by Elizabeth

For the last several months I have had the worst PMS of my life. I was irritable, I was argumentative, and I didn’t want to be around anyone. I just wanted to be left alone – possibly for the rest of my life.

I tried reigning in my feelings of rage, but I was only ever partly successful, and then only in the first half of my cycle. Once I hit ovulation mid-cycle, I somehow couldn’t control my reactions. I would fly off the handle at the least little thing. My husband would offend me, and I would refuse to reconcile. I rejected all the normal things he might try to do to bring peace and resolution back to our relationship. 

At several points during this period of time, Jonathan mentioned that he would like to see a marriage counselor, maybe for an intensive, to try to bring some warmth back into our relationship. This should have been a warning sign for me, but for reasons I’ll discuss down below, I was too self-focused and couldn’t see the yellow light for what it was.

I know this isn’t the experience of every marriage, but our relationship has always been pretty easy going. We enjoy each other’s company, and we love to get away by ourselves, whether for just a walk or coffee date or something longer like a weekend away from the kids. Those things have been part of the rhythm of our marriage forever. So this was a huge shift in our relationship. Unseen tectonic plates slipped under the pressure, the ground quaked beneath us, and we had a hard time finding our footing.

But it wasn’t just my husband who was driving me crazy. My kids were driving me crazy too. I never wanted to be around them either. And just as I knew in my head that my husband was the best human I would ever find and that I wanted to stay married to him forever – even though most of the time I couldn’t stand being around him – I knew that my kids were legitimately good kids. They didn’t have major issues. They’ve always been easy to love, and I have enjoyed mothering them. But now their mere existence was driving me bonkers.

I had read about perimenopause; I thought my symptoms might be from erratic and/or dropping estrogen levels. I assumed I would just have to weather these symptoms for the next 10 years or so, until actual menopause arrived. I had spoken with enough women to understand that after the hormone levels drop at menopause, emotions are much easier to regulate, and mood swings finally settle down. I thought back to the years I nursed babies, remembering how calm, stable, and happy I was during lactational amenorrhea, and I looked forward to the final endpoint of menstruation.

But I couldn’t understand why God would make women so vulnerable and unstable during this time of life, a time of life that often coincides with raising teenagers and launching young adults, all of whom have big emotional and psychological needs.

My mother didn’t appear to have a difficult menopause, at least from my perspective. There was no strange personality change, no loss of affection. No yelling or flying off the handle. I myself had had an easy puberty, and in general I was happy during pregnancy, though I tended to be more anxious. I even did well postpartum, when many women struggle with the drastic hormone drop after birth.

So what was wrong with me? Why was I having such a difficult time with perimenopause? My mom did fine, why couldn’t I? I tried googling “wanting to be alone in menopause,” but all I could find were articles about how women were lonely and didn’t want to be alone.

And let me tell you, I was doing all the right things. I was exercising. I was eating right. I was journaling and being grateful. I was trying to connect with my husband. I was part of a vibrant church community, and I was praying and speaking with a spiritual director. I was working hard to listen to the voice to God, to center myself and remain calm. But all the things that had always brought me peace and tranquility in the past would work for maybe 10 minutes, then the happiness would evaporate and I would be just as unhappy as I had been before my intervention.

So finally, after about four or five months of extreme irritability and more fights with my husband than I’d ever had (although after most of them, I wouldn’t have been able to tell you what we’d been fighting about, the fights were that petty), I called the midwife. I couldn’t get in for a while, but I knew I needed help, and I felt relieved to know that help was coming.

As soon as the nurse checked me in, I unloaded on her. She empathized and assured me that my midwife would help. “She gets everyone balanced out eventually, it just takes a while sometimes.” That slice of hope was everything.

When the midwife walked in the room, I unloaded everything on her again, and she said, “It’s probably the progesterone pills.” She explained that what I had been experiencing qualified as PMDD (premenstrual dysphoric disorder). It’s not just your garden-variety PMS; the mood swings are extreme and super hard to control.

At first I was so confused that I didn’t know what to say. I’d been taking oral micronized progesterone (bioidentical progesterone) since last summer to control the heavy periods of perimenopause. And it had helped. I was so happy with the menstrual improvement that I probably didn’t notice my increased irritability the first several months.

