During perimenopause you typically experience high levels of estrogen at the same time as lower levels of progesterone. It’s a bit later when estrogen begins to drop too and you are closer to a year without a period (that’s menopause). This high estrogen low progesterone state can cause Endometrial Hyperplasia (the excessive proliferation of the cells that line the uterus). Basically, the build up of your uterine lining (what you shed when you have your period). This condition can cause heavy and long periods and leave you at higher risk of uterine cancer.
Heavy and long periods – I know them well. I’ve been dealing with them for about a year. It’s been painful, uncomfortable and annoying, but to be honest I didn’t give them much thought beyond tracking on my period app (I use Flow). What preoccupied me more were the night sweats and the sleep disruptions that have plagued me on a near nightly basis for a year (and about ten days a month the year before). I didn’t realize that the heavy and long periods could be a more serious issue until I saw a gynecologist and was diagnosed with Endometrial Hyperplasia.
How did I get diagnosed?
In February I went to the Sexual Health Clinic for my regular STI testing. While there I also asked about getting the Mirena IUD. At age 46 I absolutely don’t want to get pregnant so I was interested in a back up to condoms. I thought an IUD would be ideal because it isn’t estrogen based like most oral contraceptives. I’ve been on them before and they have made me feel horrible – neutral, nonsexual, unfeminine, and emotionally flat. That’s the best way I can describe it.
Anyway, the Mirena works differently than most birth control pills. It releases small amounts of levonorgestrel (a synthetic form of progesterone) which thickens cervical mucus and helps prevent sperm from reaching or fertilizing an egg. It also thins out the uterine lining and partially suppresses ovulation.
The nurse I spoke to thought it would be a great option for me as the progesterone would help ease my periods and likely help with my night sweats and sleep issues. She didn’t want me to go ahead with it quite yet though. I needed to see a gynecologist for an exam to measure my uterus (IUDs are recommended for women who have had a child – I haven’t, but it turns out I have a large uterus for a childless woman – 9 centimetres), have a biopsy in case of abnormal cell build up, and get a transvaginal ultrasound to measure the thickness of the endometrium.
I was able to see the gynecologist in June and while the biopsy did come back negative for abnormal cells, my results showed significant build up of my lining. So yes, an IUD would be a good option for me, but first I would need to have my lining thinned out a bit. My gynecologist prescribed me a synthetic progesterone (medroxyprogesterone acetate).
Like most every other prescription medication medroxyprogesterone acetate has side effects. The ones I experienced (especially when I first started taking it) were – anxiety (I had vivid PTSD panic attacks), breast swelling and tenderness, and water retention (I’ve gained about 10lbs because of bloating). I think my body has adjusted to it because the anxiety is much less pronounced (and no longer hallucinatory) and my breasts are not as sore. I’m still pretty bloated in my face, belly and limbs – OK everywhere – but I’ve gotten used to it. I’m trying to embrace it even.
I also experienced one specific side effect that was very welcomed. Sleep! You need to take it before bed because it can make you drowsy. Since I started taking it 2 weeks ago I’ve been able to sleep through the night for the first time in about 2 years. No night sweats and no sleep disturbances. It’s been amazing. I hope when I get the IUD this continues. Fingers crossed!
One More Thing
One of the consequences of very heavy periods can be significant anemia (low iron). So no surprise (except to me) this is something I’m experiencing as well. But I will write all about that in my next blog post.
My go-to-resource for perimenopause information is Barbara Taylor, M.D. as well as The Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia. I think The Mayo Clinic’s overview is useful too.
In terms of books, I learned a lot from The Estrogen Window: The Breakthrough Guide to Being Healthy, Energized, and Hormonally Balanced-Through Perimenopause, Menopause, and Beyond. Menopause Confidential: A Doctor Reveals the Secrets to Thriving Through Midlife (except for the lubricant recommendations) is a great easy read on the subject matter. I also like Sex Rx: Hormones, Health, and Your Best Sex Ever.