Perimenopause and the Menopause Transition
One is considered menopausal after a year has passed since the last menstrual period. Prior to menopause, 85% of women experience perimenopausal changes or symptoms that accompany hormonal fluctuations. Perimenopause can last from 2 to 15 years, sometimes longer. Some women enter menopause earlier than the average 52 years, and some enter menopause through surgery or because of medical treatment. Although menopause is considered a normal developmental transition, a majority of women experience some symptoms. Some women express extreme debilitation and others only minor changes that are easily managed through diet and lifestyle changes.
In addition to disruptive hot flashes and night sweats, the list below provides common symptoms experienced in the months or years leading up to menopause.
• Sleep disruption, difficulty falling asleep, waking up frequently leading to fatigue
• Mood swings, irritability, depression, anxiety
• Decreased libido (lack of or decrease in sexual desire)
• Vaginal dryness with the potential for painful intercourse
• Menstrual changes with heavier or irregular periods
• Fuzzy thinking, poor concentration or attention
• Weight gain or difficulty loosing weight, increased food cravings
• Joint and muscle stiffness or pain
• Headaches or menstrual migraines
• Breast tenderness, breast cysts
• Scalp hair loss, unwanted facial hair; dry skin and hair; acne
• Pelvic or urinary changes, incontinence, urinary tract infections
• Increased allergies
Treatments for Hot Flashes
In the United States, about 85% of women experience hot flashes or night sweats during the years leading up to menopause. More than half of these women will continue to have hot flashes for years following menopause. For women who suffer from debilitating hot flashes, life can feel completely out of control. Hot flashes have been described as “suffocating, embarrassing, claustrophobic, unpredictable”, and for many women, create a sense of powerlessness and a lack of confidence. This lack of power over our bodies can be, perhaps, the thing women dislike most about menopause
For most of us, understanding the triggers that might initiate hot flashes can give women a sense of more control. Avoiding the triggers and taking care of self through exercise, sleep, diet and stress reduction can make a big difference. Symptoms certainly vary from one person to the next and may include a flash, or short, intense feeling of heat in the upper body, or a woman may feel hot all the time, or experience a full body sensation of heat. In addition, she may have a flushed appearance, perspiration and often chills following the hot flash.
The causes of hot flashes are thought to be from fluctuations in hormones. The hormonal changes affect a particular area of the brain and cause the brain to misread the temperature regulation system. Our body works well to protect us from overheating. With hot flashes we are not really overheating, the temperature regulating center just thinks we are so our vessels dilate, and our heart rate speeds up in an effort to cool us down. Our skin temperature can actually increase several degrees although our core temperature remains in a normal range
Why do some women get hot flashes and others don’t?
It is really not fully understood but it is known that stress is a major factor. Other cultures may report very few perimenopausal symptoms, so perhaps women in Western cultures have more demands on both personal and professional lives. Diets that are highly processed and high in refined carbohydrates, may result in a lower tolerance to otherwise normal hormonal changes.
What you can do: Monitor your hot flashes and try to determine your triggers. It may help to keep a journal. Track the timing of your hot flashes; look for stress, dehydration or not eating/drinking regularly. Are there certain times of the day or night when hot flashes occur? Are there foods or fluids, or the lack of them that trigger symptoms? Common food and environmental triggers include spicy foods, alcohol, caffeine and nicotine (tobacco users have increased symptoms), beverages or foods that are warm or hot, an environment that creates heat, such as exercise, hot tubs, overheated bedrooms, stressful events If you can identify triggers, you can begin addressing some of the underlying issues.
Support comes from a variety of resources including lifestyle modification, dietary support, stress reduction and sometimes hormonal support. In order to feel more in control of your changing body, you may need to implement some or all of the following.
Dietary support: Eating the right foods and supplementing with necessary vitamins and minerals should always be our first approach. Eating a balanced diet and providing the body with the needed nutritional support can make a big difference and can completely resolve some of the symptoms of menopause. Protein, healthy fats, complex carbohydrates, and fruits and vegetables provide your body and brain with the necessary nutrients it needs to function. A good multiple vitamin, additional vitamin D3, omega 3 fatty acids and calcium/magnesium all have added benefits. Some women have found relief using soy isoflavones and phytoestrogens such as red clover and black cohosh. Vitex, a progesterone-like herb from the Chaste tree berry has also been helpful for some.
Lifestyle modifications, exercise, and stress reduction: Stress has been identified as a major contributor for hot flashes. Stress reduction through meditation, anger reduction, biofeedback, exercise (with appropriate cool down period), yoga, and breathing techniques have been shown to reduce the severity and frequency of hot flashes and night sweats. Acupuncture and Traditional Chinese Medicine have been used successfully for the symptoms experienced in menopausal transition. Learn to value your own well-being enough to set better boundaries. Use your wisdom and intuition to identify ways to provide self care. Cultivate practices that will perpetuate positive lifestyle changes
Hormone Replacement Therapy
For severe hot flashes and menopausal symptoms that persist despite the above efforts, prescription hormone replacement therapy (HRT) remains an option. Recent studies are more promising suggesting that risks may be lower than previously thought. Benefits, for some women, may outweigh the risks. Space limitations prevent further discussion in this publication, but it is recommended that you seek more information and review individual risks and potential contraindications with a knowledgeable care provider. Consider asking your provider about biologically identical HRT; those that are chemically identical to the hormones our own body makes. These can come from compounding pharmacies, (progesterone, estriol, estradiol) or from pharmaceutical products that regular pharmacies carry (Climara, Vivelle patch, estradiol gel, Prometrium). Recent studies show that these products may have fewer potential side effects and risks. Many physicians and care providers are familiar with these products, but you may contact Women’s Care for an appointment to discuss your options in more detail.
Remember, take care of yourself, reduce stress, begin making lifestyle changes that create better health and seek additional information if you continue to experience symptoms that negatively impact your ability to function.