281: Emotional Confidence Through Hormones and Perimenopause with Dr. Mikala Albertson
If you’re dealing with up-and-down emotions in perimenopause, you may wonder, “What’s happening to my body and my moods?” In this episode, author Dr. Mikala Albertson shares how mood changes in menopause can affect us, ways to start the conversation with our doctor about hormone testing, and how we can address our fears around our bodies changing.
WHAT YOU’LL LEARN:
- [04:18] Why Are So Many Women Surprised By Hormonal Changes In Midlife?
- [06:14] Taking a Symptomatic Approach to Our Challenges During Midlife
- [11:11] What Inspired Mikala to Write Her Book “Everything I Wish I Could Tell You About Midlife”
- [15:28] How Can We Address Our Fears Around Changing in Midlife?
- [21:56] What Are The Timelines of Perimenopause vs Menopause?
- [27:11] Where Do We Start The Conversation With Our Doctor About Hormone Testing?
- [35:52] How Can We Restore and Maintain Our Libido as Our Body Changes During Midlife?
- [38:25] Can We Still Build Muscle During Perimenopause and Menopause?
- [40:26] “My Hope Is That Women Feel Seen and Understood Throughout This Book”
- [44:55] Alicia’s Reflections: How Can We Emotionally Support Ourselves During Midlife and Perimenopause? Using My Book Emotional Confidence to Help!
[04:18] Why Are So Many Women Surprised By Hormonal Changes In Midlife?
So many of us are surprised by the challenges and symptoms that come up during midlife. We expect ourselves to grow older but it often feels shocking to go through so many changes. Mikala shares that this generation is the first to be more open and to ask questions about this process. We may have grown up with parents who did not share a lot about it and people were a lot more private.
She also says that there has been a lack of research and science in women's health up to this point. For a long time, research was only done with men because they thought that women were just smaller men. We may be a bit behind in the research which is frustrating for women who are right in the middle of midlife now.
Mikala also shares that we are all so influenced by beauty and wellness culture and think we are supposed to be fabulous at 40, active and fit, and not aging at all. Then if this is not our truth we feel like something is wrong with us. There are not a lot of models for healthily moving through midlife. It is a collision of all of these things that adds to the additional challenges.
[06:14] Taking a Symptomatic Approach to Our Challenges During Midlife
Many issues compound during midlife such as changing career roles, children leaving the house, and our marriages or relationships going through difficult times. Mikala shares that it would be nice if we could compartmentalize things and say “Okay, this is hormones and this is something else” but most things are intertwined. The frustrating part for women in this life stage is that it is difficult to tell if our symptoms are from stress and anxiety or hormones. Are we not sleeping because we are worried about our kid at college or is it perimenopause? We usually cannot find the exact answer because they often build on each other.
Mikala addresses these things in her book Everything I Wish I Could Tell You About Midlife, We may feel limited at our doctor's office when we only have 15-30 minutes to talk about our bodies when we know that there are things in day-to-day life that have huge effects on these symptoms.
There are so many factors at play and it is hard to figure out which is causing which. Mikala believes that we have to have a symptomatic approach to these challenges. It helps to look at one symptom at a time.
Let’s take sleep as an example:
-How can we set ourselves up for good rest at night?
-What does good sleep hygiene look like?
-Do we have to be taking a sleep aid for a short time?
Regardless of what the underlying cause is, we need to look at these factors too. Because even if we are not quite sure of the root cause, there is nothing wrong with us. We are not broken and we can give ourselves the grace to get through it even if we do not have answers. Do not be afraid to try something for relief. There are options when different symptoms come up that you can use to get you through this season of life.
