Symptoms and treatment Perimenopause

Description

Perimenopause means "around menopause" and refers to the time during which the body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopause transition.

Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as the mid 30s.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which their ovaries do not release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help relieve these symptoms.

Once you have gone through 12 consecutive months without menstruation, you've officially reached menopause and perimenopause period.

Symptoms

Throughout the menopause transition, some subtle and some not-so-subtle — changes in your body can take place. You may experience:

Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, the flow can be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be at the beginning of perimenopause. If you have a space of 60 days or more between periods, probably at the end of perimenopause.
Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, duration and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes the dream becomes unpredictable, even without them.
Changes of mood. Mood changes, irritability or increased risk of depression can occur during perimenopause. The cause of these symptoms may be the sleep disorders associated with hot flashes. Mood changes can also be caused by factors not related to the hormonal changes of perimenopause.
Vaginal and bladder problems. When estrogen levels decrease, your vaginal tissues may lose the lubrication and elasticity, making intercourse painful. The low level of estrogen can also leave you more vulnerable to urinary tract infections, or vaginal. The loss of tissue tone may contribute to urinary incontinence.
The decline of fertility. As ovulation becomes irregular, their ability to conceive decreases. However, while you are having menstrual periods, pregnancy is possible. If you want to prevent pregnancy, use of birth control until you've had periods of 12 months.
Changes in sexual function. During perimenopause, the sexual arousal and desire may change. But if they had a satisfying sexual intimacy before the menopause, this will likely continue through perimenopause and beyond.
The loss of bone. With the decline of estrogen levels, you begin to lose bone more quickly to replace him, increasing the risk of osteoporosis, a disease that causes brittle bones.
The change of the levels of cholesterol. The decreased levels of estrogen can lead to " bad " changes in their levels of ldl cholesterol in the blood, including an increase in low-density lipoprotein (LDL) cholesterol-the "bad" cholesterol, which contributes to an increased risk of heart disease. At the same time, the high-density lipoprotein (HDL) cholesterol, the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

When to see a doctor

Some women seek medical attention for your perimenopausal symptoms. But others tolerate the changes or simply do not experience symptoms severe enough to need attention. Because the symptoms can be subtle and gradual manner, you may not realize that they are all connected to the same thing — to the hormonal fluctuations of menopause transition.

If you have symptoms that interfere with your life or well-being, such as hot flashes, mood changes, or changes in sexual function that concern you, talk to your doctor.

Causes

As you go through the perimenopause, your body's production of estrogen and progesterone, the key female hormones, up and down. Many of the changes that happen during the perimenopause are a result of the decrease in estrogen.

Risk factors

Menopause is a normal stage in life. But it can occur earlier in some women than in others. Although not always conclusive, there is some evidence that suggests that certain factors may make it more likely that the onset of the perimenopause at an early age, including:

The habit of smoking. The onset of menopause occurs 1 to 2 years earlier in women who smoke than in women who do not smoke.
The history of the family. Women with a family history of early menopause may experience early menopause themselves.
The treatment of cancer. The treatment for cancer with chemotherapy or pelvic radiation therapy has been associated with the menopause.
The hysterectomy. A hysterectomy removes the uterus but not the ovaries, usually does not cause menopause. Although you no longer have periods, to the ovaries to produce estrogen. But this type of surgery may cause menopause to occur earlier than the average. Also, if you have an ovary removed, the remaining ovary might stop working earlier than expected.

Complications

Irregular periods are a hallmark of perimenopause. Most of the times this is normal and not to worry. However, consult your doctor if:

The bleeding is very heavy — you're going to change tampons or pads every hour or two for two hours or more
The bleeding lasts more than seven days
The bleeding occurs between periods
Periods that occur on a regular basis, at least 21 days apart

Signs like these could mean that there is a problem with your reproductive system that requires diagnosis and treatment.

Diagnosis

Perimenopause is a process of gradual transition. There is a test or a sign is enough to determine if you are logged in perimenopause. Your doctor will take many things into account, such as age, menstrual history, and what symptoms or changes in the body that you are experiencing.

Some doctors may order tests to check your hormone levels. But apart from checking the function of the thyroid, which can affect hormone levels, hormone testing is rarely necessary or useful to evaluate the perimenopause.

Treatment

Medications are often used to treat perimenopausal symptoms.

The hormone therapy. Systemic estrogen therapy — which comes in pill, skin patch, spray, gel, or cream — remains the most effective treatment option to relieve perimenopause and menopause hot flashes and night sweats. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose necessary to provide relief of symptoms for you. If you still have your uterus, you will need to progestin in addition to estrogen. Systemic estrogen may help prevent bone loss.
Vaginal estrogen. Estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases a small amount of estrogen that is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort during sex, and some urinary symptoms.
Antidepressants. Certain antidepressants are related to the class of drugs called selective serotonin reuptake inhibitors (Ssris) can reduce menopausal hot flashes. An antidepressant for the management of hot flashes may be useful for women who cannot take estrogen for health reasons or for women who need an antidepressant to a mood disorder.
Gabapentin (Neurontin). Gabapentin is approved for the treatment of seizures, but it has also been shown to help reduce hot flashes. This medicine is useful for women who cannot use estrogen therapy for health reasons and for those who also suffer from migraines.
Fezolinetant (Veozah). This medication is a hormone-free option for the treatment of menopause, hot flashes. It works by blocking a pathway in the brain that helps regulate body temperature.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each one. Review your choices, annual, as their needs and the treatment options may change.

