"If I were an Egg- I would be scrambled".

It was a cold winter morning and "Susan" said this to me as she flopped down on the consultation chair in my office. She looked disheveled and worn. She looked sleep deprived and frustrated. She looked perimenopausal. I had seen this look before.

Susan had just turned 48 years old. She said her life felt chaotic and she couldn't say if it was the result of her busy life as an executive or if it "simply" was the result of the aging process? She described feeling out of control: both physically and emotionally and felt confused by these changes. She said her periods were no longer monthly but "all over the place". She wasn't sleeping through the night and she felt ashamed by the feelings of irritability particularly for her family and loved ones. She felt overwhelmed.

Susan wanted to know "what test" would help explain all this and how soon I could fix it for her.

In todays world, quick fixes to physical/emotional symptoms are commonly sought after, yet are rarely the source of true healing and lasting health. So, with a deep breath and with great empathy (having spent a year not sleeping through the night myself) I asked that we first talk about the perimenopause and focus less on the quick fix but rather an understanding of the natural process of hormonal changes and how this might be affecting her life and sense of well being.

The perimenopause is the period of a woman's life that transitions her to the last menstrual period, called the menopause. This generally occurs from the fourth to the fifth decade and is the result of ovarian function decline and a shift in the hormonal milieu of estrogen, progesterone and testosterone. During this time many women describe changes in the physical, emotional and mental realms and some more than others find their lives turned upside down or bizarrely reminiscent of the turmoil they experienced during the pubertal transition, also a time of hormonal upheaval.

For so many years our physical and emotional experiences (as women) are narrated by our menstrual calendar; manifest as the abdominal symptoms before the cycle, the change in mood the week before our bleed, the wonderful energy that reinforces us as our menses finishes, for example. Most women know these cyclic changes and the individual and intimate experience that each month brings to them. This regularity provides an understanding and a way of "explaining" how we feel. And despite the endless bad jokes (of the patriarchy) alluding to the pitfalls of a woman's cycle, this regularity is actually a remarkable timekeeper, an opportunity to understand and know one's body. There is an immense power and evolutionary beauty to this monthly meter, in spite of the symptoms that may accompany it.

And then comes this time we call the perimenopause when the rhythm of our cycles is unpredictable and subsequently, stressful. Women can be challenged by irregular periods, hot flushes, mood and libido changes, vaginal dryness and a variety of other symptoms but most often what is the greatest difficulty is the unpredictable nature of these symptoms. The inability to correlate the way one feels with the "time of the month" can be very provocative and unsettling.

In the early 20th century, only 20 percent of women lived into the fifth decade; we are new to this experience of living as busy aging women through the perimenopause and beyond. We are just learning how to process and treat these very powerful physical changes and remain sexy, working, active and intellectually astute. As a result, science (and medicine) is just beginning to understand the response to the diminution of these hormones from our body. As a result, we certainly do not have all the answers to what is the best treatment for women distressed during this time. Moreover, we have to be very careful not to blame all our challenges on hormones since we are more than just the grand sum of our estrogen and progesterone. Looking at both our physical health, hormonal status AND our life choices in work, relationships, diet and exercise, are the route to well being. Without a doubt, this time can be incredibly challenging, scary and unsettling. To feel so disconnected from ones body and yet so steeply entrenched in the physical and emotional tumult can be terribly confusing. Albeit a natural transition, it is no wonder we can feel like we are going from the "frying pan into the fire and feeling scrambled".

Healing starts by understanding what this hormonal time frame is all about. Seeking assistance with a clinician who understands and is without paternalistic judgment about this transition (think of how many women are just told to grin and bear it and shamelessly told to "not worry") can be very supportive. Evaluating ovarian, adrenal and thyroid functions are helpful in ruling out other causes for these symptoms. Looking at what and when you are eating, if you are getting adequate exercise, evaluating your sleeping conditions and examining areas of stress are important in dealing with the unpredictability of your bleeding and the varied symptoms that may arise. Treatments can vary from complementary healing modalities and allopathic hormone treatments or other medications. Psychological therapeutic interventions can also be very helpful for some during this time. It is rarely just ONE thing that makes someone feel "scrambled". And it is rarely just one intervention that makes you feel better as one evolves from a reproductive female to a beautiful crone.

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Amy Novatt:
My life as an obstetrician - gynecologist started in Pennsylvania in 1990 working in a community hospital delivering babies and learning the art of gynecologic surgery. As hard as residency was, I realized early on that I had chosen a career that suited me. The practice merged my interest in women’s health, reproductive policy and surgery perfectly. I spent many years assisting woman deliver their babies and then decided to focus on gynecology (only)- appreciating that in most offices, the concerns of adolescents and women not having babies, were often marginalized by doctors. I was interested in creating a professional arena for women to discuss these non-OB related issues. I have worked in a private practice for 14 years in Rhinebeck, NY. I have seen over 10,000 patients during those years. My work includes office GYN and surgical interventions, including advanced laparoscopic surgeries while lecturing both to professional peers and lay audiences.

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