uptodate.com/contents/sexual-dysfunction-in-women-epidemiology-risk-factors-and-evaluation?detectedLanguage=en&source=search_result&search=libido&selectedTitle=3%7E131&provider=noProvider

3)      Welt, C.  Physiology of the Normal Menstrual Cycle.  Web.  8 June, 2013.

http://www.uptodate.com/contents/physiology-of-the-normal-menstrual-cycle?detectedLanguage=en&source=search_result&search=irregular+menstrual+cycle&selectedTitle=12%7E150&provider=noProvider

Is Your Anxiety Worse With Menopause?

There are many common symptoms associated with both peri-menopause (the start of the hormonal changes) and actual menopause including hot flashes, night sweats, vaginal dryness, weight gain, increased joint pain, irregular cycles, heavier periods, hair loss, and insomnia.  In discussions with their friends, female family members and health care provider, most women have a general understanding of ‘what’s to come’ when it relates to the big hormonal transition however symptoms such as increased, worsening or new anxiety might be a surprise.  Many women have experienced at least some form of anxiety in their lifetime and find it concerning when those nervous, overwhelm, worry or fretting feelings really ramp up in their forties and fifties. 

Research (and anecdotally in my practice) shows that women who are prone to anxiety before menopause are much more likely to have higher levels as they go through it.  In fact, it is reported that 51% of women between 40-55 years old experience mood swings or anxious type feelings more regularly than when they were in their twenties and thirties.  While there is little research on the subject of “why,” and the reasons are conflicting, there are a few consistent theories that may apply.

As women approach menopause, the need to become pregnant becomes less therefore ovulation becomes less frequent.  Without ovulation a woman does not make (much) progesterone and progesterone is the more calming, soothing, anti-PMS hormone for women.  This leaves estrogen to become more dominant which can cause increased symptoms of PMS, irritation, anger and overwhelm.

This hormonal transition of menopause is often occurring at the same time that life is stressful – Murphy’s law?  Women are juggling family, work, financial, relationship, and world responsibilities while trying to eat healthy, exercise, stay sane and navigate menopause.  This causes a lot of internal stress on the body, particularly the adrenal glands, which leads to feelings of anxiety, irritability, overwhelm and panic. 

Women going through peri-menopause and menopause often experience long periods of insomnia or waking up regularly between 2am-5am.  This leads to more fatigue and less patience causing those low-level feelings of anxiety to worsen.  Everybody feels better after a good night’s sleep as it is restorative to the body.

So, what can be done?  First, recognize that it is a normal (but not fun or fair) part of going through menopause.  Talk to your female family members about their experience and then consult with your health care provider about options (even if temporary) to help you get on the other side of all the transition.  Find coping skills to first recognize what is going on and then how to act/react with yourself and those around you.  Put yourself in time out and take 5-10 minutes for yourself (or more) and just breathe deeply, go for a walk, sit in the sun, read, exercise or close your eyes.  Focus on setting boundaries and saying “no” to things that create more stress and chaos in your life and remember that it is okay to do so.  Lastly, hope that your menopause is short and sweet!

 

References:

1.       Bromberger, J., Kravitz, H., Chang, Y., Randolph, J., Avis, N., Gold, E., and Matthews, K.  Does Risk for Anxiety Increase During the Menopausal Transition?  Study of Women’s Health Across the Nation.  Web.  2 June, 2013.

http://www.medscape.com/viewarticle/803506

2.       The Merck Manual.  Menopause.  Web.  2 June, 2013.

http://www.merckmanuals.com/home/womens_health_issues/menopause/menopause.html?qt=progesterone&alt=sh

3.       Kumari, v., Konstantinou, J., Papadopolous, A., Aasen, I., Poon, L., Halari, R., and Cleare, A.  Evidence for a Role of Progesterone in Menstrual Cycle-Related Variability in Prepulse Inhibition in Healthy Young Women.  Web.  2 June, 2013.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055354/