By Leanna Coy, FNP-BC
Menopause care is booming right now. This is great news after more than two decades of women in menopause not getting the care they needed. Twenty years ago, the Women’s Health Initiative study that found increased risks of heart disease and breast cancer with hormone replacement therapy (HRT). At the time of the study, HRT was almost universally recommended for the care of menopause. However, the study results led to fear of using HRT, and menopause care quickly became limited.
Over the last twenty-plus years, researchers have re-evaluated the evidence and gained a better understanding of the risks. HRT is again being more freely prescribed, and menopause care is expanding. Expanding menopause care benefits not only those in menopause but also those going through perimenopause.
Perimenopause vs menopause
Perimenopause is the transition time from a person’s menstruating and reproductive years into menopause. Menopause occurs when periods stop for at least 12 months. During the menopause transition, hormone levels begin to fluctuate and trigger symptoms. Hormone fluctuations start in the 30s and 40s.
The average span of perimenopause is four years. However, for some people, they may have symptoms for up to 10 years before entering menopause. There is no one test to determine if you are perimenopausal. Testing hormones during perimenopause can be unreliable due to fluctuations in the hormone levels. For this reason, diagnosis is most often based on reported symptoms and a patient’s age.
Signs and symptoms
Most women will begin experiencing symptoms between the ages of 45-50. The symptoms vary from being so mild that someone may not recognize them as related to perimenopause. Other symptoms are severe, interfering with a woman’s work and quality of life. The symptoms most familiar include:
- Period changes. Periods may become heavier and longer. Or they can become shorter and lighter. The timing of periods can become irregular. You should always see a gynecologist to assess regular heavy bleeding. It is important to remember that there is still a risk of pregnancy until you fully enter menopause.
- Hot flashes and night sweats. Also known as vasomotor symptoms. A hot flash starts when the brain thinks the body is too hot and tries to cool it down. The upper body will start to feel hot and you begin to sweat. Your chest, neck, and face turn red. Then, as your body cools down, you feel chilled. Hot flashes relate to changes in the hypothalamus, which regulates body temperature. When hot flashes happen at night, they are called night sweats and may wake you up. Up to 80% of women experience hot flashes.
- Mood changes. Changes in mood include anxiety, depression, irritability, and low self-esteem. A woman may never have had mental health symptoms in the past, but about 70% of women will during menopause. These symptoms are often made worse by poor sleep.
- Disrupted sleep. Sleep disturbances range from trouble falling asleep (insomnia) to waking multiple times a night or waking earlier than planned. Night sweats contribute to sleep disruption. Poor sleep will have the domino effect of triggering fatigue and adding to brain fog.
- Vaginal changes. As estrogen levels decline, the vaginal tissue thins and is less elastic. Vaginal tissues become dryer and can trigger painful sex. Vaginal tissue and the urethra can become inflamed and irritated. These changes may trigger more frequent infections of the vagina and urinary tract. Women may also experience incontinence.
- Sexual dysfunction. Loss of interest or enjoyment in sex is a common complaint that begins during perimenopause. Some people will also have discomfort from vaginal changes related to decreasing estrogen levels. These changes include vaginal dryness, irritation, and painful sex.
- Brain fog. This ranges from forgetting a name or why you walked into a room to having difficulty focusing on work.
There are many other symptoms that may seem unusual but are, in fact, just lesser known. The less commonly known symptoms of perimenopause include:
- Itchy, dry skin
- Headaches or migraines
- Bloating
- Weight gain, especially in the abdominal area
- Joint pain and muscle stiffness
- Irregular heartbeat
- Body odor
- Dental issues
- Brittle nails
- Tingling and electric shock sensations
- Burning mouth syndrome
- Allergies
- Dizziness
Symptom management and beyond
Management of symptoms is variable for each individual. Treatments are based on the severity of symptoms and desired treatments. Each person should work with their healthcare provider to come up with a treatment plan through shared decision-making. This means discussing your concerns and treatment options with your healthcare provider to develop the best treatment based on clinical evidence, your preference, and situation. There are a variety of treatment options to consider.
Botanicals: These are herbs and supplements for managing symptoms. Black cohosh and maca can help with vasomotor symptoms. Your provider may also include magnesium, vitamin D, collagen, or others in the treatment plan.
Prescription medications: Medications such as antidepressants are used for mood changes and hot flashes. There are also medications to help with low sex drive and help with sleep.
Hormone therapy: Estrogen and progesterone are the female hormones used for hormone therapy. These replace the hormones that decline during the menopause transition. In some cases, testosterone is also used. But, this is not usually a first-line treatment.
Lifestyle changes: Many of the lifestyle recommendations during the menopause transition are the same for the general population. Cut back or avoid alcohol use, quit smoking, exercise regularly, and get restful sleep.
Care during perimenopause goes beyond just treating symptoms. Estrogen works in protecting the heart from cardiovascular risks, such as a heart attack or stroke. As estrogen levels decline, those risks go up. Estrogen and regular strength training help maintain bone health and reduce the risk of osteoporosis. Better sleep helps to improve one’s quality of life.
Many women will not notice their perimenopause symptoms. They may link fatigue due to being busy with work or family issues. They may relate period changes and lack of sex drive to stress. Body aches and weight changes may get chalked up to old age. But by looking at all these issues as a whole, a pattern of perimenopause may emerge. If you are seeing patterns or symptoms that point to perimenopause, talk with your healthcare provider.
