What Is the Perimenopause?

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Written by Allen Lawrence, M.D.

Thursday, 04 November 2010 07:28

The perimenopause is the time leading up to the menopause. During the perimenopause many women will start to notice menopause-related changes in their physical and emotional life. This is also the time when meany women think of "being in menopause" or "going through menopause." But menopause itself is only a one day period of time, when a specific woman has not had a menstrual period after twelve consecutive months. During perimenopause, the woman’s ovaries begin to shut down, she is making less of estrogen and progesterone hormones, and she is beginning to lose the ability to become pregnant. Both the perimenopause and the menopause are natural parts of aging and signal the end of the woman’s reproductive years. The perimenopause can last for years often starts in the mid 40's and is generally over by early to mid 50's. It can start however, as early as the mid 20's or as late as the mid 50's and it always ends one year (12 months) after the last menstrual period, whether that period was normal or irregular. The Length of the perimenopause will vary from woman to women.

What Are the Signs and Symptoms of the Perimenopause?

The perimenopause affects every woman differently. For some women the only symptoms may be that their menstrual periods have stopped. Other women may have many symptoms and a great deal of discomfort. Often symptoms associated with the perimenopause are confused and are more related to the specific time of life they are going though or are simply symptoms associated with getting older. There are however, specific symptoms associated withe the approach and onset of menopause. Menopause-related symptoms often experienced during perimenopause may include:

Changes in pattern of the woman’s menstrual periods (the periods can be shorter or longer, lighter or heavier, and there can be more or less time between the onset of menstrual periods)
Hot flashes and/or hot flushes (sudden rush of heat into the upper body and extremities)
Night sweats (hot flashes that happen while you sleep), often followed by a chills and/or sweating.
Difficulty getting to sleep or staying asleep through the night (with or without night sweats)
Vaginal dryness
Mood changes and mood swings, positive and negative, crying (due to hormonal changes and/or lack of sleep)
Difficulty focusing, feeling confused, mixed-up or out of sorts
Hair loss or thinning of head hair, increased growth of hair on the face, change is thickness of the hair on extremities.

The symptoms experienced by any one woman may be different from hour to hour, day to day or week to week. It may help to keep a diary of what’s happening with your period and your symptoms so that sense can be made out of the changes you are experiencing. Take your diary along with you when you visit your doctor so if he or she has questions you will have answers. Note all symptoms, their length, timing and intensity.

How Is the Perimenopause Treated? What Can I Do On My Own?

There are a number of lifestyle changes you can make to help you ease your symptoms and keep yourself healthy:

Eat Healthy — Eat a healthy diet. This is very important as you can help relieve symptoms cause by low blood sugar or nutritional deficiencies by eating a well-balanced healthy and nutritious diet. Avoid processed and refined foods, limit alcohol to no ore than one drink daily. A healthy diet will also help you reduce the risk of osteoporosis (extreme bone loss) and heart disease which begin to go up during this stage of life. Eat lots of whole-grain foods, vegetables, and fruits. Add calcium-rich foods (milk, cheese, yogurt) or take a calcium supplement to obtain your recommended daily intake. Get adequate vitamin D from sunshine and also take a vitamin D supplement at least 5,000 IU of vitamin D daily. Avoid alcohol or caffeine as they both can trigger hot flashes in some women. Another supplement you will want to start immediately is magnesium (start with 200 mg of amino acid chelated magnesium daily and every week increase another 200 mg each day, until you either reach 1,000 mg daily or you experience diarrhea. If you experience diarrhea reduce the dosage you take daily by 200 mg or until you have no more diarrhea, wait a week or two, and then restart magnesium going up again by 100 mg daily every two weeks until you either reach 1,000 mg or nothing you do stops the diarrhea except go down to the next lowest dosage, which in this case would be the highest dosage you can comfortably take. Do not stop taking magnesium, as it will help to direct calcium into your bones and reduce your risk of osteoporosis. Just find the highest dosage you can take and not suffer from diarrhea.

