Perimenopause and Verbal Vomiting

Before I meet with a potential hormone therapy patient, I review their chart and look through the paperwork to get an idea of what kind of “shape” they are in, hormonally speaking. The first two places I look is at their clinical indicator assessment questionnaire and their current labs. (The clinical indicator assessment is one of the tools we use in the hormone clinic, along with lab work, to determine the hormonal balance status of a woman.)

When I saw the clinical indicator score and hormone labs of Tori, a 38-year-old single working mother of two, I knew she was not feeling very well and hadn’t felt well for a long time. Her estrogen was non-detectable and her FSH was high.

When I walked into the room to meet with Tori, she was sobbing with her head hanging down squeezing her tear-soaked tissue in her fist.  When she heard me walk in, she hurriedly tried to wipe her tears and pull herself together but wasn’t doing a very good job of it. I said hello to her and handed her a new tissue and asked if she was alright.

“I can’t take it anymore.” She said to me. “I think my children would be better off without me but I don’t want to give up custody to my ex-husband because he’s still drinking. I don’t really want to lose my children but I feel like I’m causing them so much harm and I don’t know how to stop.”

“What makes you think you are harming your children?” I asked as I sat down next to her.

“Because no one is unscathed after one of my rages. It seems as though the tiniest thing can set me off and I can go into a heated rage in less than 10 seconds. It’s almost like I just snap and start verbally lashing out mostly at my children because they are around and can’t leave.”

Tori began sobbing harder after she heard herself out loud. I felt a lump in my throat and my eyes started to water up. I knew exactly what she was talking about from personal experience and from the hundreds of other women who came in before her who said the same thing.

“Did something recently happen?” I asked.

“It happens almost every day so pick the day. But today’s incident was really bad that I question my emotional stability and if my kids shouldn’t be away from me all the time. I think they should be away from me but I just can’t bear the thought of losing them. It’s me they need but they need me to be emotionally healthy and I can tell that I am not. When I know I am feeling this way, I try to make arrangements to have my kids stay at a friend’s house or their fathers for a couple of days while the ‘rage period’ passes so I can protect them against me. What a crazy thing to say, that my children need to be protected from me.” She started to cry again.

Once she caught her breath, she began to tell me what happened before coming into the office. 

“When I go home from picking the kids up from school, they jumped out of the car and started to play in the backyard. While I was collecting backpacks and garbage from the backseat of the car, I noticed a crumbled-up lunch bag belonging to my son. I opened it up and looked inside to see how much of his lunch he ate. I reached in the bag and grabbed a baggie that had a couple of strips of bread crust left in it. What I saw triggered me to lose it. I yelled my son’s name at the top of my lungs to come to where I was. He ran up to me with a look of fear in his eyes because he knew what the tone of my voice meant. I asked him why he didn’t eat all of his sandwich and who did he think he was to waste food like that. I proceeded to completely go off on him telling him how ungrateful he was and what a spoiled boy he was. The words were just pouring out of my mouth with such anger and disdain. As the words just kept coming out, the angrier I got and the louder I got. As I am verbally vomiting on my son, I can see the look of horror in his eyes, his confusion, his disappointment, and his pain. I could see the emotional damage I was causing. I can see his spirit disintegrating right before me. And as I continue to emotionally unload on him, I started to think about the sandwich I made for him that morning and how big it was. It was a large turkey and cheese sandwich, bigger than usual. And I was thinking in my head that he ate that whole sandwich plus other snacks and the only thing left was a measly piece of crust, and then my thoughts turned to how outrageous and out of proportion my behavior was. But I was still yelling at him when I came to the realization that I was out of control but didn’t know how to stop the harsh words that were flowing out of my mouth. Shame started to overcome me and the only way I could think to stop yelling at him was to ask him to get out of my sight. And he did. He ran as far away from me as he could and I could hear him crying in the distance. At that point, I just dropped to my knees and started to weep.”

“I feel so ashamed.” She spoke. I can’t undo what I did to my son today. This happens more times than I would like to admit. I do just as much damage to my daughter but I don’t know how to control myself. My kids are afraid of me. I don’t even know who I am. What I am doing is changing who my kids are because of my behavior. My children do not deserve that. I hate myself for being who I am to them.”

Tori sat there embarrassed with her head hanging low in shame. I wish I could say that I have never experienced something similar to what she just described but I have. And I know many other women are ashamed by their instant rage and the emotional abuse it creates to those in the way.

When things calmed down after Tori finished telling me her experience, I told her there was a reason for her irrational behavior and that it wasn’t all her fault. I showed Tori her lab work and how low her estrogen was then I began to explain what happens to women when estrogen falls too low. 

