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hormonal shifts are normal, but dealing with the symptoms doesn’t have to be
8 minute read
each hormonal transition comes with its own cross to bear, but women of all ages shouldn't have to just deal with it.
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from puberty to menopause, women experience a lot of hormonal transitions throughout their lives. these unavoidable and physiological changes are normal transitions. however, they can come with a host of changes that can severely impact a person’s quality of life. but what are women told to do about it? well, nothing. the symptoms and quality-of-life deficits are not a clinical priority. the four main transitions that drive shifts in quality of life are puberty, the menstrual cycle, the postpartum period and menopause.
“each of them really specifically has different impacts on the quality of life, so going from cramps, breast sensitivity, headaches, you also have night sweats, depression. there was also changes in sexual desire,” said alexandra richard, medical communication manager for vichy laboratories. “also, there are skin and scalp side effects, such as loss of skin density. you also have a loss of hair density, hair loss in general.”
from mood to appearance, women are consistently dealing with these side effects of simply being a woman—and it can have severe and detrimental impacts on their overall satisfaction with life and how they show up in their lives.
just because it’s normal doesn’t mean it should be ignored
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each hormonal transition comes with its own cross to bear. when adolescent girls begin puberty and start menstruating, they deal with acne from changes to skin and sweat, cramps and potentially heavy bleeding from the periods themselves, rapid growth and body fat accumulation, which can affect body image and self-esteem, and mood swings.
during pregnancy and postpartum, rises and falls in hormones can also cause fatigue, mood swings, depression and reduced libido or discomfort during sex.
around perimenopause, which is a years-long transition before menopause, estrogen becomes erratic, leading to hot flashes, night sweats, disruptions in sleep, mood changes and brain fog, to name a few. people may also experience weight gain, hair thinning and dry or sensitive skin.
finally, when menopause occurs, the drop in estrogen can also cause similar symptoms of perimenopause, such as hot flashes, night sweats and sleep disturbances, along with a lower libido and discomfort during sex. weight gain, joint and muscle aches, dry skin and increased depression or anxiety can also occur, alongside an increased risk of urinary tract infections and bladder leakage.
three of the most detrimental changes during this time are an increased risk of cardiovascular disease, osteoporosis and cognitive decline, as estrogen, which has now all but left the building, acts as a protectant against these issues.
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during menopause and perimenopause specifically, there are viable ways to deal with the estrogen changes—estrogen therapy—but because people still buy into one debunked study from decades ago, the narrative surrounding the treatment remains problematic.
“this is offensive to me at this point that we have to wait for a woman to get heart disease and to get a bone disease and to have brain mental health issues when we have something that can fix it and it’s gotten a bad rap,” said dr. colleen norris, professor and associate dean of research in the faculty of nursing at the university of alberta.
the neglect of women’s hormonal transitions
living with the hormonal changes, which arise from fluctuations in estrogen and progesterone throughout one’s life, can do a number on a person in terms of their physical and mental health. but because of the lack of research in these areas—or women’s health overall—ways to combat these symptoms as they arise have been largely left out of the clinical conversation.
dr. meghan pike, a pediatric hematologist and medical researcher focusing on the impacts of heavy menstrual bleeding in adolescents, notes that one example of a woman’s experience that’s been largely understudied is heavy menstrual bleeding.
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in some cases, heavier periods can be completely normal for the person, particularly in puberty, perimenopause or following pregnancy. in others, it may require medical intervention due to an underlying cause. but because of a lack of research in the area, both are often given the same advice: deal with it.
“i think some of it is a lack of education on the part of providers and their medical training about what constitutes normal versus not normal,” said dr. pike. “one way to counteract that is by using what we call patient-reported outcome measures, which is, i don’t really care so much about the amount of your bleeding. i care how much it’s affecting you and your life.”
heavy menstrual bleeding can cause missed work or school, feelings of lowered self-esteem or shame from bleeding through period products and onto clothes, or taking longer to do certain things because of the amount of time spent changing period products.
in other cases, where symptoms such as lowered libido and mental health decline are present because of hormonal shifts, medical providers often fail to address them adequately because they are looking at the symptom, not the cause. for example, shifts in estrogen can lead to changes in mood, such as anxiety, depression or irritability.
