What is *peri*menopause, and how do I make it go away?
This post is for my fellow 40 and fabulous crew out there who feel like they are spiraling towards something big and bad and inevitable - menopause. While there is no escaping menopause, you do not have to feel powerless or unprepared!
Peri means “around”, or really in this case, going through. It’s the years that lead up to menopause, which is technically defined as one year with no menstrual period. Perimenopause can last for several years, even a decade for some women. And while everyone experiences it differently, there are several common themes.
Most obvious is a change in menstrual bleeding. Often women in their 40s start to experience a heavier period that lasts longer and is closer together, before spacing out, skipping, lightening, and eventually stopping. Women also see changes in mood, trouble sleeping, hot flashes, and vaginal dryness which can cause sexual discomfort.
During this time of change, I often have patients reach out asking about blood work to test hormones. The diagnosis of perimenopause does not need blood work - the criteria is simply a woman over the age of 45 with a change to her period, with or without menopausal symptoms. But it is a good idea to do some blood work to rule out other causes, such as a thyroid disorder or pregnancy (eek!). GYN hormones, like FSH and estrogen, do not have to be abnormal and in fact, if you are still having a period, probably aren’t significantly abnormal. Unfortunately, lab tests don’t reveal how long perimenopause has been going on, or how much further you have to go.
So while it’s usually pretty easy to diagnose perimenopause, treatments are not as straightforward. Interestingly, there has been a fairly recent shift on the approach the medical community takes to treating menopausal symptoms. When I was a resident, the general idea was that menopause is a natural experience and hormonal therapies = badness, so essentially tell your patients to buck up.
Then, thankfully, the data was revisited with the ultimate conclusion that hormone therapy for women during menopause in the absence of significant risk factors is indeed safe, and maybe women don’t need to silently and needlessly suffer through it. Yes, menopause is a natural part of life, but it does not have to be something women grin and bear!
Hormonal therapy may not be appropriate for all women though, and some women may prefer to avoid the risks associated with taking medication. In these cases, as with any patient interested in non-medical therapies, I focus on lifestyle and behavior adjustments. Exercise is very significant during perimenopause - as discussed previously, exercise helps to improve sleep and increase energy. I like a focus on strength training for women in theirs 40s as well. The loss of estrogen that occurs during menopause results in lower bone density, so a focus on building muscle strength and weight bearing exercises like walking and jogging are essential to maintain bone health. Also important is diet - calcium for the bones and protein to support building up muscle mass, all while paying attention to calories. In menopause, an internal process that was burning calories is no longer happening. In general this leads to an output of about 200-300 calories less than before, which is why many women see weight gain.
Hot flashes can usually be managed with avoiding triggers (alcohol, spicy food, hot beverages), dressing in layers, carrying a fan or spray bottle, keeping the temperature down at night for sleep etc. There are many over the counter herbal supplements offered, but unfortunately none of them hold up under more rigorous testing. And though I have offered exercise as a treatment for most things thus far, it’s no help here and could actually trigger a hot flash due to rises in body temperature. But still necessary anyway (see above)!
So if you are confused or apprehensive as to what lies ahead, or you have already started to experience some of these symptoms but had no idea what was happening, and you are interested in discussing further, consider joining SFP! With direct access care, we will have the time and space to discuss your personal experience with perimenopause, examine how it is effecting you, and review treatment options that fit your preferences, symptoms, and lifestyle. Let SFP help you feel empowered and prepared to sail through this transition…or at the very least commiserate with you as you do :)
