Chapter 20:Perimenopause and Menopause

Catherine Lemelin HE 210-OL

What is the difference between Perimenopause and Menopause?

Perimenopause Menopause

The ovaries function erratically and hormonal fluctuations may bring a range on changes.

Can be a one-to-ten year stretch.

Changes include: Hot flashes, night sweats, trouble sleeping, and heavy menstrual bleeding.

Each woman is affected to the transition differently.

Ovaries settle down and the reproductive hormones have declined to low, steady levels.

Marked by the final menstrual period (final after one year with no periods).

Midlife PerimenopauseBrings the end of

the childbearing years.

Involves emotional, social, and physical changes.

Everything from a new sort of loneliness to a profound sense of new freedom may emerge.

The menopause transition may fill our minds with all sorts of questions:

What do I want to do? What am I not able to

do?

What can I control? How do I want to live?

Have I reached Perimenopause?

Transition can begin from late 30’s to 60 and can last from 1-10 years

Smokers tend to reach menopause earlier than nonsmokers

Women typically begin the transition at the same age as their mothers

According to Endocrinologist, Jerilynn Prior, if you apply to any three of the list below, you can assume you have begun perimenopause:

1. New-onset heavy and/or longer flow2. Shorter menstrual cycles (less than 25 days)3. Newly sore, swollen, or lumpy breasts4. New midsleep wakening5. Increased cramps6. Onset of night sweats (esp. around menstrual

flow)7. New or markedly increased migraine headaches8. New or increased premenstrual mood swings9. Weight gain without changes in exercise or eating

Non-medical self help approaches to alleviate discomforts

MeditationYogaRelaxationRegular exerciseHealthful foodEnough sleepSupport from family and friends

Perimenopausal SignsPremenstrual Syndrome (PMS)

◦ Swollen/tender breasts, bloating, anxiety, etc

Menstrual Cycle Changes◦ Shorter cycles, skipped periods

Abnormally Heavy Bleeding◦ 25% of women in perimenopause

experience heavy bleeding

Facts about Perimenopause

Contrary to popular belief, you can still become pregnant during perimenopause.

20-30% of women never experience hot flashes during perimenopause.

Sleep disturbances are common in both perimenopause and postmenopause.

Ways to Eliminate Sleep Disturbances Cut out

caffeinated beverages

Avoid smoking Avoid or limit

alcohol consumption

Go to bed at approximately the same time each night

Exercise regularly Before bed, take

a bath, listen to music or read

Filter out noise and light

Vaginal Changes Urinary ChangesVaginal dryness is a

common change in early perimenopause

Estrogen and progesterone levels decline and the vaginal walls frequently become thinner, drier, less flexible, and more prone to tears and cracks

Finding the need to urinate more often

Urge incontinence (sudden strong urge to urinate followed by involuntary flow)

Urinary incontinence Incontinence can be

successfully managed, treated, and sometimes cured (i.e. kegal exercises, bladder training, medications, vaginal estrogen)

Tips to Relieve Vaginal Dryness and Sexual DiscomfortLubricants and

vaginal moisturizers

Regular sexual activity

Wait until fully aroused before penetration

Drink more fluids

Graduated dilators

Low-dose local vaginal estrogens

Hormone therapy

PostmenopauseThe ratio of body fat to muscle mass

increases as we grow older, so it is very important to exercise to maintain muscle mass.

Weight gain is common due to a combination of slower metabolism, decreased activity, and increased caloric intake.

Eating well can help prevent/manage chronic diseases and enhance sexuality.

Bone Loss and OsteoporosisOsteoporosis is a condition of

significantly low bone density.As we get older, we start to lose

bone faster than we replace it.Prevention includes: yoga, jogging,

strengthening with weights, avoiding harmful habits, eating healthy, etc.

Vitamins that limit bone loss and reduce fractures are Calcium, Vitamin D, and Magnesium.

Care and Treatment for Perimenopauseal DiscomfortsAlternative therapies such as herbs or

botanicalsWestern medicine of drugs or surgeryEstablishing a relationship with a

healthcare practitioner or clinician whose philosophy is similar to yours and is open-minded

Possessing insurance and access to health care

Nonhormonal medications such as bisphosphonates, anti-depressants, or sleeping pills

Hormone TherapyHormone Therapy is the process

which women receive treatments and medications to help the body replace hormones that are no longer produced after menopause

Pros: Relieves discomfort of menopause (hot flashes, night sweats, vaginal dryness)

Cons: Causes health risks (breast cancer, stroke, blood clots)

Debate over Hormone Therapy

There is a current debate regarding the use of hormone therapy. Some feel that because perimenopause and menopause are not diseases, then treatments should not be pushed on women. Although HT may provide negative effects, others who suffer during this time are happy to know that there are treatment options and are willing to take the risks.

Various HormonesProgestogensMedroxyprogesterone

Acetate (Provera)Progestin-Releasing

IUD (Mirena)Bioidentical

Micronized Progesterone

PremProEstrogen/Progestin

PatchesEstrogens

◦ Estradiol, Estriol, and Estrone

Discussion Question

What are your thoughts on the debate over hormone

therapy?

“ Intellectually, I know some of my physical and mental capacities will diminish as I age, but I want to deal

with this with a sense of self-acceptance [and] not lower

expectations. I hope my generation of feminist boomers will not deny the

limits of aging and not give in to internalized ageist attitudes towards

others and ourselves as we age” (546)

ResourceThe Boston Women’s Health Book

Collective.“Chapter 20: Perimenopause and Menopause” (pages 505-546). 2011. Our Bodies, Ourselves. New York, NY: Simon & Schuster.