Perimenopause

Perimenopause is defined as the “pre” menopausal state a woman’s body goes through, one that produces a variety of hormonal imbalances and fluctuations.  It is only recently that perimenopause has been recognized as quite a different condition from menopause. 

What has been so confusing about perimenopause is that its symptoms mimic menopause so closely.  Irregular periods, hair loss, heavy bleeding, sleep disruption, dry eyes, vaginal changes, hot flashes, weight gain, headaches, low sex drive or extreme emotional distress are all hallmarks of perimenopause – so it’s not much different from menopause!  These symptoms are a direct result of your hormones being in a state of flux and it is actually your body’s way of telling you something is wrong.  Perimenopause can start up to 10–15 years before you stop having your period.  In fact, women in their late 30s, 40s and early 50s may go in and out of perimenopause numerous times before actual menopause sets in.

Perimenopause & Your Hormones

Hormones control everything from our sex drive to our state of mind.  When a woman’s three main hormones (estrogen, progesterone and testosterone) go out of balance, it throws off your entire equilibrium. 

Estrogen and progesterone are vital to a woman’s well-being.  Estrogen keeps the vagina functioning, balances cholesterol and aids in calcium absorption. Progesterone wraps a protective barrier around a woman’s uterine lining and breast tissue.  Progesterone also builds new bone mass.

While each of these hormones is important individually, you really need them to work together to keep you healthy.  Progesterone and estrogen act as a checks and balance system for your reproductive organs; if you take estrogen without progesterone, your risk for endometrium cancer goes up. During the reproductive years, the endometrium (lining of the uterus) sheds cells during menstruation. When those cells no longer shed, estrogen will force those cells to multiply, which turns into cancer.  Without progesterone, the endometrium won’t shed those cells. When you take progesterone and estrogen together, you can eliminate this issue.

Perimenopause Treatment

Hormone Replacement Therapy (HRT) can provide an answer to the perimenopause issue.  Once upon a time, hormone supplements were only available as a pill.  These days you can try pills, patches, gels, creams – even lozenges – whatever works best for your system.   Before you embark on a hormone therapy regimen, it is critical you understand what your baseline hormone levels are.  A saliva test is the best way to do this.

A good rule of thumb to follow with HRT is to choose the lowest effective dose possible for the shortest amount of time.  Depending on your individual perimenopause symptoms, you may be on HRT anywhere from three to five years. 

First, Plan ahead! Have a plan in place for dealing with rebound symptoms.  Decreasing your dosages may not be smooth sailing.  Consider lubricants for vaginal dryness, dressing in layers to deal with hot flashes and cutting back on caffeine.

Second, Time is everything! Life has its own timetable and perimenopause is no exception.  Perimenopause can seem like one more thing on an already crowded plate.  However, once your hormone therapy gets underway, you will find yourself better equipped to deal with your symptoms.  Additionally, the seasons can play an important role in when you decide to change your HRT dosages.  For example, if you experience hot flashes, stopping in the summer isn’t a good idea; wait until winter.

Doc, Please Listen