Feeling Good
CAN’T CONCENTRATE? Pants feel snug? Burning with rage? “It’s hormones,” you say. And your mom says. Actually, everyone says. Often, everyone is correct. Think of hormones as the little metal balls that wreak havoc in the board game Mouse Trap. “As they circulate through the body, hormones stimulate cells that have a special receptor for them,” says endocrinologist JoAnn Manson, MD, chief of preventive medicine at the Harvard-affiliated Brigham and Women’s Hospital in Boston. “With estrogen, for example, there are receptors in virtually every tissue, including the heart, the G.I. system, and the brain.” That’s a lot of havoc waiting to happen. And it’s more pronounced in women than men: Even though both have the sex hormones estrogen, progesterone, and testosterone, their effect is most noticeable when levels fluctuate, as they do throughout the menstrual cycle. During perimenopause, the on-ramp to menopause that can last up to a decade, these fluctuations can be drastic. But even for women in their turbulent 40s and 50s, hormones aren’t always to blame. And while you’ve been talking smack about them, you may have been letting other stealth causes get the better of you. Consider:
“I hate you!” / “What would I do without you?” mood swings MAYBE IT’S HORMONES Stable estrogen levels are associated with even-keeled moods, says Adelaide Nardone, MD, an ob-gyn in New York City who’s been treating perimenopausal and menopausal women for more than two decades. So when levels start to fall the week before your period, your mood can nose-dive, too. And during perimenopause, you may feel like
a cartoon villain, veering dramatically from anger to sadness to absentmindedness to exhaustion. WHAT ELSE IT COULD BE If you’re feeling down or are stuck on an emotional roller coaster all day, every day, for more than two weeks, it may be related to mental health issues rather than hormonal ones. Indeed, about 20 percent of perimenopausal women experience symptoms of depression. “Ask your doctor about treatment,” says Nieca Goldberg, MD, medical director of NYU Langone’s Joan H. Tisch Center for Women’s Health. Moods tend to brighten after menopause, but in the meantime, antidepressants and talk therapy may help.
The “Not tonight—or any other night” blues MAYBE IT’S HORMONES Women’s libido tends to spike around ovulation, when estrogen levels are highest, then dip once an egg is released. The bigger dipper: Estrogen levels drop during perimenopause and menopause, coinciding with the decline in libidosparking testosterone that happens with age. Perhaps not coincidentally, more than half of menopausal women in one 2008 study reported having low sexual desire. MARCH 2018
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TRACK IT! Keep tabs on your symptoms with a calendar or an app like Clue. If you notice they always occur during certain weeks of your cycle, it’s likely they’re related to hormonal fluctuations, says Nieca Goldberg, MD. (Past the period stage? The app MenoPro can help you get a handle on symptoms.)
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WHAT ELSE IT COULD BE Where to begin? Stressful life transitions (moving, switching jobs) are notorious libido killers. And resentment, alienation, or relationship insecurity can quash a woman’s drive at any age. Physiologically speaking, it’s tough to even think about sex if you’re exhausted; for the women who participated in a 2015 study, each hour of additional sleep corresponded to a 14 percent increase in the chance that they would have sex the next day. Then there’s the fire-extinguishing effect of meds like antihistamines, antidepressants, and hypertension drugs (not to mention the pill), which is something to discuss with your doc. Exercise may help you warm up to the idea of sex because of its ability to reduce stress and improve sleep (and body image)—even after just one workout. A small 2012 study found that women taking antidepressants who jogged on a treadmill for 20 minutes before watching a bit of porn became more physically aroused than those who relaxed before showtime.
Hurts-so-bad sex MAYBE IT’S HORMONES Estrogen keeps the vaginal tissues lubricated, so when hormone levels dip during the last week of your menstrual cycle—
