Perimenopause, or the time when your body begins its transition into menopause, can begin as early as your mid-30s. Due to the subtle or slowly advancing nature of some symptoms, lack of education about this phase of a woman’s life, or failure to find a qualified healthcare provider, you may not realize you are experiencing perimenopause symptoms or get adequate help. Our society also tends to portray menopause and the loss of fertility negatively, if at all, which may make you feel embarrassed to seek out care.
Recent research reveals that the majority of women say they’ve had to teach themselves about perimenopause and menopause, only half of women can define perimenopause, and 74% want more education on the topic.
Advantia Health recognizes this unmet need, and is committed to not only helping women identify when they have entered this transition but helping them manage their symptoms so that they can enjoy the greatest possible quality of life during this time. Our providers, who have built knowledge through experience and additional certification programs, can offer personalized treatment plans and education suited to your needs and goals.
What is Perimenopause?
Women will spend about one-third of their lives in menopause, the time in a woman’s life when they are no longer fertile. The first stage is perimenopause, or pre-menopause, when estrogen and progesterone production by the ovaries begin to decline.
Perimenopause can last up to 10 years, and include a broad range of symptoms, due to the fluctuations in hormones that occur throughout this transition. Menopause marks the end of perimenopause and is defined as the absence of a period, or menses, for 12 consecutive months. With menopause comes a permanent decline in estrogen production that prevents the ovaries from releasing eggs and women from being able to become pregnant.
It is important to remember that while fertility decreases during perimenopause, it is still possible to get pregnant. Maintaining your birth control regimen is advised, at least until you have consulted with your healthcare provider about your own chances of becoming pregnant.
Perimenopause Symptoms
Typically, the first perimenopause symptom you will experience is an irregular period. It is common for periods to be heavier or lighter than usual, or for them to show up more or less frequently than they have in the past.
Every woman may experience a different combination of other perimenopause symptoms, which can include:
● Anxiety (which can be accompanied by sweating, nausea or muscle tension) and depression
● “Brain fog,” which can be characterized by memory loss, or difficulty concentrating
● Irritability or other mood changes
● Hot flashes and/or night sweats (which are also called vasomotor symptoms)
● Insomnia or other sleep disturbances
● Fatigue
● Low libido, or sex drive
● Vaginal dryness, which can cause discomfort during sex
● Increased urinary urgency or frequency (or needing to go to the bathroom more often or having a harder time holding your urine)
● Breast tenderness or pain
● Muscle or joint pain
● Heart palpitations
● Hair loss or thinning hair
● Brittle finger or toe nails
● Dry and/or wrinkled skin
● Tinnitus, which is ringing in the ears
● Change in body odor
● Weight gain
How do I Know if I am in Perimenopause?
Your healthcare provider may be able to provide a perimenopause diagnosis after performing a physical exam and discussing your symptoms and medical history. They may wish to perform additional tests or assessments to confirm perimenopause or rule out other conditions, since some symptoms may also be indicators of other concerns.
Hormone tests can be used to determine if you have started perimenopause. FSH (follicle-stimulating hormone), produced by your pituitary gland, prompts your ovaries to release an egg. A high FSH level can mean that you’ve entered perimenopause. Hormone fluctuations that accompany perimenopause, and some medications, can influence these results, so the FSH test alone may not be conclusive.
ACOG does not recommend routine hormone testing to diagnose perimenopause. Hormone fluctuations can occur daily, therefore they are not reliable indicators for a diagnosis of perimenopause. Instead, we rely on symptoms and menstrual cycle changes to determine the best treatment plan.
Although hormone testing doesn’t necessarily diagnose perimenopause, it can be useful to rule out other diagnoses, such as thyroid disorder, which may have similar symptoms as perimenopause.
How is Perimenopause Treated?
While treatment options for perimenopause are primarily intended to alleviate the symptoms that may be impacting your physical and emotional well-being, there may also be secondary benefits to some medications and lifestyle changes. Even if you may not feel your symptoms are severe, it is worth consulting with your healthcare provider to discuss long-term implications and risks of estrogen loss.
Medication Options
Hormone replacement therapy, hormone therapy, and birth control are all commonly used treatments for a range of perimenopause symptoms. They work by stabilizing or increasing your levels of estrogen or estrogen and progesterone and can provide significant benefits, depending upon your age and how long you have been in perimenopause or menopause. You should talk to your healthcare provider to determine if you are a good candidate.
Depending upon your symptoms, age, and other health considerations, additional medication options can include:
● Gabapentin or fezolinetant, which can alleviate hot flashes
● Vaginal creams or lubricants, including those available over the counter, that can relieve vaginal dryness and discomfort during sex
● Oxybutynin, which can help with both hot flashes and overactive bladder
● Antidepressants, which can help with anxiety, depression, and mood swings
Lifestyle Changes
As with many health conditions, eating nutritious foods, getting enough sleep, exercising regularly and maintaining a healthy weight can help you manage perimenopause symptoms by elevating energy levels and mood. Low-impact exercises can be beneficial if you are also experiencing joint pain as a symptom of your perimenopause.
Meditation, deep breathing and yoga are all medication-free options for managing increased stress and anxiety you may be feeling. For ongoing concerns, you should consult with a mental health specialist who can guide you through this transition.
Quitting smoking will not only help reduce your risk for a range of cardio-pulmonary issues, it can also reduce the frequency and severity of hot flashes.
Perimenopause and Advantia Health
Early into perimenopause, you may be embarrassed to seek out help or unsure about available treatment options. If you are experiencing any of the symptoms listed below, please know there are options to improve your quality of life. An experienced and compassionate Advantia Health provider can develop a personalized treatment plan and provide essential educational resources to help reduce the stressors associated with this transition.
