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One thing I enjoy the most about being a doctor, is that through consultations with my patients I get to take the pulse of society – in a manner of speaking. In the past few months, I have had many consultations with women describing crippling symptoms that have had a very real impact on their quality of life. What is more distressing however, is that their family doctors or gynecologists dismiss their symptoms as a depressive state or tell them it is just part of a woman’s journey. Enter in: Perimenopause and Menopause.  

From the time women start their menstruations until menopause, traditional medicine treats the symptoms associated with women’s bodies as completely foreign and that any issues or problems like bloating, mood swings, insomnia are “normal”, and that by divine gift, they must grit and bear it.  

Well ladies, let me hit you with a hard fact – it is not normal to suffer, and I want to break down some truths about hormones.  

Women and Medicine 

Women’s health has a long history of being ignored and in some cases misogynistic forms of diagnosis have set women far back – as if you did not already know. Take the word hysteria – from the Greek word uterus, hystera. Hysteria was originally used to describe the physical and psychological distress in patients – patients who only have wombs, meaning only women. Absurd.   

Most recently a Quebec personality, Veronique Cloutier, released a docu-series entitles Loto Meno, in which she describes her own very personal experience with perimenopause and her journey to find solutions to the symptoms that had crippled her career, couple, sex life, and resulted in a huge decrease in her quality of life. 

Perimenopause can actually last 10-15 years before a woman reaches menopause, which means silently suffering through symptoms, for a number of years, without so much as a hint or whisper to get you through. And of course, the “this is normal” speech.  – thanks, but no thanks to traditional medicine.  

Let me walk you through something that we do not discuss enough but deserves a proper spotlight:  

We have all heard about menopause, some women celebrate this time as the end of periods, and some categorically identify this period as the milestone for an aged woman past her prime. But there is a period before menopause, a mystical zone of symptoms and uncertainty where some women lose a sense of themselves because of how severe the symptoms can be.  

Let’s get technical for a minute: Menopause is diagnosed only after a woman has gone a full year without a period. While there is no such thing as post menopause, the period after menopause is when women are most vulnerable to heart disease and osteoporosis. What causes menopause – the simple answer is ovaries stop working, and our production of progesterone and estrogen abruptly stops. This change in the body does not simply affect your periods but is also marked by weakened bones and changes to the way the body uses and stores energy…hello weight gain!  

But what about the time before menopause? For some women the journey to menopause is a chaotic and unpredictable stage called: perimenopause. Why chaotic? Well, you will have all the symptoms of menopause, but still have your period – or what resembles your period because that monthly visitor might take some breaks and suddenly decide to visit right before a vacation or an anniversary you’ve been planning for awhile. Thanks Mother Nature.   

So what happens during perimenopause?  


Estrogen. One of two main sex hormones which contributes to cognitive health, bone health, cardiovascular system function and other essential bodily functions. And of course, it also plays an important role in our menstrual cycles. For most of our reproductive years, our ovaries produce estrogen to develop the uterine lining to support pregnancy, while progesterone, typically produced during ovulation, is used to control that growth. No pregnancy? Estrogen and progesterone levels both drop, the lining sheds and you reach for a carton of ice cream. 

But as women age, our ovaries don’t make estrogen or progesterone in the same way. At times estrogen may spike and plummet at others, and what is the result? Let’s call them fluctuations. These fluctuations will cause all those bothersome symptoms.  


Hot flashes and night sweats will be experienced by as many as 55 percent of perimenopausal women, making it one of the most common symptoms, lasting anywhere from 3-10 minutes and can happen once a day…and sometimes hourly. Why does this happen… unfortunately the research does not really tell us. But our body is certainly reacting to something it never was exposed to before. 


Get ready for a wild ride because during perimenopause, your menstrual cycle will likely become irregular. If there is a spike in estrogen the uterine lining will become thicker, and conversely a drop in progesterone, can lead to unrestrained lining growth. What does this mean, well some may experience heavy bleeding, some might experience the opposite, with lighter bleeding. For most women, the time between cycles lengthens over perimenopause, giving the lining a greater chance to build up before its dramatic exit. But some women will see their periods get closer and closer together as a result of that hormonal imbalance.  


