Hormone conundrum
When Mina Kamal* had a hysterectomy at age 45 to remove uterine fibroids and one troublesome ovary, her heavy bleeding and severe pain vanished. But a host of new problems suddenly appeared, including major hot flashes and dramatic mood swings. Kamal carefully followed her doctor’s advice and took estrogen therapy for two years, but her symptoms worsened. It was only after another doctor took her off estrogen and put her on progesterone therapy that she saw a quick turnaround. “Soon my hot flashes got better, my mood lifted, and I started feeling like myself again,” says Kamal, a Vancouver entrepreneur.
Does this make sense? For a long time, medical science has had us believe that as a woman enters her forties, her estrogen levels start to decline, reaching rock bottom at menopause. That assumption, we now know, is not just simplistic; it’s wrong. After all, if low estrogen were the culprit causing hot flashes and night sweats, wouldn’t little children be fanning themselves and men throwing off the covers at night?
An unexpected discovery
There’s now solid evidence that during perimenopause — the two to eight years preceding menopause — those estrogen levels aren’t steadily dropping after all. On the contrary, they’re spiking. “In perimenopause, estrogen levels, on average, are 30 per cent higher than normal,” says Vancouver endocrinologist Jerilynn Prior. She’s the scientific director of the University of British Columbia’s Centre for Menstrual Cycle and Ovulation Research, and she’s also the physician who successfully treated Kamal. Prior says it’s not clear why estrogen shoots up frequently during these years, although she suggests that one purpose might be to clear the ovaries of any remaining follicles to prevent random periods and perhaps even a possible pregnancy when we’re past midlife.
What is known, however, is that as our bodies start edging down from these dramatic estrogen peaks, we may experience ghastly symptoms: overwhelming hot flashes, drenching sweats, scary palpitations, and migraines. Like estrogen junkies, we get used to our newly high levels of the hormone, and we suffer when they drop from super-high to merely high, or from high to normal. Says Prior: “The brain gets ‘addicted’ to estrogen, like to cocaine or heroin, and when estrogen is withdrawn, the whole body is affected.” For some women, it’s as though their bodies force them on a regular basis into estrogen rehab, with all its nasty withdrawal symptoms, only to send them another fix a month later.