But looking back, I think my husband did notice right away. He couldn’t get me to appreciate beauty on our walks. He felt an emotional disconnection that he couldn’t put into words and that I couldn’t comprehend. I had been working hard on my faith, which had been in tatters during the pandemic and re-entry, and I’d been working hard on my relationship with finances, which had never been great and which had been deeply triggered in early 2023 due to a complicated combination of events. I felt so satisfied with my growth in the areas of faith and finances that I was unable to see the losses in other areas of my life.

Neither of us had any idea I could be reacting to a prescribed medication.

It took a moment to absorb what the midwife was telling me and to begin to make new plans with her. As this is an unfolding story and I don’t yet know if our plans will work long term or whether we’ll need to try something else, I won’t be discussing that part of the story at this time.

I went home and told my husband that the midwife just turned my world upside down but that we had a plan. The more I thought about what she said, though, the more it made sense, and the more I realized that I had walked into that office as a blinking red light for progesterone sensitivity.

So let me back up and explain progesterone sensitivity (or progesterone intolerance). This concept can be hard to swallow, because in both the natural and conventional medical worlds, progesterone is touted as a cure-all for sleep, anxiety, and heavy periods. In the natural health world, everyone is afraid of “estrogen dominance” – which isn’t even a medical term – and promotes progesterone as the solution to all menstrual woes, including PMS.

And there is some truth to this. Progesterone can help with heavy periods. It helps you sleep. (I personally slept great while I was taking it.) Progesterone is protective against uterine cancer, and according to Dr. Mary Claire Haver, it appears to be somewhat protective against breast cancer as well. But although progesterone has a great safety profile, it has some serious side effects for some women, including PMDD. And that’s the dark side of progesterone that not everyone knows.

Initially I had no framework for what my midwife was saying, even though I had read a lot on perimenopause and menopause. And I can be somewhat skeptical, so I went home and, true to my Enneagram 5 nature, went digging for information. What I discovered was that doctors do know about progesterone intolerance, but it’s not advertised much in some circles and is downplayed in others. After all, it’s estimated that only 10% to 20% of women have progesterone intolerance. Most women are just fine. 

But one out of five women sounds like a lot of women to me, and it’s a whole lot if you are one of those women. And it makes total sense that progesterone could cause problems. Any woman would tell you that the week between her cycle and ovulation is her favorite week. She feels great and has lots of energy. 

At this time, you have some estrogen but no progesterone because progesterone is only released by the corpus luteum after ovulation. That lovely period of time is actually a time of true “estrogen dominance,” as your body is producing estrogen only. You’ve got no progesterone. It’s only after ovulation, when progesterone is released, that women have issues with PMS, whether that’s physical issues like bloating and cravings or emotional symptoms like anxiety and irritability.

I wasn’t ready for the heavy periods that were sure to come if I stopped taking the progesterone, but I did anyway. Some physical symptoms were alleviated right away. I hadn’t been paying much attention to my physical symptoms because the emotional symptoms had been so difficult to deal with, but I was struggling with constipation, which I’d only ever experienced in pregnancy and postpartum. I also had headaches, itchy ears, dizziness, a feeling of increased pressure in my body and in my head, and increasingly swollen ankles – the kind you only get in pregnancy. 

In fact, at one point I was convinced I might be pregnant – even though I knew that was impossible. I had painful gas and an acid stomach, which I only ever experienced in early pregnancy and which necessitated lying down after dinner most nights, but over the next week those digestive discomforts slowly went away.

It took a little longer to experience release from the emotional symptoms, but soon I was easy to live with once again. I didn’t yell at Jonathan for everything he did. I didn’t tell my children to leave me alone. I looked out at the yard and smiled. I went to get the mail and got stuck on the driveway staring at those strikingly strange clouds hanging in that lovely sunset. Beauty could once again lift my spirits.

Food even started to taste good again. It had never tasted bad, I just wasn’t receiving much enjoyment from it. I didn’t realize this until one night after supper when I was eating some dark chocolate, as is my custom. Apparently I started murmuring about how good it was, and my daughter told me I hadn’t done that in a long time. Then one morning soon after, I ate my normal breakfast and stated how delicious it was. Because it was delicious (cue the Little Brute Family). Food continues to be enjoyable, thank the Lord.