Lifestyle and home remedies

You are doing a healthy lifestyle can help to relieve some of the symptoms of perimenopause and promote the good health of the years:

Relieve vaginal discomfort. The use of over-the-counter, water-based vaginal lubricants (Astroglide, K-y Liquid, others) or moisturizer (Replens, Vagisil Prohydrate, other). Choose products that do not contain glycerin, which can cause burning or irritation in women who are sensitive to this chemical. Stay sexually active also helps to increase the blood flow to the vagina.
Eat healthy. Because your risk of osteoporosis and heart disease increases at this time, a healthy diet is more important than ever. Adopt a low-fat, high-fiber diet that is rich in fruits, vegetables and whole grains. Add calcium-rich foods. Avoid alcohol and caffeine if they seem to trigger hot flashes. Ask your doctor if you should also take a calcium supplement and, if so, of what type and how much — also ask if you need more vitamin D, which helps your body absorb calcium.
Be active. Regular exercise and physical activity helps to prevent weight gain, improves sleep and lift your mood. Try to exercise for 30 minutes or more on most days of the week, but not immediately before going to bed. Regular exercise has been shown to reduce the risk of hip fracture in elderly women and to strengthen the bone density.
Get enough sleep. Try to keep a consistent sleep schedule. Avoid caffeine, which can make it difficult to sleep, and to avoid the excessive consumption of alcohol, which can disrupt sleep.
The practice of stress reduction techniques. Practiced regularly, stress-reduction techniques, such as meditation or yoga, you can promote relaxation and good health throughout his life, but that can be particularly helpful during the menopause transition.

Alternative medicine

In addition to conventional therapies, many women in the transition to menopause you want to know more about complementary and alternative approaches to the treatment of the symptoms. Researchers are studying these therapies to determine their safety and effectiveness, but the evidence is often absent.

Some of the options being studied include:

Black cohosh. This herb extract is used by some women to treat hot flashes and other symptoms of menopause. There is not enough evidence to support its use. Also, experts are not sure what are the risks of taking the black cohosh poses. Some studies have suggested that black cohosh is detrimental to the liver, but other studies have not found any evidence that this is true. The researchers also question whether the extract of the herb is safe for women with or at risk of breast cancer.
The phytoestrogens.These estrogens are produced naturally in certain foods. Two main types of phytoestrogens are isoflavones and lignans. Isoflavones are found in soy and other legumes, and red clover. Lignans occur in flaxseed, whole grains and some fruits and vegetables. There are also plant-derived compounds that have estrogen-like properties. Studies on phytoestrogens — whether from food or supplements of a conflict about whether to help reduce symptoms of the menopause. The studies also conflict about the beneficial impact, if any, phytoestrogens can have on the risk of breast cancer.

The phytoestrogens. These estrogens are produced naturally in certain foods. Two main types of phytoestrogens are isoflavones and lignans. Isoflavones are found in soy and other legumes, and red clover. Lignans occur in flaxseed, whole grains and some fruits and vegetables. There are also plant-derived compounds that have estrogen-like properties.

Studies on phytoestrogens — whether from food or supplements of a conflict about whether to help reduce symptoms of the menopause. The studies also conflict about the beneficial impact, if any, phytoestrogens can have on the risk of breast cancer.

The bioidentical hormones. The term "bioidentical" means the hormones in the product are chemically identical to those your body produces. However, compounded bioidentical hormones are not regulated by the Food and Drug Administration (FDA), so that the quality and the risks may vary. Furthermore, there is evidence that compounded bioidentical hormones are safer or more effective than conventional hormone therapy.
Dehydroepiandrosterone (DHEA). This natural steroid produced by the adrenal gland is available as a dietary supplement and has been used by some to reduce the pain during intercourse due to vaginal atrophy. But the evidence on their effectiveness is mixed, and there are some concerns about possible harmful effects.

Talk with your doctor before taking any herbal or dietary supplements for perimenopause or menopause symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medicines that you take, putting your health at risk.

Low-risk complementary therapies that can help reduce stress and improve psychological well-being are:

Acupuncture. The research on acupuncture for the reduction of hot flashes is not conclusive, but promising.
Relaxation techniques. Yoga and meditation, for example, can help to reduce stress, which in turn can help to improve the symptoms of menopause.

Preparing for your appointment

You will probably start by discussing your symptoms with your primary care physician. If you are not seeing a doctor who specializes in the female reproductive system (gynecologist), your primary care provider can refer you to one.

Consider the possibility of a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.

What you can do

To prepare for your appointment:

Keep a record of your menstrual cycles. Keep a journal of your menstrual cycles during the past few months, including the first and last date of bleeding per cycle, and if the flow was light, moderate or heavy.
Make a list of the signs and symptoms that you are experiencing. Include detailed descriptions. Include any of the symptoms that may seem unrelated.
Take note of the key of the personal information. Include any major stresses or recent life changes.
Make a list of all the medications and doses. Includes prescription and nonprescription medicines, herbs, vitamins, and supplements you are taking.
Preparing the questions. Your time with your doctor is limited, so preparing a list of questions to help you make the most of your time together.

Some basic questions to ask include:

What is likely causing my symptoms?
What are other possible causes of the symptoms?
What kinds of tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach you're suggesting?
I have some other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
You should see a specialist?
Are there brochures or other printed material I can have? What sites do you recommend?
What is going to determine whether I should plan for a follow-up visit?

Questions your doctor may ask

To start a discussion about your perimenopausal experience, your doctor may ask you questions such as:

You can't continue to have menstrual periods? If so, what are they like?
What symptoms do you have?
How long have you experienced these symptoms?
How much distress do your symptoms do they cause?
What are the medicines, herbs, vitamins, or other supplements you take?