For women, the transition through perimenopause to menopause is a time of major hormonal fluctuation. The phases are often confused with each other, but true menopause is when a woman has not menstruated for a full year. Perimenopause is the phase leading to menopause and lasts an average of four years, although it can range from a few months to 10 years. A woman’s body typically begins to start the perimenopause process at age 35.
Perimenopause usually begins between the age of 35 and 50 when the ovaries begin to produce less estrogen. The imbalance of estrogen and progesterone often results in missed periods as well as side effects like hot flashes (the most common side effect of perimenopause), fatigue or low energy, difficulty sleeping, decreased libido and what some women call “PMS plus” —instances when pre-menstrual side effects worsen.
Like many transitions, perimenopause can be physically and emotionally challenging. There is no quick fix for troublesome side effects but many women find relief in lifestyle changes that improve overall health, including:
- Adding moderate exercise to your daily schedule
- Improving nutrition
- Avoiding smoking and alcohol
- Reducing stress
- Increasing water intake
- Practicing good sleep hygiene
Hormone replacement therapy (HRT) and bioidentical hormone therapy (BHT) provide side effect relief for some women. These therapies help balance hormone levels that vary throughout perimenopause. However, using hormones to control symptoms are NOT mandatory. The first question to ask is, “how much do my symptoms affect my daily life?” And if the answer is not at all, then no hormones are needed at that time. The fluctuations of the hormones are like the waves of the oceans. Symptoms are variable depending on lifestyle habits, stress during that particular period in your life, weight loss or weight gain, climate and weather changes and Mother Nature.
Even though menopause is the official ending of your menstrual periods, the hormone fluctuations that created side effects during perimenopause are still occurring, meaning that some perimenopause symptoms may remain (or return) and new side effects could appear during menopause.
Once women reach menopause they are at greater risk for developing osteoporosis, a disease that weakens bones. The post-menopausal drop in estrogen is directly related to loss of bone mass. Because there are no symptoms of bone loss, it’s often only after a bone-related injury that the presence of osteoporosis is discovered. Bone mineral density tests (BMD) are x-rays that measure bone density. Screening should begin if you have any of the following risk factors or at the cessation of the menstrual cycle. The following puts you at a higher risk of developing osteopenia or osteoporosis:
- Advanced age
- Your race – Caucasians and Asians have a higher prevalence of osteoporosis
- Family history of osteoporosis
- Body frame – people with petite frames can have a higher risk because they often have less bone mass to begin with.
Likewise, your doctor can offer osteoporosis treatment and prevention suggestions which may include:
- Eating foods high in calcium
- Calcium and vitamin D supplements
- Bone density medications
- Estrogen therapy
- Exercise, especially weight bearing exercise
- Medically Supervised Weight Management
- Avoiding smoking and alcohol
Health Care Options for Perimenopause and Menopause
Perhaps one of the most important things to know about perimenopause and menopause is that you aren’t alone. Approximately three million women transition to menopause every year and there are abundant health care options for both phases. Each woman will enter this phase in her life. During these transition years, remember that these symptoms are not forever. Your doctor can help get you through the storm, by teaching you to dance in the rain.
Certainly the scope of this topic is much more in depth and much more individualized than can be covered here. Knowing that the greatest years of your life don’t have to be the darkest days, lends hope for every woman to reclaim her body.
Dr. Raman’s Concierge Medical Practice is focused on caring for each person as a whole, not just a list of symptoms. Our office is committed to helping our patients stay well and maintain good health rather than treating patients only after they become ill.