Unprompted, I started kissing my baby girls. Turns out, they needed some love. It had been missing from our home for a long time. My husband gets more hugs, and so do I. He can tell me something I did wrong, and I won’t turn and attack him over it. I enjoy spending time with him again, and he enjoys spending time with me. We don’t need to go to a marriage intensive – which is probably a good thing for a marriage counselor. I just needed to quit taking progesterone.

I couldn’t believe how good I felt, and my family couldn’t believe how different I was. My children had their old mother back, and my husband had his old wife back, and it was all just so mind-boggling. So I did another deep dive into hormones to make more sense of what I was experiencing, and I found some interesting tidbits.

According to Dr. Lisa Mosconi (a neurologist who uses brain scans to study the changes to the female brain during perimenopause and menopause), puberty, pregnancy, and perimenopause are vulnerable times in a woman’s life. A lot of brain remodeling is happening in each of those seasons. 

Mosconi explains that the best predictors of how you will handle perimenopause and menopause are the past: pregnancy and puberty. That’s part of why I was so frustrated with my intense mood swings – except for the increased anxiety I experienced during each pregnancy, puberty and pregnancy were relatively easy for me. 

But there was more to the story than that. I did have one difficult pregnancy. I had severe acid stomach, but what was worse than that was my mood. I hated everybody during this pregnancy, which made ministry rather difficult. As soon as I delivered, I literally leaned back in the bed and breathed out, “I think I can love people again.” 

I thought my extreme irritability was due to the hormonal interplay of carrying a girl instead of a boy, but the next time I was pregnant with a girl, my emotions were even-keeled. I was always mystified by this until I learned about the effects of high progesterone. Suddenly the lights went on: I’d had a hard time getting pregnant with my third child and had had to use progesterone to get pregnant. I was not a nice person to live with that year.

According to Dr. Mary Claire Haver, board-certified Ob-Gyn, we experience a mini perimenopause each month of our cycles as the ratio of estrogen to progesterone changes and we feel what equates to an estrogen dip due to the rise of progesterone. Our estrogen feels lower, relatively speaking, and therefore whatever symptoms we feel premenstrually are likely to be magnified during perimenopause. For me, that’s irritability, rage, and anxiety. 

Dr. Mosconi says the brain experiences changes early, before a woman’s periods change. And changes to the menstrual cycle can come as early as a woman’s late 30s (they did for me). This made me wonder if my troubles with yeast infections and OCD were related to the hormonal changes of perimenopause, but I can’t know for sure. I do know that the anxiety caused enough suffering on its own. And I have heard multiple menopause doctors explain that for many women, the first sign of perimenopause is an increase in anxiety – either the onset of new anxiety or the worsening of already existing anxiety.

All of this information is highly interesting, but it isn’t inconsequential. My family suffered deeply when my progesterone levels were high. My maternal love just disappeared, and my kids wondered what happened to their nice mommy. My husband thought I’d left him, emotionally speaking, possibly forever – which was a double whammy after wondering if I’d disappeared forever into OCD-brain in 2019. 

The good news is, the wicked witch of the west isn’t the real me. The bad news is, my family still had to live with that cranky woman for eight or nine months. Clearly not every woman does great on progesterone, and I’m one of those women. I just wish people talked about this more.

Because it matters deeply. Our hormones are integrally connected with our faith. This year on Easter, we sang “Because He lives, I can face tomorrow . . . and life is worth the living just because He lives.” But it’s hard to believe those Easter truths when your neurotransmitters are off. God wants to connect with us in our minds, but it’s hard to do that when your internal chemistry has deviated from the original created order.

I’m so thankful for my midwife. She gave me back my marriage and my family, and six Trotters will be forever grateful.

Sources:
Estrogen and Brain Health (interview with Dr. Lisa Mosconi) 
The Wisdom of the Menopause Brain (Dr. Aviva Romm interviews Dr. Lisa Mosconi) 
How to Lose Belly Fat, Sleep Better, and Stop Suffering Now (interview with Dr. Mary Claire Haver)
Mary Claire’s YouTube channel
Dr. Barbara Taylor’s YouTube channel