Perimenopause and Menopause: The Effects and Possible Treatments

Menopause is one of every woman's biggest worries. This may be due in part to the lack of information that many women have on the subject matter. In fact, one common misconception among women is that menopause is merely a one phase process, but really a woman's body is preparing for menopause before it even happens.

The phase called perimonopause occurs before menopause generally between 35-45 (Association of Women for the Advancement of Research and Education, 2007), but it can onset as late as the 50s since every woman's body and body functions are different. What can be frustrating about perimenopause, and just one more reason why many women are unaware of it, is the fact that physicians fail to catch the symptoms perimenopause. It is often missed or overlooked due to the fact that it can occur as early as the 30s and few women would think of early onset perimenopause as the cause. The signs and symptoms of perimenopause can be recognized by the individual experiencing them fairly easily as the symptoms include many that are typically characteristic of menopause such as hot flashes, worsening of premenstrual symptoms, mood swings, fatigue, and breast tenderness among other things (Chaddha, 2007). What's important to note is that these symptoms don't always signal perimenopause; however, a hormone check through a blood test can give an exact diagnosis. It's also good to know that most women don't find perimenopause particularly difficult. According to the Association of Reproductive Health Professionals most find it to be a normal transition in their lives (2004).

There are treatments available for the symptoms of perimenopause but, like menopause, it cannot be avoided. For a woman, perimenopause and menopause are a fact of life. Still, the Association of Reproductive Health Professionals mentions beneficial effects of herbal supplements, special diets (including soy - which contains natural soy estrogen), yoga, and meditation (2004).

Perimenopause generally lasts for three to four years, but there is some debate about the exact period of time. Following perimenopause menopause occurs. Menopause typically takes place around the age of 50 and is marked by the end of menses, or your menstrual cycle (Association of Women for the Advancement of Research and Education, 2007). Gradually a woman's ovaries begin to decrease in function, this decreasing estrogen production. Typically women report changes to their menstral cycle before it actually ceases. These changes can include a shortening in the time period between cycles, or a lengthening of the time between cycles, skipped cycles, or even heavy periods (Chaddha, 2006). All women experience menopause differently, just as all women experience perimenopause differently. Reports on menopause state that about 75% of women experience the notorious hot flashes which can occur either during the day or night. Night hot flashes can also result in chronic sleep deprivation. Mood changes such as irritability can be present, as can physical effects such as vaginal dryness and increased frequency of urination.

Both perimenopause and menopause can affect a woman's sex life on top of the other effects that menopause possesses. Some women find the physiological effects of menopause negatively impacts sexual enjoyment. Effects such as vaginal dryness, night sweats, loss of androgens (lowers sexual libido), and hot flashes are due to a loss of estrogen and each can negatively impact sexual enjoyment. However, according to The University of Rochester Medical Center's Gynecology Department, there are other age related factors besides menopause that can also affect one's sexual enjoyment and desire for sex. These changes can include "Decreased blood flow to the pelvis - ovaries no longer need as much nourishment, and the reduced blood flow causes the vagina to become smaller and less elastic. Walls of the vagina may become thin and tender, causing intercourse to be very painful. Problems with urine leakage or increased urinary frequency due to weakening of pelvic muscle support" (University of Rochester Medical Center, N.d). Additinally, vaginal dryness tends to make sexual intercourse painful and unpleasant and sleep deprivation can reduce the energy a woman has for sex.

Despite all this, women can make it through menopause relatively easily. A treatment called hormone replacement therapy is a common choice by most women and their doctors. Hormone replacement therapy contains estrogen and progestin (for those women who have had a uterus removal usually only estrogen is used.) Hormone replacement therapy seeks to minimize or completely rid a woman of the symptoms of menopause. However, there are downsides to HRT (hormone replacement therapy). Woman's Health Initiatives has conducted a number of studies concerning hormone therapy. Medline Plus reports that two studies on different forms on HRT in 2002 and 2004 were stopped early due to an increased risk of breast cancer and stroke respectively. In turn, the WHI (Woman's Health Institute) reports benefits associated with HRT as well. It reports that "women taking HRT had 34% fewer hip fractures and 24% fewer fractures than women not receiving hormones" (Medline Plus, 2006). However, the same report goes on to state that "the short-term use of HRT to relieve symptoms at the time of menopause does little to prevent fractures in women when they reach 75-80 years of age. Women who take estrogen to maintain bone density must continue taking estrogen because the beneficial effects on bones disappear when it is discontinued" (Medline Plus, 2006).

Overall, it seems the benefit-risk ratio must be assessed by a doctor depending on the number of years one would be on HRT, and one's medical history. In some cases it seems that the risks of breast cancer, stroke, blood clots, and heart disease outweigh those of the risks of osteoporosis (Medline Plus, 206). The decision to take these risks or avoid them and try other forms of therapy, such as those mentioned in the section on perimenopause, should be made by patient and physician. Menopause can be a trying time in a woman's life, but with proper medical advise and a willingness to learn and embrace the changes, a woman can make the experience a fair deal easier.

References:

Chaddha, J. (2007). Your Guide to Perimenopause. June 23, 2007, from WebMD: http://www.webmd.com/menopause/guide/guide-perimenopause

Association of Women for the Advancement of Research and Education. (2007). Perimenopause. Retrieved June 23, 2007, from Association of Women for the Advancement of Research and Education Website: http://www.project-aware.org/Experience/perimenopause.shtml

Association of Reproductive Health Professionals. (2004). Perimenopause: Pathways to Change. Retrieved June 23, 2007, from Association of Reproductive Health Professionals Website: http://www.arhp.org/patienteducation/onlinebrochures/perimenopause/periapt.cfm?ID=283

University of Rochester Medical Center. (N.d). Women's Health. Retrieved June 23, 2007, from University of Rochester Medical Center Website: http://www.stronghealth.com/services/womenshealth/gynecology/sexandmenopause.cfm

Chaddha, J. (2006). Menopause Guide. Retrieved June 23, 2007, from WebMD Website: http://www.webmd.com/menopause/guide/understanding-menopause-basics

Medline Plus. (2006). Hormone Replacement Therapy. Retrieved June 23, 2007, from Medline Plus Website: http://www.nlm.nih.gov/medlineplus/ency/article/007111.htm