There is a popular but natural misunderstanding that perimenopause is actually "pre-menopause." While this isn't completely untrue, it deflects the focus from a real medical condition that can last up to ten years. Among the many challenges are that a large number of different symptoms affect women over a wide age range. And let's face it: we are a goal-oriented culture so the end game appears to be menopause, defined as one full year without menstruation.
Playing detective through a set of costly tests (blood, urine and saliva) can point the way to a diagnosis, but women with so-called normal results may still be in perimenopause as hormone levels can vary widely day-to-day. Instead, diagnoses arise mainly from patient-reported symptoms and in the absence of other medical conditions. My best advice is twofold: first, women should listen to their bodies carefully and second, any woman concerned with altered menstrual patterns (especially age 40+) should take time to visit with their doctor.
Perimenopause can represent a new and unusual experience for many women. Patients generally report changes in their menstrual cycle (irregular periods: shorter/lighter, heavier/longer, spotting and more) and potentially any one or more of a wide number of symptoms, including:
> Hot/cold flashes; night sweats or other sleeping disturbances;
> Loss of libido; vaginal dryness;
> Hair loss or thinning hair;
> Mood changes/swings: depression, anxiety, memory lapses/confusion;
> Gastrointestinal distress;
> Increased frequency of urinary tract and other infections; and
> Weight gain, bloating and more.
Women in perimenopause (which can begin as early as the mid-30s) need advice and treatment tailored to their symptoms. It can range from taking birth control pills (which should really be renamed hormone-management pills), using compounded skin creams comprised of bio-identical hormones (bi-est and others which include plant-originated forms of estrogen such as estriol and estradiol) and, of course, natural alternatives such as acupuncture, black cohosh, evening primrose oil and isoflavones. Vaginal tissue, which can become delicate during this time can be improved with internally applied creams like Estrace (estradiol) or Replens, an over-the-counter vaginal moisturizer.
The reality? Whatever works best for you, works best for you. There is no single answer and, in tandem with your doctor, you can develop a treatment plan to manage symptoms. I always suggest two things to women under my care. First, let me do the worrying for you! We can find a solution together but your time spent researching on the Internet can be both productive and terrifying at the same time. Secondly, strive for balance in all things. On any given day, we take so many things into our bodies that create systemic imbalances such as plastics, environmental toxins and antibiotics, and we have to consider managing these imbalances with practical solutions like fish oils, probiotics, calcium, Vitamins C, D and E and more.
So please consider this mystery solved: perimenopause is one of many natural life phases for women. We can diagnose it and treat it with confidence together.
Dr. Kate Skaggs is a strong patient advocate, practicing obstetrics and gynecology at High Country Healthcare OB/GYN Specialists office in Frisco. Aside from traditional care, Dr. Skaggs' special interests include menopausal treatment to include options for hormonal therapy - both traditional and bio-identical; and bladder health and function. Additionally, Dr. Skaggs works with cancer survivors, particularly patients those which affect their health as a woman.