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Perimenopause and Menopause – The Great Unknown

Women’s reproductive needs change as they age.

When you are young, it is all puberty, acne, and menstrual cycles. Then, you hit your early adult years and it is birth control, sexually transmitted infections, and pregnancy (in no specific order). You get busy taking care of kids, pursuing a career, etc. And before you know it, you are 40 years old.

All of a sudden, your menstrual cycles begin to change. If your period used to be five days in length, now it may be longer or shorter. You may bleed heavier than you used to, or if you are lucky, maybe less. Your periods may be more or less frequent and harder to predict than they used to be. Add in hot flashes, weight gain and what is up with this brain fog? Why can I not stay asleep? What is happening??

Menopause is not a disease

You are experiencing a very normal transition called Perimenopause. Perimenopause typically begins in a woman’s fifth decade when her ovaries start to fail and continues until menopause. It can last for several months or a decade, with the average length of perimenopause being three to four years.

Menopause, defined as the lack of menses for twelve months, represents the end of a woman’s reproductive potential. Menopause is a retrospective diagnosis, meaning you do not know you are menopausal until twelve months have passed without a period. The average age of menopause is 51, but some women can experience this earlier or later.

During perimenopause, a woman’s estrogen levels are fluctuating dramatically, which causes many of the symptoms she may experience such as menstrual irregularity, hot flashes or night sweats, mood swings, and sleep disturbances.

The importance of estrogen

Fluctuating estrogen can also affect the vaginal tissues, making them thinner and drier. This can cause burning and itching of the vagina, and it can make intercourse painful. Additionally, because the tissue of the vulva and vagina is not as healthy as it once was, it cannot protect as well from bacteria that causes urinary tract infections (UTIs).

Other changes that are not so obvious with perimenopause are loss of bone mass and increased risk of heart disease. Estrogen is protective for your bones. When estrogen levels drop, your body begins to lose bone mass more quickly than it can build it. This can lead to weak bones that are more susceptible to fracture. Changes in cholesterol levels can increase a woman’s risk of heart disease. HDL (the good cholesterol) may drop, and LDL (the bad cholesterol) may rise due to low estrogen.

Alleviating symptoms

During this transition, you can help alleviate some of the symptoms with lifestyle changes. Exercise has shown to increase bone mass and improve sleep. Hot flashes can be reduced by avoiding spicy foods, caffeine, and alcohol. You may consider increasing calcium in your diet to support bone health and/or supplementing with iron if you are experiencing heavy periods.  

It is important that you discuss any of these perimenopausal symptoms you are experiencing with your medical provider. Your provider can order tests to check your bone strength, your hormone levels, and your cholesterol. Hormone therapy may be recommended to help reduce hot flashes and vaginal dryness. Be sure to discuss risk versus benefit of hormone therapy with your provider. Additionally, hormonal contraception may be recommended to control heavy periods. In some cases, if a woman is having extremely heavy periods, she may be a candidate for surgery. Even though perimenopause and menopause are natural milestones in a woman’s reproductive life, it does not mean that this period of life is easy.

Don’t discount lifestyle changes in your ability to provide relief for menopausal symptoms. Dietary changes, decreasing stress, and exercise can all be valuable in helping to reduce symptoms.

Understanding that your experiences are normal can go a long way to reducing anxiety about your symptoms. Do not hesitate to talk to your medical provider about any symptoms that affect your quality of life like sleep issues, heavy vaginal bleeding, or painful intercourse.

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