Period 23: Getting insomnia just in time for this Cape Cod book event
I’m still on vacation but this week is the not-vacation vacation, meaning we put our youngest in camp so we could actually work during the day. My partner and I were getting pretty twitchy about the volume of unread email (still largely unread) and all the projects we weren’t working on (making a little progress). It turns out I actually like what I do so if I spend too many days away from it I get sad.
I drafted the first half of my next book and sent it off to my editor weeks ago. But I have been flailing a bit in terms of which direction to go in for the second half. I have about ten different things I want to write about, then I try to remember the overall big idea and direction of the book, then I get flustered because which of the ten is the right one to work on next? Yesterday I re-read that first half to get a feel for where the heck I was going, and today I think I finally have some ideas about what I need to read on stratified reproduction and compulsory motherhood to frame out the chapters and the science. Stratified reproduction is this concept that reproductive expectations are influenced by race in particular, but also other categories like disability. I write about it a bit in PERIOD: the idea that white women’s fertility has to be protected, while the fertility of most other people has to be contained. It shows up in how people are treated in gynecology offices, how easy or hard it is for certain people to get hysterectomies, the different ways people are judged if they have abortions versus miscarriages, and more. So, onward!
Now I have two book event updates for you!
1. Come see me Tuesday! That day I’m on The Point, which is a radio show put out by WCAI, but I’ll ALSO I’ll be at the Titcomb Bookshop in Sandwich MA that same night at 6:30pm. Here’s the even better news: for both I’m being interviewed by my sister, Liz Lerner! As you might imagine we have a pretty good rapport so the radio interview is great and I suspect the book event will be as well. (Please note the event is free but you do have to register!)
2. My Women and Children First event in Chicago Illinois with Heather Corinna has been rescheduled for Friday September 22nd. I’m so excited about this one, more details soon!
Links
So, the Try Guys have tried the period cramp simulator. I have to admit, I don’t necessarily love most of the videos that I have seen on this – cramp simulators overfocus on negative symptomology and put menstruating people on a pedestal as amazing humans who endure unspeakable pain. They’re also usually a fly by – ramp up the pain, see some very masculine people not endure it, laugh at them for being wimpy. Which, hello, that’s sexist because what we’re laughing at is masculine men doing something we don’t think of as masculine.
The Try Guys did something a bit different. In addition to trying mild, medium, and strong cramps, they actually talked to menstruating people they work with about their experiences. They had a menstruating person explain how often they went about their day with cramps. And then they spent a decent part of their work day wearing the cramp simulator. By wearing it for a longer period of time they really seemed to understand what it means to experience chronic pain in a world that forces you to go about your day as though nothing is happening in your body. They also have a great interview with Dr. Jennifer Lincoln who explains some of the science. I honestly think this video is worth a watch!Another look at chronic symptoms, but this time on fatigue in long COVID and ME/CFS, Ed Yong has written a lovely piece (as usual) for The Atlantic. He talks to researchers and patients, compassionately detailing what “fatigue” really means to people with these conditions… and how problematic it is that we do not have a coherent definition of the term within clinical science.
Agustin Fuentes has a recent piece up in Science: “Systemic racism in science: reactions matter” that is worth a read. This piece is largely in response to the Supreme Court’s trash ruling on affirmative action and how universities have responded. Also worth a read: the PNAS article he cites lead by Joseph Graves Jr (and co-authored by Maureen Kearney! Gilda Barabino! Shirley Malcom! A dream team!). I appreciate the continued attention on racism in major science publications even as I wonder what material efforts those publications are making towards positive change.
Weird period fact: estrogen and sleep
If you’re an occasional sufferer of insomnia like me, read this weird period fact!
It started maybe seven years ago. I’d wake up at one o clock, two o clock, maybe even three. Did I startle from the house settling? An alarm? Did I need to pee? Usually it was nothing, but I was wide awake, often for hours.
I’ve tried all the things people tell you to try: sleep meditations, good sleep hygiene, blackout curtains, getting up and doing something until you feel tired again. But when I get a bout of insomnia very little seems to help. And if anything, the harder I work to get back to sleep, the more elusive it seems to be.
Over the last year, as my insomnia has worsened I’ve also started to develop night sweats. Helloooo, perimenopause! I’ve had night sweats at other points in my life, especially in the year or two I was lactating after both my kids’ births. I’ve even written about it. So I knew the night sweats were vasomotor symptoms that were likely a combination of my lactation, how that affects my ovarian hormones, and the fact that I was exercising close to bedtime.
This time around, I wasn’t lactating or exercising too late at night. Instead, I’m older. So out of curiosity I started tracking when my insomnia seemed to be the worst. Almost without fail it happened the few days before my period, with other bouts sprinkled in if I was especially stressed about something the day before. Night sweats are a bit more diffuse – they seem to be worse in the winter, when I bundle up a ton for bed because our house is freezing, and then overheat.
So as usual, I went to the literature. There is a recent systematic review that looked at estrogen, progesterone, as well as synthetic forms of both from hormone replacement therapy, and their relationship to sleep. As suspected, most of the high quality studies with objective measures of sleep quality do show that the lower your estrogen and progesterone, the worse your sleep. And if you are perimenopausal or menopausal, hormone replacement therapy (on the lowest possible dose, and only if not contraindicated by family history) can improve insomnia. Most of the studies pay more attention to estrogen than progesterone, and it does look to be a bit more of the driving force between the two hormones.
As I share in PERIOD and have in past newsletters (number 19), in the perimenopausal period estrogen is often higher, not lower, than your earlier years. So what gives? As the authors point out, several studies have shown it may not exactly be the quantity of estrogen that is affecting quality of sleep but how much it declines. So if my estrogen at its peak at midcycle is higher than it’s been in my younger cycles, the decline I experience is going to be sharper. This is also suggested by the fact that people who have their ovaries removed tend to have harsher sleep disruptions than those who go through natural menopause.
Certainly if your insomnia is really terrible and greatly interfering with quality of life you should see your doctor and talk through treatment options. For me, where insomnia is intermittent and I’ve built up a decent way of managing it, it’s just helpful noticing the pattern of when it happens. Because then when I do have a few days in a row of insomnia, and it’s in the days before I get my period, I also know it’s almost over and better sleep is on the way. This knowledge helps calm my brain and not catastrophize my lost sleep. Like this week, when I’m due for my period soon, and have that book event in a few days where I’d really like to be coherent…
But we’ll see if my opinion on this changes as I continue to age!
Source: Haufe, A., Baker, F. C. & Leeners, B. The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review. Sleep Medicine Reviews 66, 101710 (2022).