By Shayna Mace | Photo courtesy Dr. Sheryl Spitzer-Resnick
In Dr. Sheryl Spitzer-Resnick’s experience, women are getting a raw deal from the medical community during crucial years of their lives: in perimenopause and menopause.
“Most doctors don’t talk about it. They just tell people, ‘You’re not in menopause yet.’ [Most doctors] ignore perimenopause and they don’t think physiologically about what’s happening, because you can fix almost all of the symptoms [with pharmaceuticals],” she explains.
But simply recommending hormonal birth control (such as an IUD or oral contraceptives) and/or prescribing anti-anxiety medications (which all treat the physical and mental symptoms women may experience) doesn’t reveal the entire picture of a patient’s wellbeing, she says.
She’s on a mission to educate women that it’s crucial they advocate for themselves during perimenopause and menopause, because it’s imperative to their future health.
The Facts
So, what happens during perimenopause? Just as the brain ramps up hormone production during the teen years to ready the body for possible reproduction, during the perimenopause years, the ovaries start to lower progesterone levels, which causes increased variability in estrogen levels throughout the month. Perimenopause typically starts for women in their late 30s and early 40s — and can last for up to 10 years before menopause. Eventually, women experience menopause, which is the cessation of a menstrual period for 12 months. Estrogen levels also decrease during menopause.
Perimenopause symptoms can include:
- Anxiety
- Hot flashes
- Irregular menstrual periods
- Insomnia
- Brain fog
- Skin issues
- Vaginal dryness
- Worsening PMS symptoms
The drop in progesterone during perimenopause is what causes these symptoms, explains Dr. Spitzer-Resnick.
“Physiologically, the first hormone your ovaries stop making as much of is natural progesterone. And that is your calming, anti-inflammatory hormone that’s also protective against breast cancer, uterine cancer and more … [Also] what happens to so many people … is they’re used to being at the top of their game, and then all of a sudden [they may] have a week or even a month where their brain is short circuiting. They’re angry, irritable — their personality isn’t the same. It’s because of this hormone drop.”
Symptom Management
In 2015, Dr. Spitzer-Resnick opened her own clinic, A New Way Forward, to help women experiencing perimenopause and menopause symptoms, as well as hormone and thyroid issues. A Harvard-educated doctor, her previous experience at UW Health and Wildwood Clinic informed her decision to strike out on her own after she saw so many women struggle with their wellbeing during this time in their lives.
Dr. Spitzer-Resnick’s main focus is getting to the root cause of her patient’s symptoms so they can feel better, by balancing their hormones and treating nutritional deficiencies to potentially lower their risks for cardiovascular events, cancer and memory issues down the road.
If “balancing hormones” sounds woo-woo to you, she can explain. Progesterone is a protective hormone for our breast, brain and bone health. Which is important, because a woman’s risk of stroke, heart attack, osteoporosis, dementia and other health issues increase after menopause. That’s because estrogen, which is also protective against these health issues, drops during menopause.
Dr. Spitzer-Resnick typically prescribes patients natural progesterone in a pill or topical cream starting in their 40s, when they start to experience perimenopause symptoms. As a woman advances through her 40s, Dr. Spitzer-Resnick says a patient may need to increase the dose of the cream or the pill as perimenopause symptoms may become more severe.
“When you go through perimenopause, your pituitary gland yells at your ovaries to make more progesterone — but they can’t. So, they make more estrogen and testosterone. And too much estrogen causes rage, irritability, anxiety, heavy bleeding, etc. But when you put somebody on progesterone, it lowers those estrogen swings.”
When patients hit menopause, she’s in favor of having women continue to supplement with natural progesterone, and adding in topical estrogen via a cream or patch. (There are caveats to this, of course — women who’ve had breast cancer and other hormonally-influenced health conditions would warrant a different treatment course.)
Advocate for Yourself
Dr. Spitzer-Resnick says the original Women’s Health Initiative (WHI) study, which took place from 1991-2005, scared women away from using hormone replacement therapy (HRT) due to increased breast cancer and heart disease risk. However, many women in the study were prescribed oral synthetic estrogen and progesterone (progestin) — which increased those risks. (Numerous studies and articles online also debunk the WHI study, and state that bioidentical HRT is safe for women to use that are experiencing perimenopause symptoms.) She’s careful to explain that the estrogen and natural progesterone she prescribes are bioidentical (the molecular structure looks identical to the hormones made in our bodies), which doesn’t increase these same risks.
Perimenopause and menopause are much more in the spotlight these days — for good reason. Dr. Spitzer-Resnick says all women should advocate for themselves at their doctor’s office if they’re experiencing uncomfortable symptoms. What she prescribes won’t be a fit for everyone — but she’s adamant that the medical community needs to evolve to not only better educate women about this stage of their lives — but help them make the best decisions for their health.
“A good provider should be willing to work with you to find the solutions that work for you. I always encourage patients to read and talk to friends to see what works for them.”
