Perimenopause & Menopause
Hot flashes. Mood swings. Irregular periods. These all sound like common symptoms of menopause for women. However, these are also similar symptoms for women going through perimenopause. For many women in their 40s, they may think they are too young to be going into menopause but may be experiencing menopausal types of symptoms, this is called the perimenopausal stage. The average length of perimenopause is 4 years, however, for some women, it can last months or up to 10 years. The official start of menopause is 1 year after your last menstrual period. Our providers are here to help women across the Valley to better understand these different stages and cycles they’re experiencing and encourage women to seek help in finding relief and managing the perimenopause and menopause stages.
Stages of Menopause
For many women, there seems to be a genetic component (i.e., knowing at what age your mother’s stages began) associated with the onset of the stages of menopause.
There are three stages of menopause:
- Perimenopause – Perimenopause is the stage in a woman’s reproductive life that begins several years before menopause. The ovaries will gradually begin to produce less estrogen. This usually starts when women are in their 40s but can start even earlier. In the last one to two years of perimenopause, estrogen production declines rapidly. At this stage is when many women experience menopausal symptoms. Are you going through Perimenopause? Take our free online assessment below to help you find out.
- Menopause – Often referred to as “the change of life”, menopause is a normal phase during which a woman’s menstrual period ceases. On average, this typically occurs around the age of 51, although some women experience menopause in their 40s or later in their 50s.
- Postmenopause – After menopause, a woman is in this stage, which lasts the rest of her life.
Causes of Menopause
Menopause naturally occurs when the reproductive hormones estrogen and progesterone decline to a level where the menstrual cycle stops.
Early menopause can occur as a result of:
- Hysterectomy with a salpingo-oophorectomy – a surgery that involves the removal of the uterus, fallopian tubes and ovaries.
- Hysterectomy, even when the ovaries are left intact, can lead to a decrease in estrogen and ovarian function, sometimes years after the procedure.
- Chemotherapy and radiation treatments for certain types of cancer.
- Chronic stress.
- Poor diet, drastic and extreme diets.
- Exposure to chemicals or pesticides.
- Certain autoimmune diseases.
Symptoms of Perimenopause & Menopause
Common symptoms that women may experience during perimenopause can be a continued into the menopause stage. These symptoms may include:
- Hot flashes.
- Breast tenderness.
- Worsening of premenstrual syndrome.
- Decreased libido (sex drive).
- Irregular periods; lighter/less frequent periods including skipping.
- Vaginal dryness; discomfort during sex.
- Urine leakage when coughing or sneezing.
- Urinary urgency (a pressing need to urinate more frequently).
- Mood swings.
- Difficulty falling asleep or staying asleep.
Treatment Options and Managing Symptoms of Perimenopause and Menopause
Every woman’s symptoms are different and their treatment options need to be tailored to the symptoms they’re experiencing. These treatment options will also be individualized to their overall general health and what stage they’re in the menopause process.
Provider’s who specialize in this stage of a women’s life can create a treatment plan specifically for each woman, monitor for effect and adjust as needed. Risks and benefits will be thoroughly explained so every woman is fully informed, and an active participant in their care. Depending on your age, medical history and family medical history your provider will also discuss which important health screenings you may need (i.e. mammogram, colonoscopy, peripheral artery disease, etc.).
Hot Flashes: What You Should Know About New Treatment Options
Hot flashes are all too familiar for many women going through perimenopause and menopause. Until June 2013, those sudden feelings of warmth and blushing had few easily obtainable and uncomplicated non-hormonal remedies – other than an ice pack and a high-powered fan. Now, however, a new FDA-approved non-hormonal drug, known as paroxetine, has hit the market for treating hot flashes.
Hot Flashes: Symptoms
But first – do you know if your symptoms are actually hot flashes, or something else? Hot flash symptoms are sometimes confused with the symptoms of hyperthyroidism and even heart attack. Common symptoms of hot flashes include:
- The feeling of spreading warmth in the upper body and face
- Flushed, red, or blotchy skin
- Rapid heartbeat
- Upper body perspiration
- Chilled feeling after the episode is over
Hot flashes can last anywhere from a couple minutes to a half hour. Depending on the woman, hot flashes may occur multiple times a day or just once every few days. In most women who experience hot flashes, episodes recur for at least a year.
