Perimenopause is a frame of time which could even last 10 years before menopause, where women start noticing that their menstrual periods become somewhat irregular. They may come closer for a while, every 21 days instead of the usual 28 days. Eventually, they may start missing periods where they have a period every one to three months. Eventually they stop having periods.
It can be late 30s, early 40s. That’s pretty typical.
Menopause is technically not having a period for one year (12 months).
Symptoms can vary from woman to woman. Some women go through a smooth transition where that’s the only thing that they notice while it can be quite severe in other women. They may have hot flashes, night sweats, insomnia and mood changes. They may notice vaginal dryness. They may be having pain with intercourse. They may have heart palpitations. There is a whole host of symptoms that women may have.
Over the course of the 30 years that a woman may live beyond menopause, she may develop osteoporosis, which is a thinning and inflexibility of the bones and can lead to fracture and disability. In addition, it could lead to heart disease, stroke, heart attack and dementia.
The idea behind hormone replacement therapy is to replace the hormones that a woman makes in her reproductive years, which are estrogen, progesterone and testosterone.
Hormone therapy does, depending on the type you’re using, carry a small increase in the risk of breast cancer. But if you look at the North American Menopause Society’s statement in 2017, they stated that they felt the benefits outweighed the risks in terms of hormone therapy.
It’s a product that’s synthesized from plant sources. It is synthesized to look like your natural hormones. For example, your main estrogen that you make is estrodiol. It is going to look like the chemical structure of your estrodiol and be absorbed in a way that your natural estrodiol would be into your system.
Bioidentical hormone therapy can help keep your bones strong, prevent osteoporosis, heart disease and dementia. In addition to helping with quality of life issues, it can help with vaginal and bladder tissues. The risks are a slight increase in the risk of breast cancer.
Bioidentical hormone therapy, because it looks like the hormones that your body produces, is going to bind to the receptors in your body the way it should. Women tend to feel better on it. We believe there are less risks involved with bioidentical hormone therapy.
In terms of hot flashes and night sweats, we know that women who weigh less tend to have less hot flashes and night sweats. Weight reduction can be helpful. Eating a healthy diet, avoiding alcohol, too much caffeine, too many sugar products can be helpful. Regular exercise can be helpful. Some products can be helpful in terms of tolerating symptoms. For example, a lot of women are woken up by night sweats. Wearing breathable clothing at night or a cool pad underneath your sheets on your mattress can be helpful. There are pillows that are made now where you can have coolness on your head, so if you’re experiencing a night, sweat, you sleep a little bit better.
Some women get a little benefit from over-the-counter supplements, non-prescription, such as soy products or black cohosh-based products.
There are some prescription medications that we give to women that are non-hormonal that can be helpful with some of the symptoms that women experience.
Whether you’re a woman and you’re going through your late 30s and starting to have symptoms or into your 50s or beyond, it’s important to talk to your gynecologist about what you may be experiencing.
We can help you to figure out an individualized plan, whether it be hormone therapy or something else to help you through this transition.
Watch the San Diego Health video with Susan Taylor and Dr. Kelly where they discuss what to expect during perimenopause and menopause.