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dr. norris had her own personal experience with this when, at 42, she felt herself experience unexplainable anger, and she couldn’t figure out why.
“i was snapping at everyone, and she, the physician, said, ‘has your cycle changed?’ and i said no, i’m 42, i’m not close to that,” said dr. norris. “she said, ‘must be stressed. why don’t we try an antidepressant?’ that’s still happening today.”
being given an antidepressant to fix an estrogen depletion isn’t the right way to go because so much more is going on under the surface than a mood disorder.
“if you are leading the stressful lives that everyone is leading, you are probably in a state of chronic stress, and so cortisol is running in your body, and the brain prioritizes the production of cortisol over follicle-stimulating hormone to get you some estrogen,” dr. norris said. “the brain is saying, ‘okay, you’re under so much stress. you’re in fight or flight. this is not a time for you to be pregnant.”
women have consistently told medical providers that they need more answers, more interventions and better care for these issues that affect everything from their minds to their libido and physical health, but continue to be shut down in the process.
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“two out of three women who struggle in silence when they face hormonal changes, they feel misunderstood, they feel unsupported, uninformed,” said richard. “it’s really a cry for help. it’s really exposing a systemic neglect in terms of hormonal changes and how women are accompanied through that.”
it’s important to note, too, that women make up almost half the population in canada, and yet these very real, women-specific topics of health receive only seven per cent of federal health research funding.
giving women hope for a better tomorrow
addressing the severe gap in research and funding is only one piece of the puzzle. health-care providers also need to become well-versed in that area, and the health-care system has to encourage more open discussion and dialogue, and provide more time to do those things than they’re currently capable of.
virtual clinics that give women the opportunity to really sit down and speak with health-care providers are a step forward. but because of the shortage, even they have waiting lists. a clinic opened by dr. norris has made progress in helping women by giving them time to really ask their questions and learn about what’s going on in their bodies, but since it launched in february, appointments have booked up fast.
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“we’re booked into may,” she said, noting that while it’s booking up fast, it’s really making a difference. “i was at a meeting the other day in edmonton, and at the break, she (a woman) says, ‘i just have to tell you. i went to your clinic, and no one has ever listened to me like that in my entire life.”
other options include seeking support through different means until the health-care system and research catch up to where it should be.
vichy laboratories has also launched hormonall: women’s hormonal wellbeing across every life stage, dedicated to bridging gaps in quality-of-life care for women who have no choice but to navigate these transitions and manage hormonal shifts.
the platform includes four training modules that cover the science behind hormonal changes, their impact and how to improve well-being while dealing with them.
“we want to empower women through their hormonal journey,” said richard. “we want to make sure they really are provided with the most accurate and recent information that we have on what is happening in their bodies and how they can manage these symptoms, and they can especially address them with their health-care professionals.”
dr. pike mentions that support groups and society organizations can also be of help to women who feel like they have been left to deal with symptoms and a lowered quality of life without any assistance. an app, known as wethrive, is especially helpful for adolescents dealing with their first introduction into hormonal shifts and to help them identify if what they’re experiencing during menstruation is normal or something that should be investigated further.
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getting a second opinion also never hurts if a woman feels as though her provider isn’t listening to her.
“you are well within your rights to ask for a referral to someone who could investigate things further if you’re not satisfied with the care that you’ve received or if you’re suffering,” she said.
lifestyle efforts, such as managing stress, getting enough sleep, eating a whole-foods diet and exercising, are also vital for managing quality-of-life issues. another app, called aura, can also help in that way by giving women actionable ways to address any deficits they can control in their lives.
that said, these interventions are meant to be supplemental because there’s so much more to it than lifestyle; telling women to just fix it themselves isn’t enough.
at the end of the day, newer programs and a higher understanding of these shifts and how they affect quality of life are the best way to help women maintain well-being while they go through hormonal fluctuations. while the issue won’t be fixed tomorrow, changing the narrative helps move everyone a few steps closer to relief and optimal health and well-being.
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