Mrs. Peri Minipause was in the office. She is 48 years old and having a very rough time. She’s not sure, but she thinks she is going crazy. She complains about wild mood swings, inappropriate crying, and being a “bitch” to her husband and children. She’s sure it is not menopause as she still has her “curse”, and she had her hormones tested at the local lab and they were “normal”. To make matters worse, her curse is now irregular and heavier than usual. She wants her thyroid checked. She is gaining weight and has heard that a poorly functioning thyroid will cause all of her symptoms.

Peri does not want any medication; she just wants answers. If you haven’t figured it out yet, Peri is premenopausal. She is not crazy. I wish she was. Treating a “crazy” woman is much easier than treating a perimenopausal or menopausal woman. First of all, there are no rules. Every woman does menopause differently. The lucky ones don’t even know they are in menopause; life just goes on uninterrupted. The unlucky ones, like Peri, trade one “curse” for another. 

Menopause and its forerunner can be very destructive. Not only is Peri in trouble, but her husband and children are, as well. They can’t do anything right. I’m in trouble, as well. Since she is still menstruating and her hormone tests are normal, Peri is not buying the diagnosis. She wants more tests. The more tests that come back normal, the more frustrated Peri is going to be. When Peri is frustrated, her moods swing; and I’m right in the middle of those swings. I’d rather get hit by a golf club.

I’ve given Peri a reading assignment. I’ve informed her that normal hormonal levels mean nothing. I offered her an assortment of medications, including hormonal support. I need a Staples, “That Was Easy” button. When I mentioned putting her on SSRIs, the tears flowed. “I must be crazy. You want me to take anti-depressants!” I tried to explain that SSRIs are used to relieve symptoms of menopause. She’s not buying.

At this point, I want to refer her to a specialist. When all else fails, a second opinion is helpful and gets me off the hot seat. I’ve taken care of Peri for 27 years, so I don’t refer her. It’s my job to work through her problems with her. I am sure she will survive. I think I will.

We draw her thyroid panel and set up our next visit. We discuss medicinal, as well as bioequivalent, hormones. The all-natural approach is to go through menopause sans medication. Peri needs meds. We discuss nutritional support and exercise. I have requested a family conference so that I can explain things to her husband and children and enlist their aide.

If you are like Peri, rely on what your body and doc are telling you. No tests are perfect; all have false positives and negatives. Everyone will go through menopause in her own, unique way. There is no shame in taking medication or hormones when needed. Medications best known as antidepressants are often useful in menopause, not because your doc thinks you are depressed, but because they influence your neurotransmitters.

Peri, take a deep breath. You will endure, survive, and have a bright future.

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