These symptoms are very similar to hyperthyroidism symptoms. However, hyperthyroidism usually includes the following symptoms, in addition to those listed above:
- Sudden weight loss (despite an increased appetite)
- Changes in bowel patterns
- Enlarged thyroid gland (swelling at the base of the neck)
- Fine, brittle hair
- Fatigue and muscle weakness
Occasionally, patients write off symptoms of a mild heart attack as a hot flash. If you ever experience pain or pressure in the chest, shortness of breath, pain in one or both arms, the neck, back, jaw, or stomach, then you may be experiencing a heart attack. Call 911 immediately.
Hot Flashes: Treatments
There are many different treatment options for hot flashes, each with its own set of pros and cons. It’s important to keep in mind that hot flashes do not require treatment. If your hot flashes are few and far between – or if they don’t bother you that much – then you may wish to avoid medication, as the side effects could be more bothersome than the actual hot flashes. A few widely adapted treatment options include:
- Hormone Therapy. Oral dosages of estrogen and progesterone may be used to provide symptomatic relief. (Women who have had a hysterectomy do not need progesterone.) Estrogen can be effective for reducing symptoms but is typically not recommended for women who are at risk for heart disease, breast cancer, or blood clotting.
- Many women who cannot – or do not want to – use hormonal drugs find low-dose antidepressants to be effective in reducing hot flash symptoms. However, antidepressants could have undesirable side effects that outweigh their benefit, including nausea, weight gain, disinterest in sex, and dizziness.
- This prescription medication is used to prevent seizures. However, some women have had success in reducing hot flashes with gabapentin. Side effects may include drowsiness, headaches, and dizziness.
- This hypertension medication, available in the form of a pill or patch, has been known to reduce hot flash symptoms in some women. Side effects include dizziness, dry mouth, constipation, and drowsiness.
Paroxetine: Non-Hormonal Treatment Option
Understandably, many women are reluctant to introduce additional hormones to their bodies, as the use of hormones can increase the risk for breast cancer and other diseases. Paroxetine offers an alternative. Paroxetine is a non-hormonal drug that has recently received FDA approval for treating hot flashes. Paroxetine’s original use was for treating major depression and various behavioral health disorders.
Paroxetine for hot flashes is a low-dose form of paroxetine mesylate. It is used to treat moderate to severe vasomotor menopausal symptoms, such as hot flashes and night sweats. The drug functions as a selective serotonin reuptake inhibitor (SSRI). This means that the medication regulates the amount of serotonin in the brain, which is believed to help regulate the body’s temperature.
Though paroxetine and other antidepressants have been prescribed for hot flashes for many years, this new FDA-approved SSRI is specifically designed for treating hot flashes, which leads many physicians to believe that it could be a safer, more effective alternative. However, the drug is too new for studies to confirm it is safer or more effective than hormonal therapies.
Tips to Help Cope with Minor Symptoms
Here are a few helpful tips that may help provide comfort for women going through menopause:
- Recognize your “triggers” and try to avoid them if possible.
- Avoid or limit the amount of alcohol, caffeine and spicy foods you consume.
- Avoid hot beverages, especially before bedtime.
- Drink plenty of cold liquids.
- Dress in layers so you can remove as needed.
- Avoid heavy fabrics.
- Cotton “breaths” so it is much cooler than synthetic fabrics.
- Sleep in layers so they can be easily removed.
- The higher the thread counts of bed linen the better. Indulge yourself if possible!
- Fans of all kinds are your best friends; ceiling, free standing and/or handheld.
- Try applying a cool wet cloth to your neck and face.
Vaginal dryness is a common problem for women during perimenopause and menopause, due to the decline in estrogen. Normally a thin layer of clear fluid lubricates the vaginal walls. Estrogen maintains this fluid and keeps the vaginal walls healthy, thick and elastic. Thinning, drying and loss of elasticity in the vagina can cause uncomfortable itching and discomfort and/or bleeding during or after intercourse. There are products available to treat vaginal dryness. Estrogen creams and water-based lubricants are available to assist you. Please speak with your healthcare provider to discuss what will be best for you.