While the number and quality of our eggs may be declining during this time in our lives, there is always that ONE overachiever.   


It could be the hormones, it could be the symptoms, it could be the dryness. But most women will experience a significant loss of libido. What I want you to remember though, is that contrary to how women are perceived in society, women like sex! Just because you reach a certain age, it is not normal that there is a low libido. Whether it is vaginal dryness, urinary incontinence, there are treatments that exist, and it is only a matter of asking the right professional to get you back on the horse.  


….and lots of them. More than half of perimenopausal women are fighting fatigue, and those with little to no anxiety are likely to feel high anxiety triple. Depression? PMS? Women who have a clinical history in these departments are predisposed to feeling depression at this time.   


The likelihood that women are already not sleeping is high enough, but during perimenopause expect this rate to go through the roof! Most probably because you are drenched from those night sweats…but also bye progesterone!  


Lots of peeing. Lots and lots of it. Your pelvic floor is not what it used to be. Muscles and ligaments stretch and weaken, especially in women who have given birth. This process can lead to a pelvic organ prolapse because there is not enough support for the organs. The good news is that there are many great options: pelvic floor physiotherapy and if you don’t know about the Emsella, well then you should!   


Get ready to set your calendar up, because brain fog is VERY real during perimenopause. Fact; nearly three-quarters of women say they have problems remembering names, while half struggle to remember where they put things, what they just said, what they just heard and what they were, at that precise moment, meant to be doing.  

Estradiol, the most potent of our three estrogen hormones, is a crucial part of memory formation and cognitive function. So, if you find yourself at a loss, there is a high chance it is related to a drop in estradiol around the time of perimenopause. 

But Dre Landry, what can we do? Well, I am glad you asked. I have been prescribing hormones to my transgender and nonbinary patients for over 10 years. During this time, I have developed keen competencies to understand hormone levels and the types of changes to expect. As a doctor who often treats women for sexual dysfunction it became very clear to me that I needed to orient my practice to uplifting women even more by giving more options to their course of treatment. Introducing Bioidentical Hormone Therapy.  

My patients often come in to see me and are very discouraged because they’re about to lose their job, their mind, their husband and feel like everything is falling apart, then I explain to them what may relieve their symptoms. Hormones.  

Hormones are there to balance all of our body systems and keep them healthy. There are more than 300 functions regulated by oestrogen and progesterone, and bioidentical hormonal therapy aims to replace the ovaries production. The term bio identical refers to hormones with the same chemical structure as those naturally made by the human body and are metabolized by normal metabolic pathways without the harm seen with chemically different hormones that can produce harmful metabolites… It gets very technical from here and the famous WHI study in 2002, that favored sensationalism over rigour while journalists incorrectly spread datas and generalized it to a different class of medication (this study was NOT made with bioidentical hormones). Unfortunately, in the year following the spreading of the false information in the news about the risk of breast cancer with hormonal therapy, many women were scared their hormones would suddenly make them sick and abruptly stopped their hormones, and the number of prescriptions of antidepressants went up by 300%. Just think about that for a second, take a deep breath, let it out, I am here to help.  

We replace every hormone and neurotransmitter in our body with medication…but not women’s hormones. I could go on and on about how medicine has let down women over the course of history, and how marginalized women’s health is to some researchers but let’s live in the light. Doctors like Dre Sylvie Demers, my mentor, and others have done incredible research to demonstrate the advantages of BHRT during perimenopause, throughout perimenopause and onwards.  

My goal is to simply open the door….BREAK down the door actually of traditional medicine and replace it with a more modern model for women’s health. A model where women will have their symptoms validated and can be heard during their medical consultations. A model where women will be presented with FACTS and options so that they may take their own decision for their course of treatment.  


Read more from Dre Landry; How to Care for my Vulva/Vagina?, Sexual Wellness,Sexual Dysfunction and Vaginal Microbiome.

If you have any questions for Dre. Gabrielle Landry, feel free to leave them in the comments below, or can contact her clinic Elna Clinique.

Feature image via Let’s Talk Sex.

GLW Contributors - Professionals in their field. Contributing to Girls Living Well their knowledge, experience and advice.

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