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. 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 can improve
vaginal dryness. Estrogen, used vaginally in the form of a cream, ring,
or tablet, can help if lubricants fail. 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 healthcare 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.
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. 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
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 healthcare 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 You library,
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 healthcare practitioner with your
specific concerns and questions.
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