[11:11] What Inspired Mikala to Write Her Book “Everything I Wish I Could Tell You About Midlife”
Mikala decided to write this book in the middle of midlife because she has heard a lot of the same concerns, stories, and issues from women over the past two decades as a doctor. Even though she has just turned 45 and is only in early perimenopause, she has been dealing with other life transitions as well. Her oldest child is 19 and her youngest is 8 so she has kids in very different stages of life. She sent her son off to college for a year and now he is living back home so they are trying to readjust to that. She has also been married for 20 years and has had some big career transitions. Two years ago she quit her clinic job and has now been writing full-time and figuring out who she is. This has been a surprise to her because she thought at 45 she would have these things nailed down. It has been fun but it has also been unsettling, she says.
When things are changing like this, it can affect how we show up. When we are going through the younger years with our children, there are boundaries on what we can and cannot do because we have been devoting time to them but as they grow up, suddenly there are other options. Or we may want to do something different and it is time to transition out of something. It might feel like shaky ground which makes it even more important to lean into our faith.
Mikala shares that she was living the first half of her life thinking she was on the right track because people told her she was. Over the last few years, she has asked herself “What do I really like and what feels good?” and although she has not had the same affirmation from others, she feels better internally. God allows us to stay grounded in Him as we dig deeper and decide who we want to be. This is a reminder that no matter what we are going through, we are all a work in progress.
[15:28] How Can We Address Our Fears Around Changing in Midlife?
Many of us struggle with the fear of losing control of who we are and who we will become during midlife. We wonder “How will these changes affect my marriage? How will this affect who I am? Can I overcome this and come out better on the other side?” There is a lot of uncertainty and it is difficult to get over the mental aspect of this fear. Mikala shares that she relates to this a lot, especially as she enters this stage of motherhood. When your children are young, you are the one orchestrating everything – so when they get older and are doing their own thing, it can feel like a loss of control.
Mikala understands how that fear can be overwhelming. She is still navigating the transition of realizing that her core identity, the person she is on the inside, her values, interests, and what brings her fulfillment, remain mostly unchanged. It has been rewarding for her to prioritize these aspects more and dedicate more time to them. Maybe this shift is essential during this phase because it leads us to become more authentically ourselves.
In the introduction of her book, Mikala shared a story about a conversation with her editor when she first started writing. They discussed how women often feel weary in midlife, and her editor suggested focusing on reassuring women that the best is yet to come. She started to reflect on if she could say that. She did believe that there was peace coming and a lot of letting go but she did not know if we came out “better” as far as the world's point of view. It is okay to feel scared – but this is why it is important to keep turning inward and become more grounded in ourselves and our faith.
There are also scary changes to our bodies. We may have been in good health up until this point and we are wondering “What is happening?”
I (Alicia) am currently dealing with a frozen shoulder for the last 10 weeks. I finally got an MRI and they said it was hormones and I sat there thinking “Why does this happen when I have always been active?”
Mikala shares that the roller coaster of perimenopause (which is 4-10 years before menopause) is usually what causes all of these symptoms. It is the up and down, the unpredictability, and our bodies sometimes having ovulatory cycles and sometimes not. We may have different sleeping patterns and less muscle mass, but studies do show that this stuff gets better when we are postmenopausal.
[21:56] What Are The Timelines of Perimenopause vs Menopause?
The definition of menopause is 12 months after your final period. For perimenopause, there is not a hormone level that we can look at but you can base it off of symptoms. If you are still sometimes having a period and symptoms along with it, then you are in perimenopause. If you are still having symptoms in menopause, you would certainly meet the criteria for benefiting from menopausal hormone therapy.
Other ways that you can know if you are in perimenopause are:
-Different sleeping patterns such as waking up at 3-4 am.
-Brain fog (trouble remembering things or are not sure why you walked into a room)
-Hot flashes and night sweats
-Vaginal changes. When estrogen is decreasing in our body, it can change the mucosal lining which can cause vaginal dryness, irritation, and sometimes more frequent urinary tract infections.
-Joint issues like frozen shoulder. The good news is that this usually goes away with physical therapy.
These are all symptoms of perimenopause but again, once menopause starts, things level out and you start to feel more steady.
