What is perimenopause and what are some suggestions in terms of managing it?

Menopause is defined as the last menstrual cycle in a woman’s life, and marks the end of her reproductive years. Perimenopause is the term used to describe the time of transition between a woman’s reproductive years and menopause. This period of transition may be quite brief or may last as long as ten years. For many women, this transition begins in the forties and lasts through and sometimes beyond menopause. (The average age of menopause for American women is fifty-one.) A woman can theoretically conceive at any point up until the active time of menopause. Therefore, it is still necessary to use contraception throughout the perimenopause.

During this time, declining ovarian function is associated with changes in the production of estrogen, progesterone, and androgens (the hormones which regulate women’s menstrual cycles). These changes can lead to a variety of symptoms in women, including memory changes; menstrual irregularities (either more or less frequent, and with either a very heavy or light flow); hot flashes or night sweats; libido changes; insomnia; or mood fluctuations including symptoms of irritability, anxiety, or depression. Eventually, women might also experience signs of urinary or vaginal atrophy (meaning a loss of elasticity or thinning of the tissue) such as vaginal dryness, burning, discomfort with intercourse, and urinary frequency or discomfort. Some women experience none of these changes, while others struggle with many changes and symptoms during the perimenopausal period. For many women, this is also a busy and demanding time in life, whether related to a career, raising a family, or caring for aging parents. Women need and want to feel better, and many look for ways to more comfortably manage their perimenopausal symptoms.

There are a variety of approaches to the management of perimenopausal symptoms. Often, simple changes in a person’s diet, exercise routine, and lifestyle can make a positive difference. Women sometimes also find relief with the use of nutritional or herbal supplements. This may include the use of “phytoestrogens” which are plant-derived estrogens, such as black cohosh, Mexican wild yam, or soy products. Acupuncture is another modality which can be quite useful, particularly in treating the “vasomotor” symptoms, i.e., hot flashes or night sweats.

Some women opt for the use of hormonal supplementation during the perimenopause phase. This may mean the use of a low-dose oral contraceptive pill, or even the initiation of hormone replacement therapy (HRT). By supplementing a woman’s own physiologic production of hormones, women frequently feel relief from many of the symptoms related to hormonal fluctuations of perimenopause. However, HRT can be associated with health risks, so only after a discussion with a healthcare provider should HRT be initiated.

If you are interested in learning more about Perimenopause and Menopause, please join us for our monthly talks in our office during evening hours. Please call our office at 603-431-6011 to learn more about this special informational series.