Though the words perimenopausal and menopausal are
often used, their meaning isn't always well defined. So let’s start
there, with definitions. Peri is a prefix meaning around or
near, and perimenopause is the transitional time a woman goes through
before menopause. Its length is variable, and its most common symptom is
irregular menstrual cycles. This can mean periods that are closer
together, further apart, heavier or lighter. An increasing number of
periods are missed, usually in an unpredictable fashion. Generally, it
takes women four years to go through this transition, but that may vary.
A woman is in menopause when she has not had a period for a full year.
Many women have other perimenopausal symptoms, including hot flashes,
night sweats, mood swings and vaginal dryness. Hot flashes are sudden
feelings of heat in the upper body. They may be accompanied by chills
and usually last less than five minutes. Night sweats are flashes that
occur during sleep and cause women to wake up.
The cause of flashes is unclear, but may be due to changes in the body's
temperature-regulating mechanism. Dressing in layers and avoiding
triggers such as stress, cigarettes, alcohol and spicy or hot foods are
good ways to start managing flashes. Oral contraceptives, for the
appropriate candidate, have the benefit of lessening flashes and also
provide contraception and regulate menstrual flow. Estrogen is not
generally recommended for use in perimenopause; however, it can be used
for brief periods, particularly in women who have flashes in the week
before their period. Herbal remedies, because of their lack of
standardization as well as the possibility that they may interact badly
with other medications, are not routinely recommended.
Mood swings and depression are not the same thing. Women can have mood
swings and irritability for many reasons. An interrupted night’s sleep
because of flashes can cause a short temper, as can life
situations—teenagers, aging parents and job stress, to name a few. By
and large, perimenopausal women are no more depressed than anyone else.
The one exception is women with a history of depression or severe PMS.
This is a time in their lives when it may recur or become more
pronounced. If a woman is significantly depressed, antidepressants and
therapy are helpful.
Fluctuating levels of estrogen can lead to vaginal dryness. This, in
turn, can lead to discomfort during intercourse and may be related to
increased incontinence—the loss of bladder control. While it is a common
belief that perimenopausal women have less of an interest in sex, this
is not the case for all women. Some of the change in desire for sex may
be because of the discomfort. Over-the-counter lubricants and
moisturizers can improve vaginal dryness. Estrogen, used vaginally in
the form of a cream, ring or tablet, can help if lubricants fail. There
is now an oral pill that is similar to but not estrogen, taken daily
that will alleviate dryness. Increased sexual intercourse may also be
helpful since it increases blood supply to the vagina, which in turn
improves lubrication. Another reason for a change in the desire for sex
may be the commonly held belief that older people are not sexual.
However, most women find no change in their interest in sex, and some
women have an increased interest. Perimenopausal women still need
contraceptives to prevent pregnancy. The likelihood of pregnancy is
small, but it is possible. There are many contraceptive options
available. Talk with your health care provider about the best one for
When Is It?
Women often want to know where they are in their perimenopausal
transition. Most women will begin perimenopause in their 40s, but that's
a large span of time. Many look for medical tests to give them some
guideposts. Unfortunately, no one test can accurately give this
information. The markers most often requested are FSH (follicle
stimulating hormone) and estrogen. The brain produces FSH to cause the
ovary to ovulate (release an egg). In menopause, FSH is elevated, but in
perimenopause it fluctuates from week to week, making it unreliable for
diagnosis. Estrogen levels are low in menopause, but in perimenopause
the level can be low, high or normal. The diagnosis of perimenopause is
based on symptoms, not bloodwork. In general, once you begin to miss two
or more menses in a row you are about two years from your final cycle.
A New Chapter
This time in a woman's life is really a beginning rather than an end. It
is an opportunity to reassess lifestyles and make changes that benefit
your health, such as:
Stop smoking. Smoking can cause more intense
flashes, an earlier menopause, weaken your bones, and
thin the skin (more wrinkles!).
Exercise more. Exercise will promote good heart
and bone health. You will be stronger, have more energy,
and improve your mood.
Eat well. 1) Eat smaller portions and fewer
calories. Obesity is directly linked to diabetes,
hypertension, and heart disease. Women who are
overweight have more hot flashes than women who are not.
Choosing a low-fat diet and exercising can keep the
pounds from creeping on as your metabolism slows down a
bit with age. 2) Increase the fiber in your diet with
fresh fruits, vegetables, and whole grains. This may not
only improve cholesterol but can decrease the risk for
colon cancer. 3) Add omega 3 and 6 fatty acids. These,
too, have a positive impact on cardiac health. Salmon,
sardines, mackerel, walnuts and flax seed are good
sources. 4) Increase your calcium intake, which should
total 1000-1200 milligrams daily. Dairy products, juices
with calcium, dark green vegetables, tofu, and nuts are
a good place to start. In order to achieve the daily
total, you may need a calcium supplement as well.
Get regular cancer screenings. Make sure your
cancer screenings are up to date. Pap smears, mammograms
and colorectal cancer screenings are all important.
Discuss the frequency of these with your health care
Have your cholesterol checked. Heart disease
remains the #1 cause of death for women in this country.
Cholesterol should be checked every five years, or more
often if your health care provider recommends.
Play and laugh more! Reduction of stress will
have short-term and long-term benefits.
This article is part of the Menopause and Youlibrary,
a web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own health care practitioner with your
specific concerns and questions.
To speak with our nurse counselor, call 1.888.876.8764 or email email@example.com.
Membership on the medical staff of Main Line Hospitals does not
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