Perimenopause can be a confusing time for many women. It can also be a challenging time for many healthcare providers who are not familiar with the symptoms associated with perimenopause. Very often many women are misdiagnosed for several years, resulting in much unnecessary emotional stress and pain.
What is perimenopause?
Perimenopause refers to the time during which a woman’s body makes the natural transition to menopause, marking the end of the reproductive years. Simply put, perimenopause means ‘around the time of menopause’. The time when premenopausal symptoms begin varies tremendously. A woman may notice signs of progression toward menopause, such as menstrual irregularity, sometime in their 40s, but some women notice changes as early as their mid-30s. Once a woman has gone through 12 consecutive months without a menstrual period, she has officially reached menopause, and the perimenopause period is over. Many of the changes a woman experiences during perimenopause are a result of decreasing oestrogen.
Symptoms of the perimenopause
Most women will experience some form of perimenopausal symptoms prior to the menopause. Some of these symptoms might be subtle and some not-so-subtle. Women might experience the following:
• Irregular periods. The length of time between periods may be longer or shorter, the flow may be light to heavy, and the woman may skip some periods.
• Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
• Mood changes. Mood swings, irritability or increased risk of depression, may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.
• Vaginal and bladder problems. When oestrogen levels diminish, the vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low oestrogen may also leave the woman more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
• Decreasing fertility. As ovulation becomes irregular, a woman’s ability to conceive decreases. However, as long as she is having periods, pregnancy is still possible. If she wishes to avoid pregnancy, she should use birth control until she has had no periods for 12 months.
• Changes in sexual function. During perimenopause, sexual arousal and desire may change. If you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.
• Loss of bone. With declining oestrogen levels, a woman starts to lose bone more quickly than she replaces it, increasing her risk of osteoporosis — a disease that causes fragile bones.
• Changing cholesterol levels. Declining oestrogen levels may lead to unfavourable changes in blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — decreases in many women as they age, which also increases the risk of heart disease.
Treatment
There is not any treatment to stop perimenopause. Perimenopause is a natural part of life. There are a number of things a woman can do to manage her perimenopausal symptoms. The following have been shown to be helpful:
1. Be physically active
Staying active and eating healthy foods are beneficial for every phase of perimenopause. Aim for five days a week of 30-60 minutes each day of aerobic and strength training exercise.
2. Make healthy food choices
Nutrition in the form of whole foods (quality protein, vegetables, fruits, complex carbohydrates, and good fats) will help keep blood sugars level. Eliminating or reducing alcohol, caffeine, and sugar may also help reduce symptoms. This can help stabilise moods, and fight fatigue, belly bloat, and weight gain.
3. Medications
Some doctors use drug therapy to treat symptoms. This includes hormone replacement therapy, vaginal oestrogen, and antidepressants.
4. Alleviate hot flushes
Hot flushes are generally managed conservatively with dressing in layers, personal fans and avoiding irritants such as spicy foods. However, moderate to severe symptoms may require medication.
5. Improve Sleep
Try to keep a consistent sleep schedule. Avoid caffeine which can make it hard to get to sleep, and avoid drinking too much alcohol which can interrupt sleep. Treating hot flushes can help alleviate some of these sleep disturbances.
6. Lubricants
Over-the-counter, water-based vaginal lubricants might be used in some patients for vaginal dryness.
7. Herbal medications
A number of herbal medications are available today. Many have not been found to be helpful in clinical studies. Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. Many of these products are not regulated and some can be dangerous or interact with other medications you take, putting your health at risk.
Many women will visit their doctor when symptoms are interfering with their daily activities. If you were unsuccessful in managing your symptoms and symptoms, are severe, it is time to see your healthcare provider.
Conclusion
Perimenopause is the transitional period before menopause. During perimenopause, levels of oestrogen, a key female hormone, start to decrease. A woman may begin having menopause-like symptoms, such as hot flashes or irregular periods, in her 40s. Perimenopause can last for years and ends when menopause begins. There are various ways to manage symptoms associated with perimenopause, especially in women where the symptoms are severe and interfere with daily activities.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty eight years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
