Could I already be in menopause?? Why it matters for Alzheimer’s prevention

Dr. Jen Kerns

Dr. Jen Kerns

I have my yearly appointment with my OB-gyn tomorrow, and my big question for her will be whether we can draw blood to check all my hormone levels to try to figure out whether I could already be menopausal. Technically, a woman isn’t officially deemed to be in menopause until she has gone an entire year with no periods. But it can be tricky in women who are on oral contraceptive pills, because the birth control pill provides hormones to your body that mimic, to a certain extent, the natural hormonal cycle that the body goes through, where at the end of each 28 day cycle there is a 4 day period of time (no pun intended) when the progesterone-like hormone is missing. This “progesterone withdrawal” is typically what triggers a woman to bleed. So women could theoretically already be in menopause, where their own bodies aren’t producing the hormones needed to ovulate or create menstrual cycles anymore, but the birth control pills are making them continue to have cyclical bleeding. I started having hot flashes several years ago, and at first had no idea what they were – because what woman in her early 40s with a 2 year old at home thinks of herself as perimenopausal? But after it happened a few times, I researched it and found that hot flashes can begin up to 10 years before a woman is menopausal. At the same time, I felt more anxiety than usual, and I also noticed continued declines in my sleep quality and quantity. I spoke to my OB-gyn about it all, and she put me on an oral contraceptive called Lo LoEstrin Fe to help “smooth it out.” I’ve been on them more maybe 2 years now, and indeed, they eliminated my hot flashes and I no longer felt anxious. My sleep quality improved too (except for that 4 day window when the progestin disappeared each month). But oddly, I never got my period when expected. I might spot in the middle of the pill pack and then have no period during the time when it would be expected, or I might go for 6 weeks with nothing. I realized that I am only 2 years younger than my mother’s age at menopause, and I got my period at a very young age (11), so it wouldn’t surprise me if I spent my egg reserve sooner than someone who got their first period at age 14. So now I am wondering whether I could even already be menopausal but just don’t know it because or the birth control pills.

Who cares? I do, because 2/3 of late onset Alzheimer’s patients are female, and the sex difference is thought to possibly be related to the loss of female hormones. The menopause transition is a time in a woman’s life when her brain is suddenly more vulnerable, and brain imaging studies have shown that there are dramatic changes in the structure and function of women’s brains as they go through perimenopause and menopause.

Brain images from Lisa Mosconi’s study referenced herein.

Many Alzheimer’s experts believe that there may be a critical window for replacing estrogen to help minimize these changes. So I am particularly interested in learning whether I might be entering menopause, because I might choose to go on hormone replacement therapy with bioidentical hormones — estradiol and progesterone just like the actual hormones that my body used to produce — rather than the lower doses of synthetic hormones provided by my birth control pills.

So, I have gone off my birth control pills in anticipation of getting blood drawn to take a peek at my hormone levels and try to figure out whether I am still just “perimenopausal” or actually in menopause. It can’t be definitely determined with a single blood draw, but if my estradiol level is super low, that’s one indication that I might benefit from hormone replacement.  When I stopped taking my birth control pills last week, I noticed an immediate effect on my sleep quality and have struggled to sleep through the night. I’m dying to get back on them, but am refraining in the hopes that being off them will help with getting a more accurate blood draw (since the pill suppresses your own body’s hormone production, any results obtained while on the pill would be inaccurate).

Wish me luck!

Project 135 stats:

Starting weight: 159.6 (May 2020)
Week 1: 157.2
Week 2: 155.6
Week 3: 155.4
Week 4: 153.8
Week 5: 151.0
Week 6: 152.8
Week 7: ? (Dad’s death)
Week 8: 150.8
Week 9: 152.6
Week 10: 154.2
Week 11: 152.6
Week 12: 150.8
Week 17: 155.2 (sugar binges)
Week 18: 154.4
Week 19: 153.8
Week 25: 146.6
Week 26: 148.2 (Halloween candy)
Week 27: 146.8
Week 28: 146.6
Week 29: 148.8 (Thanksgiving)
Week 30: 148.4
Week 31: 149.0
Week 32: 152.2
Week 33: 153.0 (Christmas)
Week 37: 153.8 (January 2021: Start intuitive eating experiment)
Week 38.5: 160.8 (on Feb 1, 2021 -> go back to NSNF)
Week 40: 156.4
Week 41: 154.4
Week 42: 151.6
Week 44: 153.0
Week 45: 154.4

Total weight loss: 5.2 pounds (3.3%)

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