The Highly Sensitive Person & Perimenopause
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With diminishing estrogen, or rather, the roller coaster of its fluctuating levels during perimenopause, anything can happen, and not just to the hormonally targeted female organs and tissues. While changing menstrual patterns and flows are inevitable, the most common complaints are hot flashes, insomnia, vaginal dryness, and mood changes, the latter referring to depression (new, reappearance, or worsening of current) and anxiety as well as their cousins, irritability and prickliness.
Shrinking estrogen levels also cause a narrowing of the thermoneutral zone in the hypothalamus (a region in the brain) which causes one’s range of comfortable temperatures to become smaller. Not only that, but lowered estrogen increases sympathetic nervous system tone (“fight or flight”) and enhances the thermoneutral zone’s sensitivity to norepinephrine, a neurotransmitter which is released more readily with this higher sympathetic tone. So, what happens with these changes? The onset of hot flashes, new or intensified anxiety, and maybe, palpitations, too! Another lesser-known consequence of diminished estrogen is loss of its mild anti-inflammatory influence which may account for random achiness and vague discomfort.
Because of these effects, I wonder if diminishing estrogen doesn’t heighten sensory perceptions in women, especially those who are highly sensitive persons to begin with, an under-recognized personality trait. But first, what is a highly sensitive person (HSP)?
HSPs are individuals who are more sensitive to sensory stimuli (visual, auditory, olfactory, food texture and taste, temperature, and touch) than most people. They may also be hyperaware of the moods, feelings, and opinions of others. Growing up, they are often told that they are too sensitive to remarks or criticism, undermined about their sensations (how it’s not so bright, so loud, so hot or cold), and questioned about refusals to eat certain foods, wear uncomfortable (to them) clothes, or enter places with many scents. They may require smaller doses of medications and are quite responsive to caffeine. Indeed, even before perimenopausal hormonal shifts, many HSPs have high sympathetic tone and startle easily. Moreover, crowded settings, violence, and chaotic situations are physically and emotionally draining, and indeed, HSPs are thought to be more prone to developing PTSD than neurotypical persons. The sensory, emotional, and social sensitivities may all occur in a single individual, but not always, and the sensitivity to any of these elements varies individually.
HSPs often mask their feelings to offhand remarks (was that disparaging?), criticism, or being told that something troubling them isn’t a big deal. HSPs can be introverted or extroverted, but like introverts, they may need more “down time.” Social anxiety is real for many, as is depression. That said, being overwhelmed from sensory overload is often misinterpreted by others as anxiety. In these cases, the individual often has difficulty verbalizing their discomfort and instead, might have a “meltdown” or explode when what they need is an escape from overstimulation.
Whether an HSP considers their hypersensitivity to be a weakness or an advantage depends on their upbringing, life circumstances, and current situation. They often feel like they are the proverbial “canary in a coal mine,” written off as a complainer or an outlier until something is measurable or noticed by others. As patients, they often feel early discomfort or that something is off long before a physical exam or testing shows anything. Unfortunately, they are routinely told that nothing is wrong, and that they are just anxious. Many times, a problem is simply due to being very sensitive and reacting strongly to neural input, but on occasion, as symptoms ramp up (or don’t go away), they are finally taken seriously with further testing finally revealing a diagnosis.
This neurologic difference in sensitivity is an example of neurodiversity, a concept first introduced about 25 years ago. Learning about this as I researched my book (The Hot Flash Diet), I couldn’t help but question how being highly sensitive impacts the presentation of perimenopausal complaints. Does the thermoneutral zone of HSPs narrow more than that of others? Do female HSPs experience more frequent and intense hot flashes and night sweats? I imagine that being acutely aware of ambient temperatures compounded with a newly narrowed thermoneutral zone and the high sympathetic tone that already accompanies having multiple sensitivities creates a scenario for intense hot flashes, likely over a prolonged period. What a hellacious experience! And who knows what other sensibilities become more keen?
Becoming aware is more than half the battle. Realizing the neurodiversity of sensitivity for the first time is eye-opening when you recognize this trait in yourself or someone dear. Hopefully, it will allow you to be gentler with yourself or the loved one and improve communication with family members and friends in times of overwhelm when “alone time” or a “time out” is needed. It can lead to a better understanding of the self or other person and past interactions, perhaps leading to acceptance, forgiveness, and future planning. Getting enough sleep and practicing meditation and paced breathing can all reduce the “fight-or-flight” response and may also temper the sensitivities. Moreover, these sensitivities to pain, other sensory stimuli, or medications should be discussed with physicians and taken into consideration with medical care.
Although internists and family practitioners are learning more about the menopause transition, a gynecologist or menopause specialist may still be the best doctor to ask regarding symptoms of perimenopause, especially if they seem overwhelming to you. You can find a menopause practitioner by going to the North American Menopause Society website.
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I am a retired primary care MD who now has time to write about the menopause transition, health, nutrition, food, and other random topics. If you like this story, sign up to get the next ones emailed to you. (No spam.) Look for the envelope with a plus-sign button below.
You can also check out my website, www.hotflashdiet.com, for more information about my as-yet-to-be-published book (The Hot Flash Diet), recipes, and other topics about the menopause transition.
