Perimenopause and Burnout 

KevinMD article from September 20, 2019 

I am an experienced OB-GYN, well-versed in Obstetrics, Infertility, Gynecology, Surgery, and yes, Menopause, or so I thought. So why was I so blind-sided by my own menopause transition?

I thought I was going through burnout, with anxiety, anger, mood swings, irritability, and depression. I was at a point in my career as an ObGyn of 20+ years that patients flocked to me because of my reputation, and expected me to deliver their babies. After all, I had delivered 99% of my own patients over the past 15 years, 24/7/365. Yet, I had become torn between my career obligations and my family obligations. My two adolescent children needed me to chauffer them and assist them in all things teenager: soccer, piano, homework, dinner- all these things required my attendance and participation. Yet, I would commonly get paged out of dinners, soccer games, and personal appointments, and I assumed this had all just caught up with me. I was miserable, and I let everyone know it. My office staff walked on egg-shells around me, and I was confronted by my partner about my attitude.

But, why had these things become so overwhelming to me "all of a sudden" at the age of 50?

As the aforementioned experienced Ob-Gyn, I, of course, managed my own medical care. Not that I could do my own pap smears, but I did order my own mammograms, and prescribe my own birth control pills, thyroid medication, allergy meds, etc. I had been taking OCPs continuously for many years to avoid menstrual migraines. So when I reached 50 and started having anxiety (and hot flashes, by the way), I didn't think it was perimenopause. Because, after all, isn't perimenopause due to estrogen fluctuations? And I was taking estrogen, so my levels should be very steady, right?

Well, what do we really know about perimenopause? Estrogen levels can actually be higher than usual, ovulation is erratic, so progesterone is low, periods are all over the place, "vasomotor" symptoms (hot flashes, night sweats) can occur. And what is the treatment for perimenopausal vasomotor symptoms? Well, isn't it estrogen? So, I couldn't understand why I was having these symptoms. I assumed it must be new-onset anxiety, related to my career vs. family mental turmoil. Who knew that vasomotor symptoms of menopause are more than just estrogen-related?

Try as I might, I could not find reliable information. But, since we do treat patients with SSRIs, and SNRIs for hot flashes, how can they be effective? Hmmm, maybe there are other neurotransmitters and hormones besides estrogen involved...

So, what did I do? First, I took a week-long excursion to the Life Enhancement Center at Canyon Ranch in Tucson. I did some true soul-searching about what I wanted and needed in my career and life. After that, I sought therapy, I learned to meditate (sort-of), and I started Zoloft. Ultimately, I decided to stop doing Obstetrics to alleviate the constant turmoil I felt between my (albeit self-imposed) obligations to patients and my role as mom and wife.

As I have come through the other side of this journey, now at age 56, and after doing much research on both burnout and menopause, I have come to the conclusion that my burnout symptoms had a LOT to do with perimenopause. I have since transitioned to menopausal hormone therapy, and still have occasional hot flashes, although tolerable. I also still have occasional pangs of anxiety, although much less. I have learned to do deep breathing and meditation to control these feelings. And, I am sleeping great, since I am no longer taking OB call. I no longer feel the pull of patient vs personal health and family. I no longer get PTSD at the beeping of my pager, because I no longer carry it.

We still have a lot to learn and to do in dealing with the physician burnout epidemic. For women physicians, and the coaches, therapists, and counselors who see them, please be aware that hormonal changes can be a strong contributor. This includes women who are postpartum, or who are perimenopausal. I hope that my story will help women physicians, as well as their loved ones and colleagues, recognize the impact that hormonal changes can have on feelings and attitudes about work and career. Knowledge and empathy can go a long way to helping women cope with these issues.