[27:11] Where Do We Start The Conversation With Our Doctor About Hormone Testing?
Mikala shares with us that when you start to notice some changes around 40, establish primary care with a doctor and see them a few times. It does take a bit to figure out what is wrong and a lot of medicine is trial and error. Sometimes it is not an easy fix which is frustrating for both parties but oftentimes when bloodwork comes back as normal, doctors do not mean that nothing is wrong. Her hope when she says that to her patients is that it is a reassurance that other things are not going on so you can rule them out. Initial blood works help to rule out all of the other things before doctors settle on perimenopause because if it is something else, you will need different treatments. So initial blood work is important and it should feel reassuring when it is normal then you can look at perimenopause and see what you can do.
Mikala also shares that doctors typically do not check hormone levels to determine how to treat perimenopause. You do not need specific estrogen, progesterone, or testosterone levels to decide whether hormone replacement therapy (HRT) is necessary, she says. Hormone levels fluctuate so much and what they measure today could be completely different five days later. Sometimes checking them just adds confusion. She sees a lot of talk about this on social media and it is frustrating for her as a provider because it feels like people are being misled. You do not need to have your hormone levels constantly checked every few weeks.
You can start menopausal hormone therapy (which we prefer to call it since we are not bringing you back to pre-menopausal levels but just treating symptoms) without having your levels checked at all. The next step, if your blood work is normal but you are still experiencing symptoms, is to say, “I feel like this is perimenopause, and I’d like to treat the symptoms, either with hormones or other medications.” From there, your doctor can target specific treatments based on your main symptoms. If you are a candidate for hormones, and there are no contraindications, that is often a great place to start.
Those out-of-pocket hormone clinics can often be predatory, making money off unnecessary treatments. You can get the help you need through your primary care provider or even specialized menopause clinics that are covered by insurance. And if your doctor tells you everything is normal and suggests coming back later, but you are still experiencing symptoms, that is the time to advocate for yourself. Say, “I am still having XYZ issues.” You can even bring in Mikala’s book and point out the chapter on perimenopause, showing a list of symptoms. If you are experiencing several of them, ask, “Can we talk about hormone replacement or menopausal hormone therapy?”
If you are in the early stages of the menopausal transition, sometimes birth control pills can be helpful. They are easy to take and affordable, and they help by suppressing ovulation, so you do not experience drastic hormone swings. Later in the menopausal transition, when periods become irregular, doctors usually prescribe estrogen and progesterone separately, but at lower doses since you are not having regular ovulatory cycles anymore. You can do all of this with your general practitioner.
I (Alicia) think there has to be that balance for us as patients to be able to know enough and to advocate but also to have a relationship with a doctor so we can say, “I trust that if I ask you this, that you're going to help”
[35:52] How Can We Restore and Maintain Our Libido as Our Body Changes During Midlife?
Dealing with changes in libido is different for everyone and every relationship, Mikala says. The cultural standards come back into play and we start to think “Okay everyone is having sex three times a week, is that what we should be shooting for? And if we do not do that, does it mean something is wrong with us?” This is why it is important to sit down with your partner and ask them “Hey, are you happy with the sex that we're having? Should we be doing something different there?” And if you are both happy, even if it is just a couple of times a month, then that is great.
This can change throughout your relationship and what was normal for the two of you when you were in your 20s will probably be different in your 50s and 60s. The most important thing is that you are both happy and satisfied. There is a typical pattern that there is less libido for both men and women in this season because of not only perimenopause and testosterone but also because you might have kids living with you or many other reasons that can get in the way. This is why it is important to figure out if it is a libido problem or a life problem and have discussions with each other about these life changes.
[38:25] Can We Still Build Muscle During Perimenopause and Menopause?
