The Patient: “Alicia,” a 39-year-old pastry chef.
Why she came to see: The first thing Alicia said to me was, “I’m not sure if I’m in the right place, or if I should be at a psychologist’s instead.” Ten months earlier, her life had felt “calm and satisfying.” She worked as a pastry chef at a high-end restaurant and was building a cult following within her community and on social media. She was dating a wonderful man, she had no major health concerns, and she felt wholly confident with the trajectory she was on in life.
In the last seven months, however, her moods had started careening out of control. Profound anger compelled her to try to break up with her boyfriend every few weeks. Equally intense sorrow sometimes rendered it difficult for her to get through a shift without crying. Anxiety often robbed her of pleasure and made her snap at her partner and coworkers. “Some weeks I feel at the top of my game, other weeks I feel slightly off-kilter, and other weeks still I feel like I’m going positively crazy,” she confessed. The daughter of a physician who appreciated medicine, she said she “wanted to rule out possible medical issues before anything.”
How I evaluated her: Alicia and I began with a comprehensive review of her life and overall health, including her mental and emotional well-being. While she’d gone through a bout of depression after her father’s death four years earlier, she’d spent most of her childhood, 20s and 30s “super cheerful and stoked about life.” That contentment and ease had returned in the years after grief therapy, but it had recently shifted dramatically. In addition to swinging between rage, irritability, angst and despair, she was also experiencing interludes of insomnia and night sweats.
We then moved on to her sex life and her lifestyle in general. Alicia had been with her current partner for roughly two years and claimed that she vacillated between feeling deeply attracted to him to being completely uninterested in sex. Though her periods had long been so regular they were, to her, a “non-issue,” she’d recently started having heavier, longer periods accompanied by exacerbated PMS.
While she’d always been sporty and slim—which she maintained with frequent workouts and a healthy diet (despite or in spite of her work as a pastry chef, she joked)—she’d begun to experience bloating that was downright discomfiting. Two to three nights a week she also stayed out late with her restaurant crew—evenings that often began and ended with cocktails at their favorite rooftop bar, and left her feeling worse the next day.
To rule out any health problems underlying Alicia’s acute mood swings and other symptoms, I ordered a full physical that included a gynecological exam. Furthermore, I ordered a 24-hour urine test on the 21st day of her cycle to assess her levels of estrogen and progesterone.
What my evaluation revealed: Much to our relief, Alicia’s physical and gynecological exam came out clean. Her hormone exam, however, confirmed what I had deduced from both her age and her symptoms: Alicia was in perimenopause.
As I explained to Alicia—who gasped at the mere mention of menopause (“I’m only in my thirties,” she reminded me)—perimenopause is the female body’s way of shifting towards menopause, which is classically defined as the complete cessation of a period. To think of it differently, a woman (or man, for that matter) doesn’t enter puberty without warning; subtle shifts, from budding breasts to acne, begin to reveal themselves before puberty officially begins. Likewise, perimenopause—which can vary from symptoms as mild as an occasional breakout to the sharply felt symptoms Alicia was experiencing—serves as the precursor to menopause, and can ultimately lead to unsettling issues that disrupt a woman’s life.
This is due to hormonal fluctuations that can begin to occur anywhere from two to 10 years before a woman has her final menstrual period. In other words, beginning perimenopause in one’s 30s—like Alicia—is not only common but also, in a way, expected.
As is typical for perimenopause, Alicia’s hormone test revealed low progesterone levels. What I like to call the “age-defying hormone,” progesterone—which is produced in the adrenal glands and ovaries—assists in maintaining hormone stability. It can increase overall health by promoting calmness; it can also relieve tension, help “relax” connective tissues and aid in one’s ability to sleep soundly. Because of its effects on mood-altering brain chemicals such as “feel-good” serotonin, dopamine and GABA, balanced progesterone can be highly conducive to balanced moods.
Low progesterone, however, can make a woman feel like she’s on an emotional rollercoaster—but, as I assured Alicia, she is not alone in this. Many women have decreasing progesterone levels beginning in their 30s. Whether this is due to a stressful lifestyle or simply because they’re naturally less fertile at this time in their lives (ovaries age as well), they tend to have deficiencies of progesterone compared to estrogen, particularly during the second half of their menstrual cycles.
Symptoms of this progesterone-estrogen imbalance, which is called estrogen dominance, include heavier periods, night sweats and bloating. Another strong indication of low progesterone is insomnia that occurs during the second half of one’s cycle. Since progesterone can activate receptors in the brain that promote mental calmness, another sign of low progesterone is anxiety that happens exclusively during the second half of a woman’s cycle. Issues also include the very thing that brought Alicia to my office in the first place: Extreme mood swings.
How I addressed her problem: To help Alicia find some equilibrium with her moods, we aimed to achieve hormonal equilibrium, primarily through dietary changes and herbal assistance.
To start with, I urged Alicia to nix her “industry nights”…or, if not, to replace cocktails with sparkling water. Alcohol can impair sleep by increasing cortisol, diminish the body’s natural detoxification abilities and impact hormone levels, all of which can lead to unpredictable—even explosive—mood swings.
I also advised Alicia to modify her diet primarily through the exclusion of processed foods—even those nibbles she liked to take while baking—and the inclusion of cruciferous vegetables such as broccoli, cauliflower and Brussel sprouts, which contain compounds that convert unfriendly estrogen into friendly estrogen. I also urged her to supplement her diet with magnesium. Often called the “miracle mineral,” (though it could also easily also be dubbed the “relaxation mineral”), magnesium not only plays a fundamental role in maintaining a healthy nervous system but also supports the production of brain chemicals that are essential for smoother moods.
Furthermore, I recommended balancing her estrogen and progesterone with 175 milligrams of Chaste Tree Berry. Also known as Vitex, Chaste Tree Berry has the power to heighten progesterone production in the ovaries. (Indeed, research reports that it can boost progesterone by 150%; other studies demonstrate it can help women feel better in general by decreasing PMS symptoms.)
Additionally, I encouraged Alicia to keep up her workout routine even on those “dark, moody” days when she didn’t feel like it. Exercise diminishes bloating, fosters sleep and restores hormone harmony through the bearing it has on estrogen and testosterone. Physical activity also stimulates dopamine and serotonin—two neurotransmitters that are key to achieving happiness, tranquility and equanimity.
Finally, I urged Alicia to download Hormonology on her phone. The savvy menstrual cycle app not only allows users to record their symptoms but also lets them see precisely where they are in their cycle and how each day has a different impact on their mood (knowledge is power, after all). Daily “horoscopes” also include tips on how to make one’s day better, from sipping chamomile tea for enhanced sleep to loading up on iron-rich foods to diminish the blues.
The patient’s progress: Two months after our treatment plan began, Alicia returned to my office with excellent news: She’d made it through her last two periods with minimal (though still occasionally extant) mood swings, her sleep had “improved dramatically,” and her relationships—at work and in romance—were richer and more at ease. Most of all, though, she felt capable and empowered to take control of her health and to be ready for what lay ahead.
Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.