TOPIC: Perimenopause
(Editorial Release Date: June 1, 2000).

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Perimenopause: What Mother Never Told You

Perimenopause is on my mind this month. Yes, it’s a topic of interest mostly to women, but those men out there who live with us and must deal with us on a daily basis should find this fascinating information too. And if you gentlemen don’t have a wife, female partner or lover, surely you have a mother or a sister or co-worker you are concerned about, right? First, I’d like to take a head count – how many of you haven’t even heard the word? How many of you are only vaguely informed about menopause (or as it’s known in street vernacular, “The Change”)? How many of you, when you ask your mothers about this topic, are met with blank stares, embarrassment, or worse, told that she doesn’t even remember going through this stage? How many of you know that perimenopause and menopause are two distinct stages in every woman’s reproductive life and that every woman responds differently to this time of change and transition? Well, if you are currently uninformed and would like to know more, keep reading.

Perimenopause can be defined as that time in our lives before we reach menopause. The first half of the word, “Peri,” means “around the time of” and, of course, menopause is defined by most physicians as the stage at which we have stopped getting our periods for twelve months in a row. While most people are semi-informed or even well-informed about menopause itself, most do not realize that the time before menopause (or perimenopause) is the time of the most difficult transitions we women can face. At menopause, women’s progesterone and estrogen levels become quite low. However, it is during the years before menopause, or during perimenopause, that our bodies prepare themselves for these new lower levels. The stage called perimenopause can last as long as ten to fifteen years or more and can start for some women as early as the mid to late thirties. It is the fluctuation of these hormones along with FSH (follocular stimulating hormone) and LH (leutinizing hormone) that can cause most of the symptoms of perimenopause.

The symptoms of perimenopause can vary from woman to woman and even within the same woman on various days throughout her cycle. These symptoms can range from merely annoying to extremely disruptive and debilitating. They can include:

Hot Flashes / Cold Flushes
Concentrated mostly in the head and neck areas, these hot flashes can range from feeling a sensation of warmth to feeling profoundly hot accompanied by profuse sweating. If these flashes happen during the night or while asleep, they are often called night sweats. Some women experience cold flushes instead or a wildly fluctuating combination of both.

Changes in Menses (irregular cycles)
Women’s periods can become extremely erratic. The flow can be heavier, lighter, come more frequently or less frequently, last longer or be of shorter duration. These changes are directly attributable to changes in hormone levels resulting from ovaries that are completing their life cycle.

Mood Changes
Ever find yourself crying one minute and laughing the next? These mood changes are quite similar to what happens to many women who experience PMS. Women can feel more anxious, worried, teary, irritable, or frightened than usual. They can even fly into rages with very little or no provocation. Some even experience a strange sort of emotional detachment that they’ve never had before. These mood changes can be accompanied by food cravings and/or an increase or decrease in appetite.

Sleep Disturbance
This is among one of the most common symptoms. A woman can have trouble falling asleep, staying asleep, or have early morning awakening. These different types of insomnia can often lead to feelings of depression and confusion.

Again, another very common symptom. Many women describe this as more than simple tiredness. This is exhaustion in the extreme, the kind of exhaustion no amount of sleep ameliorates or corrects.

Memory Changes
Are you forgetting things you never had trouble remembering before? A common term for this is “brain fog,” or a feeling that you just aren’t thinking as clearly and/or as quickly as you used to. You may experience difficult concentrating too. Headaches are often common as well. Some women who’ve never experienced migraines before may find they are getting them now for the first time in their lives and those who have had migraines may experience an increase in severity, frequency or duration.

Urinary Symptoms
This can be experienced by some women as the feeling that you have to go to the bathroom all the time or that you cannot get there fast enough. It is termed stress and/or urge incontinence. There can even be some urine leakage if a woman coughs, sneezes or laughs too hard. These urinary symptoms are often accompanied by an increase in urinary tract infections (UTI’s).

Sexual Changes
Many women report a decrease of interest in sex during perimenopause. In addition to the psychological changes, some also experience vaginal dryness and itching which can make intercourse uncomfortable or even painful. Many women and men do not understand the true cause of this lack of interest in sex and start blaming each other or their relationship for their difficulties.

Some women experience extremely dry skin or the sensation of “crawling bugs.” The skin feels tight, dry and may even burn.

Aches and pains in the joints and/or muscles not attributable to an increase in activity or exercise are often reported.

Digestive Disturbances
Heartburn is very common.

This symptom can be experienced as a pounding or racing heartbeat. Some women report a sensation of skipped beats. Although this is often accompanied by shortness of breath and happens most often during hot flashes, it is harmless to the body. However, every woman with heart rhythm disturbances should be checked by her physician to rule out any other causes for these very distressing symptoms.

While this all sounds very discouraging, let me assure you that something can be done for you if you are experiencing any or all of these symptoms. You no longer have to suffer through perimenopause or menopause alone. Women everywhere are coming out of the closet about this topic and demanding research and answers, and they are turning over every rock they can find in an attempt to locate informed primary care physicians and gynecologists. There are many treatments available, ranging from birth control pills, to hormone replacement therapy to natural and/or alternative methods. It might take some investigation and trial and error on your part, but you can find relief or at the very least, some lessening of symptoms.

My goal was simply to introduce you to this topic and get you to start thinking about it. Even if you are still a young woman in her teens or twenties, it is good to be informed about your future. And if you are an older woman and think that this information does not apply to you because you have passed through this transition, think again. Lowered estrogen levels in post-menopausal women have been linked to such serious women's health issues as heart disease (after a woman transitions through menopause, her risk of heart disease equals a man's), osteoporosis, and Alzheimer’s disease. Though every woman is different and will need to make her own decisions regarding hormone replacement therapy (HRT) during and after menopause, it is important that she makes these decisions as an informed healthcare consumer.

Now I’d like to turn you over to the experts for all the information you could ever want about perimenopause and this most important time of transition in women’s lives. Please stop by HotFlash!, the most informative site I’ve found on this topic. You will find all the information I’ve summarized for you here along with book recommendations, articles by leading experts in women’s health, discussion groups, a symptom chart you can fill out and take to your next appointment with your gynecologist, answers to the most frequently asked question about perimenopause and menopause, treatment options, analysis of recent studies done regarding hormone replacement therapy and breast cancer, and you can even join a mailing list to discuss your issues with other women who are going through the same things you are. Since it is often difficult to locate a physician who is completely informed about perimenopause, it is important to arm yourself with as much information as possible before going in to see your doctor. In some cases, you may find yourself educating him or her. There is no need to go through this change uninformed, or worse, silently suffering and not knowing where to turn or what to do. We’ve found our voices, ladies. Now it’s time to take charge of our health! My best wishes to you all as you take one of the most important journeys of your life.

Author’s Note: My thanks to the fine folks at Hotflash! where I found most of the information for this editorial.

Disclaimer: The information provided in this editorial is for informational purposes only and the author cannot make guarantees of accuracy or application of the information to any specific individual. Diagnoses and treatments should be obtained and/or recommended only by a qualified healthcare practitioner. All women are encouraged to speak to their doctors first before making any significant changes to their healthcare regimen.



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