Menopause is defined as the 12-month period after a woman’s last menstruation. Perimenopause, or menopausal transition, is defined as the years leading up to a woman’s last period, and is what women commonly think of as “menopause.”
Perimenopause can begin between 45 to 55 years old and can last between 7 to 14 years. During this time, the body’s hormones, progesterone, and estrogen vary greatly. Menopause can be triggered by a hysterectomy or surgical removal of the ovaries.
Some women experience symptoms during perimenopause and others do not. Common symptoms include:
- Changes in menstruation. During perimenopause, periods may become more irregular in their length and flow. They may last shorter or longer and have a lighter or heavier flow than usual.
- Hot flashes. Hot flashes can last between 30 seconds to 10 minutes and can occur as frequently as several times an hour or as infrequently as once or twice a week. Hot flashes can present as flushing and heat on the face and neck and red blotches on the chest, back and arms. Women may experience heavy sweating followed by cold shivering.
- Difficulty sleeping. Hot flashes can occur at night, often waking women up. Other women report difficulty falling or staying asleep.
- Changes in mood. Women may experience changes in their mood, such as irritability, depression, and anxiety.
- Painful intercourse. With the loss of hormones, the vagina begins to atrophy and become drier, often making sexual intercourse painful or uncomfortable.
- Bladder incontinence. Women can have difficulty holding urine long enough to get to the bathroom. They may experience a sudden urge to urinate, as well as urine leakage during exercise, sneezing, or laughing.
- Weight changes. The body starts to use energy differently, leading to fat and muscle redistribution. Women may experience a loss in muscle mass and gain weight more easily. They may also experience thinner skin and stiff and achy joints and muscles.
- Bone changes. During this time, bones can become less dense, leading to osteoporosis or fractures.
If you are experiencing any of these symptoms, or think you may be entering perimenopause, we recommend speaking with your provider. Your provider may want to obtain lab work to check hormone levels and discuss therapy options to manage symptoms.
There are many lifestyle modifications you can make to improve your symptoms:
- Hot flashes. Try carrying a portable fan or dressing in layers that can be removed if needed. Avoid eating spicy foods or drinking alcohol or caffeine. It is recommended to quit smoking. Hot flashes can be more frequent and severe in overweight and obese women, so maintaining a healthy weight is encouraged. If you are experiencing hot flashes at night, try drinking small amounts of cold water before bed. Self-calming techniques, such as yoga or meditation, can also help manage hot flashes. Severe hot flashes can be treated with prescription medications, such as SSRIs or hormone replacement therapy.
- Sleep. Maintaining a regular sleep schedule, such as going to bed and getting up at the same time, is very important. Avoid naps in the afternoon, as well as eating large meals or drinking caffeine before bed. Avoid using a phone or watching television before bed. Melatonin supplements can help you fall asleep faster and stay asleep longer. Improved sleep can also improve mood changes such as irritability, anxiety, and depression.
- Bladder Incontinence. Limit or avoid caffeine. Losing weight can relieve extra pressure on your bladder. Kegel exercises can strengthen pelvic floor muscles and improve bladder function. Urinary pads or reusable urinary caps can be used on a daily basis.
In addition to lifestyle changes, there are over-the-counter supplements and natural remedies available. If symptoms do not improve with lifestyle modifications, speak with your provider about possible prescription medications.
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