Preparing for Perimenopause
Been thinking about perimenopause lately. My insomnia and brain fog may be attributed to this condition. My doctor speculated that my bipolar symptoms may be related to perimenopause. So I got curious about this change that women have to face in their lives at a certain point.
I suspect my mother was in her early 50s when she went through menopause (she died at 54 of ovarian cancer). So it isn’t too presumptuous to assume that I’ve been in the midst of perimenopause in my late 40’s.
Perimenopause is that transitional period between normal menstruation and no menses at all, the dreaded menopause. It is defined by the World Health Organization and the North American Menopause Society as the two to eight years preceding menopause and one year following final menses.
With that transitional time comes a particular group of symptoms like hot flashes, night sweats, irregular periods (sometimes this is the biggest tipoff), fluctuations in mood, memory changes, sleep disturbances, vaginal dryness, vaginitis, decrease in libido, and bone loss (crucial due to the change in estrogen levels). Those of just a handful of issues that a woman goes through during this period of time.
Some of those symptoms like hot flashes and night sweats fall into the category of vasomotor symptoms of perimenopause, in which a woman’s blood vessels dilate, releasing heat. Sometimes the quantity of heat let off is so massive that a patient feels cold, leading to chills. Unfortunately, scientists do not know how the hormonal shifts of perimenopause cause this.
Perimenopause is not a disease. Menopause is a normal phase of life. But it can occur earlier in some women compared to others. Rest assured, symptoms during this period of time can be managed.
Some factors that may influence whether or not you experience perimenopause early are smoking, a family history of early menopause, cancer treatment, and a hysterectomy.
Once a woman has gone 12 consecutive months without a menstrual period, that is considered officially menopause and the perimenopausal stage is over.
What’s more, some women don’t seek out medical advice and attempt to cope with perimenopausal symptoms on their own. Don’t be a hero, if you have these symptoms seek out your physician if need be.
What happens during perimenopause is that it differs slightly from the normal menstrual cycle. In the beginning of your menstrual cycle, the brain’s pituitary gland produces a hormone that stimulates egg-producing follicles (little sacs within the ovaries that contain one ovum apiece) to produce estrogen.
After a few days, one of the follicles becomes dominant and at mid-cycle, about the 14th day, that follicle ruptures, producing an egg.
The empty follicle then produces progesterone to line the uterus.
If you don’t get pregnant, by day 22 or 23, then the empty follicle starts to die. Progesterone levels fall off, estrogen levels drops, and your uterus sheds its lining as a period. The whole cycle repeats itself next month.
But as you age, the number of egg-producing follicles in your ovaries decreases, so there’s fewer of them to produce estrogen, which drives the whole process. The brain's pituitary gland then pumps out even more of the follicle- stimulating hormone to try to improve the production of estrogen.
Not only are there fewer follicles during perimenopause, there may not be, in any given month, a dominant one to produce an egg. No egg, no ovulation, no empty follicle to produce progesterone. But the change is gradual not linear.
One way to detect menopause is by blood test. If the follicle stimulating hormone is high, it usually means the body is having difficulty getting an egg and estrogen to release.
With lower-than-normal hormones during perimenopause, the uterine lining may build up, eventually shedding in heavy bleeding. Sometimes a woman may skip a menstrual period. Or the time span between periods may vary.
A woman may assume that irregular periods means she’s infertile and therefore be at risk for an unwanted pregnancy. Taking birth control pills may be a good solution.
But basically, the estrogen level is chaotic. Taking an oral contraceptive pill will even out the hormone levels as it provides contraception. If you are on the pill, your doctor may want to test you during a pill-free week to check on your follicle stimulating hormone level.
If that level is in the menopausal range, your doctor may want to try hormone replacement therapy with a combination of estrogen and progesterone. Women should take hormonal therapy for as long as needed. But practice caution. Hormone replacement therapy may not be the best course of action for everyone, especially if you have a history of blood clots, breast cancer, cardiovascular disease, or liver disease. For some women, antidepressants may help with elevating mood and reducing hot flashes.
There are some self-help remedies and nonmedical therapies you can undergo ease your way through this transition such as staying active and doing weight-bearing exercises. Wear cotton or linen in cooling colors to “turn down” the heat from those hot flashes. Some women find it helps to increase their soy intake. Here’s a recipe to start with.
Ultimately, it is up to my gynecologist if she agrees with my psychiatrist whether or not I am perimenopausal. I take comfort in knowing I’m not alone and that it is just part of my journey as a woman like my mother before me. But maybe I need to chart a somewhat different path that is unique to me.