Why Women Rage

Estrogen is the biggest influencer in mood and feelings in women than anything else. When estrogen is low, women will have a hard time controlling their anger or the brutal words that can flow out of their mouths. They will have mood swings, rage tendencies, and responses that are not proportionate to the situation at hand. Rational thoughts go out the window. Women without estrogen can fly into a rage at the drop of a hat. They do not like themselves much and develop self-distrust because they never know how they are going to behave or what might come out of their mouths. It is one of the reasons women isolate themselves from others they don’t want to damage with their words or behavior. Women without enough estrogen are guaranteed depression and anxiety and irrational behavior. When a woman cannot depend on themselves, they lose self-respect, self-esteem, self-confidence, and self-worth. They tend to develop self-hatred and self-loathing and because they can’t stand who they are, they go on some sort of psychotropic drug to numb up so they can tolerate living with themselves.

Estrogen influences absolutely everything in the female body right down to the core of every cell, including serotonin and dopamine production, as well as norepinephrine. Serotonin and dopamine are mood regulators and are strongly dependent upon adequate circulating estrogen levels to function the way they are intended. When estrogen is too low, so too will be serotonin and dopamine. When women lose estrogen, serotonin, and dopamine, it is a recipe for mental and verbal disaster.

I went on to tell Tori that she will never go into another rage once her estrogen levels were restored and went on to tell her a bit about the benefits of having plenty of circulating estrogen. Estrogen is the mental calming hormone in women, even more than progesterone. When women have enough estrogen, responses are proportionate to the situation at hand. Irrational behavior and emotional outbursts are not a part of an estrogen sound woman’s life. In fact, there is a higher level of confidence and contentment women experience with enough estrogen. A woman’s ability to cope and handle things that come her way increases allowing women to experience a level of secure well-being and self-trust.

I worked with Tori for a few months as I helped her get her hormones balanced, and it was quite a transformational journey for her, as it is for most women. If I do my job right, a woman gets her hormones balanced they go on with their life with very little to complain about. Once hormones are finally in the Hormone Sweet Spot^™, I typically don’t see the patients but once every four months.

When I saw Tori in the hormone clinic a few months later, I asked her how she was doing on the hormone therapy. She said, “I can’t believe it was estrogen all along that I needed. It kind of makes me mad that for many years I was told I had mental illness and that I needed psychotropic drugs to manage my horrible behavior. You were right, I have not had a mood swing or raged-out since getting enough estrogen. I can’t believe that was once my life. It took me a while but I have built back my relationships with my children and they can trust me again. Just that alone is worth so much to me.”

Verbal vomiting is a forceful and continuous stream of many hurtful, hateful, angry, insulting, personal verbal attacks, and is emotionally abusive no matter who it is aimed at. I have never met a woman who was proud of herself after an emotional verbal vomit. In fact, a great deal of shame and embarrassment tend to contribute to the already low self-esteem that estrogen deficiency brings.

Perimenopause is a time in a woman's life when estrogen begins to decline and because of this decline, women are more susceptible to mood disorders, emotional disorders, behavioral disorders, and 85% of other mental health issues women are told they have to live with. And perimenopause is occurring at younger and younger ages. We see women in the hormone clinical as young as 32 go into Stage I perimenopause. And perimenopause and its side effects are preventable and reversible for most women. 

Verbal vomiting is abusive and can be a frightening feeling to not have the ability to control the things you say or do but it is very common in women with low estrogen no matter how old they are. If it feels like you are verbally vomiting over the ones you love and sense it may be your hormones, I encourage you to participate in my signature program Balance Your Hormones. I can help you get your hormones balanced and keep them balanced so you may never verbally vomit again. There is no reason a woman should ever have to be a prisoner to her own emotions and tongue as long as estrogen is around.

_Reference:

_{Amin Z, Canli T, Epperson CN. Effect of estrogen-serotonin interactions on mood and cognition. Behav Cogn Neurosci Rev. 2005 Mar;4(1):43-58.}

_{Craig MC, Cutter WJ, Wickham H, van Amelsvoort TA, Rymer J, Whitehead M, Murphy DG. Effect of long-term estrogen therapy on dopaminergic responsivity in post-menopausal women--a preliminary study. Psychoneuroendocrinology. 2004 Nov;29(10):1309-16.}

_{Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015;57(Suppl 2):S222-S232.}

_{“Estrogen Deprivation Leads To Death Of Dopamine Cells In The Brain.” ScienceDaily, https://www.sciencedaily.com/releases/2000/12/001204072446.}

_{Li RX, Ma M, Xiao XR, Xu Y, Chen XY, Li B. Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine (Baltimore). 2016;95(32):e4466.}

_{Musial N, Ali Z, Grbevski J, Veerakumar A, Sharma P. Perimenopause and First-Onset Mood Disorders: A Closer Look. Focus (Am Psychiatr Publ). 2021 Jul;19(3):330-337.} 

_{Sammel MD, Freeman EW, Liu Z, Lin H, Guo W. Factors that influence entry into stages of the menopausal transition. Menopause. 2009;16(6):1218-27.}

_{Serova L, Rivkin M, Nakashima A, Sabban EL. Estradiol stimulates gene expression of norepinephrine biosynthetic enzymes in rat locus coeruleus. Neuroendocrinology. 2002 Mar;75(3):193-200.}