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Have these started for you yet? I remember my first month of getting them every once and awhile and in my practice most of my female patients complain of having them.

Night sweats occur as our hormones change during the month and through the years. Early in our menstrual life, our estrogen decreases prior to the onset of our period (bleeding), during the days leading up to our period we can have night sweats as part of PMS.As the years go by, we learn to live with the few days that interfere with our sleep, but then leading up to menopause perimenopause happens (8-10 years). Night sweats begin to increase which causes more sleep issues, finally we get tired of not sleeping and start to ask questions. Many products are on the market today for night sweats, for example, cooling mattresses, cooling pillows, cooling sheets, even cooling night gowns, but our search continues to find a solution.Increasing night sweats are often due to decreasing estrogen and more irregular patterns of estrogen loss as well as lower levels of other hormones, specifically AMH and Inhibin B.

Women also start to lose progesterone. Progesterone is the most important hormone during perimenopause and takes priority in my prescribing for women prior to menopause. Most of the patients that I see in perimenopause report three goals in seeking bio-identical hormone replacement therapy (BHRT); sleep, weight, and energy. Can you relate?Progesterone is like nature’s Ativan, it controls our mood, sleep, and offsets the effects of estrogen to regulate cycles and monthly bleeding. If a woman has too much estrogen and not enough progesterone the effects can be harmful, for example, heavy menstrual bleeding can lead to iron deficient anemia. (I will talk about the importance of a healthy ferritin (iron) level in a future column.)

Progesterone can be administered in a variety of ways, the most prescribed progesterone is Prometrium (a small capsule taken at bedtime), Progesterone slow release (compounded capsule), progesterone cream, and progesterone as an injection. I typically prescribe the first two, Prometrium and Progesterone slow release, for many patients the results are as expected; improved sleep and mood and decreased monthly bleeding.Let’s talk about a case example this week. Mrs. Smith is a 46-year-old female who complains of lack of sleep, decreased energy, heavy monthly periods, irregular moods throughout most of the month, and increasing fatigue. She is at her wits end with sleep and feels hopeless and helpless about her moods, admitting to dark thoughts some days. She feels that she is unable to work most days but forces herself as she needs the money. After several discussions and labs results, she is found to have low progesterone, low testosterone, low iron, and high estrogen. She is diagnosed with perimenopause.Let’s talk more about this patient’s sleep pattern, she finds it hard to get to sleep even though she is exhausted at the end of the day. When she finally gets to sleep, she wakes at 3 a.m. unable to get back to sleep. She stays awake for at least two hours, finally able to get back to sleep only to have the alarm ring a few hours later. She wakes up feeling unrested. She is prescribed Prometrium (progesterone) 2-3 capsules at bedtime, after a month she reports improved sleep, able to get to and to stay asleep. She feels much more rested. Other positive results after being on Prometrium for three months include a stable mood, decreased monthly bleeding, and increased energy. She feels joy in her life again and her dark thoughts have stopped. The other hormones prescribed for this patient included testosterone cream, iron at supper time, and Dim supplement to decrease estrogen levels.Other symptoms of low progesterone include frequent headaches, chronic bloating, anxiety priority to your period and severe PMS. We will dive into these symptoms in future columns.If sleep is a problem for you and/or you are having other symptoms of low progesterone, stop wasting money on products and supplements that aren’t working. Reach out to Tammy at Happy Hormones East to book your initial consultation and blood work. We can help!

Tammy O’Rourke is a Nurse Practitioner with a Ph.D. in Nursing. She spent the first 20 years of her career in primary care. About seven years ago she started having symptoms of several hormonal imbalances, for which her doctor prescribed medications to address anxiety, depression, and sleep issues. These medications left her feeling numb, more tired, and angry at a system that wasn’t addressing the root cause. Tammy was in perimenopause, that 8–10-year period before menopause that leaves women feeling tired, out of control, moody, lacking in self-confidence, and unwell.

She made the move to invest in her health and discovered bio-identical hormone replacement therapy, which helped significantly with her symptoms. So much so that she decided to learn more about hormones. She became certified in the United States through World Link Medical and she has been helping men and women with their hormone problems for more than four years. Tammy is passionate about her hormone practice and continues to help women and men across the country.

She recently relocated to Cape Breton Island with her husband, who grew up in The Pier.


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