A Decline in Hormones

Perimenopause is the period of time before menopause when menopausal symptoms are first noticed; it extends until one year after menopause occurs. Women who experience menopausal symptoms often notice them slowly increasing for several years before their menstrual period stops completely. Menopause is marked by a full 12 months without a menstrual period. Actually, the phrase “going through menopause” refers to perimenopause.

Just as perimenopause represents a gradual change over time, the symptoms of perimenopause are due to the gradual loss of estrogen and progesterone production over that same time period. As hormone levels decrease, many women experience the classic symptoms of perimenopause, including hot flashes, irregular periods, mood swings, and night sweats.

Perimenopausal symptoms can become so troublesome that some women may contact their doctors for help in coping with them. Lifestyle changes in nutrition, exercise, and relaxation may improve symptoms. For others, a low-dose contraceptive pill will help control irregular bleeding, while stabilizing other symptoms of low hormone production. Once menopause has been confirmed with laboratory tests, the low-dose contraceptive pill can be switched to menopausal hormone therapy (previously known as hormone replacement therapy) if symptoms continue to be problematic. Although there are many natural or herbal products that claim to help treat perimenopausal symptoms, the National Institutes of Health has suggested that more research is needed before these therapies can be recommended as effective and safe for long-term use.

Transition into Menopause

Perimenopause is associated with a loss of vaginal lubrication and elasticity. When lifestyle changes do not improve perimenopausal symptoms, low-dose birth control pills may be prescribed.

For most women who experience natural perimenopause, symptoms begin in their late 40s or early 50s. However, some women notice symptoms even earlier. Perimenopause and its symptoms are a normal consequence of lower hormone levels, not a disease. However, these symptoms can be distressing and affect both physical and mental well-being. Women should seek treatment from their gynecologist or family physician when symptoms become severe, especially when menstrual bleeding is very heavy or lasts longer than 10 days, or if periods are very close together.

Symptoms of Perimenopause

Perimenopause can last for five to 10 years, with symptoms varying from mild to severe. The length of perimenopause depends on the individual woman. Most women will have irregular periods as they approach menopause, including shorter or longer monthly cycles, shorter or longer bleeding, and lighter or heavier flow than in the past. Some women suffer from dramatic hot flashes during the day. Restful sleep can be difficult to attain, and hot flashes during sleep can cause night sweats, followed by chills. Mood swings, irritability, and depression can affect women during perimenopause and are likely worsened by a lack of restful sleep. Since estrogen provides the vagina and urinary tract with a natural defense against inflammation by keeping the tissues moist, elastic, and at the proper acidity, a lack of estrogen may lead to vaginal dryness and itchiness, as well as urinary tract infections. Although there is no laboratory test for perimenopause, a doctor can measure blood levels of follicle-stimulating hormone and luteinizing hormone to determine if a woman is in menopause.

Treating Perimenopause

Lifestyle Changes: Women who suffer from perimenopausal symptoms are often advised to make simple lifestyle changes before beginning medication therapy. Recommendations include eating a healthy diet, exercising regularly, and performing relaxing activities. A diet low in fat and high in calcium, vitamin D, and fiber can maintain health during this time and throughout life. For some women, caffeine and alcohol can worsen hot flashes and should be avoided. An exercise routine that includes at least 30 minutes per day of low-impact activity will improve mood, sleep, and weight control. Scheduling a relaxing activity each day will help prevent mood swings and irritability.

Low-Dose Contraceptives: If lifestyle changes do not result in symptom relief, low-dose contraceptive pills are commonly prescribed to treat perimenopausal symptoms. These medications help regulate menstrual periods and control most other symptoms related to low hormone levels. In addition, these contraceptive pills are effective birth control, even though they contain a lower dose of hormone than that in regular contraceptive pills. Although fertility is much lower during perimenopause than in earlier years, it is possible to become pregnant as long as periods continue. Low-dose contraceptives are not a good choice for women who smoke or have a history of blood clots. Low-dose contraceptives can be discontinued briefly, and hormone levels can be measured to determine menopausal status. Once menopause has been confirmed with laboratory tests, a switch can be made from low-dose contraceptive pills to a menopausal hormone therapy, if symptoms continue to be bothersome.

Herbal Products: There are many over-the-counter botanicals (herbal supplements) marketed as effective in the relief of perimenopausal symptoms. These include soy, kava, ginseng, black cohosh, red clover, and dong quai. However, none have sufficient data to prove they are both safe and effective. Many have serious interactions with other drugs or nutritional supplements. In addition, since these products are not regulated as drugs, the manufacturing process and quality of ingredients are not ensured by the government. Until the results of ongoing studies are available, these botanical products cannot be recommended to treat the symptoms of perimenopause.
US Pharmacist
Copyright 2003 Jobson Publishing, LLC