Perimenopause: The Prelude to Menopause

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brandywine_sq_am13_Vitasta_BamezaiBy Vitasta Bamezai, MD


Women regard menopause with mixed emotions – some look forward to the ease of not having a monthly period, while others experience sadness about the end of their childbearing years.

The signs of menopause are frequently discussed among women and on the pages of women’s magazines: hot flashes, mood swings, and menstrual irregularities, to name a few. You may be surprised to learn that these symptoms are actually not hallmarks of menopause, but of perimenopause, the transition period before menopause. According to health experts, menopause is not a time span, but a single event: the cessation of the menstrual cycle. The U.S. Department of Health’s Office on Women’s Health defines menopause as the day that a woman has not had a period in 12 months, and perimenopause as the time leading up to menopause.

Perimenopause can last anywhere from two to eight years and usually begins in the 40s, but for some women it can begin as early the mid-30s.

Symptoms of perimenopause include irregular menstrual cycles; weight gain; hot flashes or night sweats; sleep disturbances; joint pain; mood swings such as irritability or depression; changes in sexual desire or vaginal dryness, and bladder problems such as incontinence or frequent urinary infections. Many of these symptoms are caused by fluctuations in your body’s production of the hormones estrogen and progestin. An important change you won’t be able to observe – but one that is significant – is your body’s declining production of estrogen. Lower estrogen levels mean that your body loses bone at a higher rate than it can generate new bone mass – which contributes to osteoporosis, or brittle bones. Your cholesterol levels are affected, too. Declining estrogen levels contribute to an increase in your body’s supply of LDL, or “bad” cholesterol, and a decrease in HDL, or “good” cholesterol.

Although perimenopause is inevitable, certain health or lifestyle factors can bring it on early: smoking, the age that your mother or sisters experienced menopause, not having delivered a baby, childhood cancer treatment, or a hysterectomy.

If you believe you’re entering perimenopause, begin a diary of your symptoms over several weeks or months. Keep a record of your menstrual cycle – when it begins and ends, the lightness or heaviness of bleeding, as well as any other symptoms. Sharing the information with your doctor will help evaluate whether you are entering perimenopause. Your doctor will consider your age, menstrual history and symptoms, and may also order a thyroid test. Thyroid problems can mimic several symptoms of perimenopause: mood swings, weight gain and menstrual irregularity or fertility problems.

Your doctor can recommend various treatment methods for the symptoms of perimenopause, from lifestyle changes to medication such as hormone replacement therapy (see sidebar). Regular exercise – at least 30 minutes per day – and medication or yoga help with stress management and also protect your bone health. It’s important to eat a diet that includes whole grains, fruits and vegetables, and calcium-rich foods to guard against osteoporosis. A daily vitamin D supplement, and avoiding caffeine and alcohol, can help reduce hot flashes. Hormone replacement therapy can take the form of a topical cream or gel, or a pill. As you’re approaching perimenopause, it is time to analyze your life style

and make positive changes for your future health.

If you’re experiencing unusual menstrual symptoms and suspect that you’re approaching menopause, see your family doctor.

Vitasta Bamezai, MD is board certified in Internal Medicine and practicing with Gateway Internal Medicine at Brandywine. She is an independent member of the medical staff at Brandywine Hospital. To reach her for appointments, please call 610-384-5110.

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