During menopause, ovulation ends, menstrual periods stop permanently, and the production of female hormones drops suddenly in a short period of time, signaling the end of female reproductive capacity.
Most women go through menopause between 40 and 58. The average age is 51. Menopause is a natural change. OBGYNs define menopause as when a woman has no vaginal bleeding for a year.
The 4-6-year period before menstrual periods stop is called perimenopause, which causes its own symptoms
During perimenopause, women typically experience irregular periods, which can be longer or shorter, lighter or heavier. Symptoms include:
- Hot flashes- a sudden wave of heat lasting one to ten minutes followed by shivering
- Night sweats- hot flashes that interfere with sleep
- Vaginal atrophy- the drying and thinning of vaginal tissues causing pain, burning and soreness, especially during sex
- Mood swings – irritability, feeling out of control, anxiety, fatigue, and depression. Depression can cause sleep disturbances.
- Decreased sexual desire
- Memory problems like difficulty concentrating and short term memory problems
- Urinary incontinence- a persistent, involuntary loss of urine
Symptoms may improve with treatment. *individual results may vary.
- There is no blood test to check hormone levels during perimenopause
- Testing for elevated follicle-stimulating hormone (FSH) levels. If these hormones are elevated consistently and she hasn’t had a period for a year, this is evidence of menopause. But this can be misleading if the woman is in perimenopause.
- Menopause symptoms may be due to a thyroid problem. The thyroid makes hormones that regulate metabolism. When the thyroid is underactive – hypothyroidism- the gland fails to produce enough hormones to maintain healthy function. If untreated, it can lead to high cholesterol, osteoporosis, heart disease and depression. It can be diagnosed with a simple blood test and treated with thyroid replacement therapy. Hyperthyroidism is when the thyroid produces too much thyroid hormones. Symptoms can include hot flashes, heat intolerance, heart palpitations and insomnia.
Hormone replacement therapy (HRT) may help with the symptoms of perimenopause including controlling moderate to severe symptoms like hot flashes and vaginal dryness, up to age 59.
HRT may be only estrogen replacement if the woman doesn’t have a uterus; and estrogen/progesterone therapy for women who still have a uterus, to protect against uterine cancer. The general consensus is that a woman should take estrogen/progesterone replacement therapy for 5 years or less.
Low dose estrogen therapy has been associated with a lower risk of blood clots and strokes than the standard doses. Hormone therapy should be individualized based on a woman’s priorities and quality of life.
Individual results may vary.
HRT Risks and Benefits
- Blood clots in the legs and lungs
- Uterine cancer
- Breast cancer- risk increases with 5 or more years of continuous estrogen/progesterone therapy. The risk decreases after the therapy is stopped.
- Less hot flashes and night sweats, better sleep, less brain fog and irritability
- Relief from vaginal dryness and thinning tissue and painful intercourse with vaginal estrogen
- Relief from overactive bladder and recurring UTIs
- Protects your bones, fractures
- Lowers you risk of heart disease if you start HRT within 10 years of menopause
- Help prevent type 2 diabetes
Individual results may vary.
Perimenopause treatments for symptoms:
- Progesterone to treat hot flashes
This occurs in about 1% of women age 40 or younger. If it is not genetic, it can be caused by metabolic and autoimmune diseases, or other poorly understood conditions.
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