Create a Regular Exercise Program — Get Moving. Regular exercise helps keep your weight down, helps you sleep better, makes your bones stronger, and boosts your mood. Try to get at least 30 minutes of exercise most days of the week, but let your doctor recommend what’s best for you.

Find Healthy Ways to Cope with Your Stress — Consider meditation or yoga as both can help you relax, reduce stress and handle your symptoms more easily. Avoiding alcohol and caffeine will also help as they tend of only work for short periods of time to reduce stress and then, if the conflict causing the stress has not been resolved. will allow a rebound reaction.

Medical Treatments

Tranquilizers, Mood Elevators, Anti-Depressants and Hormones

Many doctors treat perimenopausal symptoms using tranquilizers, mood elevators, and anti-depressant medications. They can help. In many cases they are actually called for, however, they are really only covering up symptoms and not treating the causes. Many are addicting and once started addiction may become a problem. There are two main causes for mood swings, depression or emotional instability in perimenopausal women. One, hormonal imbalances and two, emotional imbalances, unresolved conflicts, excessive stress. In some women both can happen at the same time.

The perimenopause is a time of great hormonal upheaval, so if depression, mood swings, crying are caused by “raging hormones” or hormonal deficiencies, there is only one real treatment, rebalance the hormones. This can be done using bioidentical hormones or by using birth control pills.

Some women take birth control pills ("the pill" or oral contraceptives) to ease perimenopausal symptoms. Generally we suggest that women who are still menstruating (regular or not), having regular sexual relations, do not have a tubal ligation (had your tubes tied) or their partner has had a vasectomy and pregnancy is a possibility, birth control pills are the treatment of choice. Since these women can get pregnant and they can be helped with hormones, birth control pills solve two problems at the same time. Many women believe that they cannot get pregnant during this period of time.....they are wrong. It happens all the time. So, if pregnancy is going to be a problem, and hormones are needed birth control pills are perfect for both problems.

If you have had a tubal ligation, your partner a vasectomy, or if you have had a hysterectomy, with or without removal of your ovaries, and therefor pregnancy is not an issue, then bio-identical hormone replacement therapy is the way to go.

We strongly advise against taking Premarin with or without Provera. While Provera may have some benefits in inducing menstruation it should not be used for greater than 3 months for treatment of perimenopausal (or post menopausal) symptoms. It can and does increase the risk of breast cancer and heart disease in women with prolonged use.

Birth control pills may well induce or help keep your periods regular as well as ease your symptoms listed above. You should talk with your doctor to see if this option is for you. If you are over 35, you smoke or have a history of blood clots, then you should not take birth control pills.

Birth control pills should be continued for at least one year to 18 months after you stop having regular menstrual periods. If birth control pills continue to cause you to have “periods” (most commonly withdrawal bleeding) then at age 55 you can stop them, continue to use an alternative method of contraction such as condoms or diaphragm, or use an IUD, and then begin bio-identical hormone replacement therapy. Once you have reached menopause, whether or not you have menopause symptoms, we suggest switch from birth control pills to bio-identical hormone therapy (HRT). HRT contains much lower doses of estrogen and progesterone and thus reduces your risk for side effects associated with the birth control pills.

Can I Get Pregnant While in Perimenopause?

Yes, you can get pregnant until you’ve gone at least 12 full months in a row without a period. If you have been spotting regularly or irregularly we suggest using one or another method of contraception for at least 18 months. Talk to your doctor about your birth control options. Keep in mind that birth control pills, shots, implants, or diaphragms will not protect you from sexually transmitted venereal diseases nor HIV. If you are having sexual relations with a committed monogamous relationship this should not be an issue, but if you change partners or have open sexual experiences have your partner use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms also do not provide 100% protection against transmitted venereal diseases and HIV– the only sure protection is abstinence (not having sex of any kind) or being in a committed monogamous relationship. But making sure to always correctly use latex condoms or other barrier methods can help protect you from transmitted venereal diseases and HIV.

For more information about Contraception, click here.

For more information about Menopause, click here.

For more information about Osteoporosis, click here.

For more information about Sexually Transmitted Diseases, click here.