It is never too late to build muscle mass during perimenopause, and Mikala encourages everyone in their 30s to start strength training now. Muscle mass naturally decreases with age, beginning in our 30s, so it is important to actively combat this through strength training. This can be done using dumbbells, yoga, resistance training, or other methods. The key is to take action to prevent further muscle loss.
Maintaining muscle mass offers significant benefits for mobility, joint health, and overall physical activity. It also plays a crucial role in managing weight, preserving bone density (which helps prevent fractures), and improving body composition. Weight training 3-4 times a week is just as important as aerobic exercise for overall health.
[40:26] “My Hope Is That Women Feel Seen and Understood Throughout This Book”
Mikala wrote her book “Everything I Wish I Could Tell You About Midlife” for a few reasons. For one, she knows how frustrating it is to see your provider and feel unseen, unheard, or misunderstood. She also knows what it is like to be inundated with health information, some of it being contradictory, so we do not know what to believe. She hopes that women feel seen and understood throughout this book because it is full of stories from her life, her patients’ lives, and her friends' lives.
Each chapter begins with a relatable story that you will be able to see yourself in. The second half of each chapter is easily digestible background information and general science. When we have this knowledge, we feel empowered. She wants women to be able to go to their provider and say “Hey, here is what I know about this, so what are we going to do about it?” She wants everyone to feel in control of their decision-making. She also wants women to feel at peace because they are not the only ones going through these things.
[44:55] Alicia’s Reflections: How Can We Emotionally Support Ourselves During Midlife and Perimenopause? Using My Book Emotional Confidence to Help!
I hope this has been a time for you to pause and reflect, allowing yourself to truly see the challenges you are facing. If you are in the season of perimenopause (like me), navigating the changing hormones and life situations, it is important to recognize that some of the things affecting you might have gone unnoticed. I hope this message makes you feel seen and heard.
From an emotional perspective, I want to talk about what we can do to support ourselves during this time. We want to focus on the medical and physiological aspects because they are both important but I also believe that acceptance and acknowledgment play a huge role in this stage of life. In my signature framework ADD (Acknowledge, Discern, Decide), acknowledgment might be the strongest tool we have during this period.
It is easy to get lost on days when you have no idea why you feel a certain way. When it feels like your body is betraying you, or you are walking into a room and forgetting why you are there. Maybe you are emotionally overwhelmed and do not understand why. In those moments, it is helpful to start asking: “Why does it make sense that I’m feeling this way? What is happening that might explain these emotions?”
After acknowledgment comes discernment. It may be true that you are feeling things or it might be a challenging season for your family – but it is also true that the ups and downs you are experiencing do not mean you are losing control or that something is wrong with you. You are still the person God created, someone who is loved and known by Him, and it is comforting to remember that this season will not last forever.
The final step is “decide” which is knowing what you are feeling, acknowledging it, and asking yourself: “What is the next best step to take care of myself? What would God want me to do? Where should my emotions and thoughts dwell?” It is about choosing to live in the truth of God’s presence, knowing He is with you, and believing that this is not permanent. There is hope, and there are things you can do to help yourself through this season. You do not have to stay in a place of despair. You can choose to believe that God is with you and will guide you through.
I encourage you to check out her book, “Everything I Wish I Could Tell You About Midlife”. It offers both medical insight and personal stories, helping you feel understood and providing practical steps for moving forward.
And if you are looking for more support in managing emotions during this time, my book, “Emotional Confidence: 3 Simple Steps to Manage Emotions with Science and Scripture”, will be available soon. I truly believe both books complement each other, offering the science and stories to guide you through midlife and practical emotional tools to navigate it. Remember, you are not alone and there are tools to support you during this transition.
RESOURCES:
Tired of up-and-down feelings stealing your peace, sabotaging your relationships, and filling your mind with self-defeating thoughts? If so, make sure to get my new book, “Emotional Confidence: 3 Simple Steps to Manage Emotions with Science and Scripture”, coming November 12, 2024!
Connect with board-certified family practice doctor and author Dr. Mikala Albertson
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