- Avoid mentally stimulating activity before bedtime (i.e., computer games, work you brought home, television, etc.).
- No strenuous physical exercise before bedtime. Try to do your workout earlier in the day.
- Avoid eating right before bedtime and drinking hot beverages.
- Engage in whatever activity is relaxing for you (i.e., take a bath, listen to music, meditate, read a book, etc.)
- Place fans in the bedroom. Do not be afraid to have them blowing directly on you.
- Layer bedding and sleepwear, for easy removal.
- The higher the thread counts of bed linen the better. Indulge yourself if possible!
- Have extra pillows for comfort.
- Keep the bedroom cool, dark and quiet, except for white noise from fan.
- When you wake up in the middle of the night, relax and allow yourself to fall back asleep.
- Avoid stress as much as possible.
- Enjoy relaxing activities.
- Take time every day for yourself.
- Plan activities or outings you enjoy.
- Engage in regular exercise such as walking or yoga.
- Take deep breaths before reacting to a bad situation.
- If your mood swings are more severe and include feelings of depression, anger, or anxiety please see your healthcare provider.
As the brain ages, it too needs to stay physically fit and be exercised. A balanced healthy diet and sleep are also essential. Take advantage of learning opportunities that are available online, on television education shows and in your local community. Use an online search engine and explore the Internet for brain teasers, exercises, riddles and trivia. A popular website to improve core cognitive functions is lumosity.com. Puzzle apps are also available for download depending on phone and tablet devices. Even in today’s technologically advanced society, mind stimulating games and puzzles still exist and can be found in newspapers and bookstores.
Just as your body needs to have physical activity, take the time to routinely keep your brain healthy, alert and active.
There are options to help with this distressing and potentially embarrassing issue. Talk to your healthcare provider about what options will be best for you.
The providers at Steward Medical Group Women’s Health Associates have extensive experience in helping patients manage menopause. For more information, or to schedule an appointment, please contact us. You can also schedule your appointment online.
What is bioidentical hormone replacement therapy?
If you are a woman going through perimenopause or menopause, then you may have heard about bioidentical hormone replacement therapy (BHRT), an alternative to traditional synthetic hormones. BHRT has many patient benefits; however, the approach is also commonly misunderstood due to its representation in patient literature and the media.
The healthcare providers at Steward Medical Group Women’s Health Associates have created this easy-to-understand FAQ as a resource for patients interested in bioidentical hormone replacement therapy. Before taking any new drugs, always consult with your healthcare provider. The information presented below is not intended to replace a professional health consultation.
How are bioidentical hormones different from other hormonal drugs?
Bioidentical hormones are derived from natural sources (such as yams and soy). These chemicals have a molecular structure that is identical to the hormones your body produces; some proponents say that this makes it easier for your body to recognize and process the hormones. While bioidentical hormones are derived from natural sources, they still have to be processed like synthetic hormones.
What are the benefits of bioidentical hormone replacement therapy?
Women undergoing BHRT may experience the following potential benefits:
- No more night sweats
- No more hot flashes
- Better energy levels
- Better mood (less anxiety, depression, and irritability)
- Improved sex drive
- No vaginal dryness or thinning
- Improved fat loss and better muscle tone
- Fewer skin wrinkles
- Lesser risk of heart disease
- Better bone health (protection from osteoporosis)
Is BHRT different from synthetic hormones?
Yes, there are some differences. Here are just a few examples of how bioidentical hormones differ from synthetic hormones:
- BHRT is taken in a customizable dosage. A simple saliva test allows your provider to determine the appropriate dose of bioidentical hormone for you. Synthetic hormones are not easily customizable.
- Bioidentical hormones are identical in chemical and molecular structure to natural hormones.
- Bioidentical hormones are derived from plant sources; synthetic hormones are not. Beware of “natural” hormones, such as Premarin (derived from pregnant horses’ urine), which may be from a natural source, but not “bioidentical” on the chemical and molecular level.