by Judith A. Norris, Ob-Gyn, RNP
Often, the first clues to declining reproductive functions are changes in the menstrual cycle and development or worsening of PMS Women in mid-life may also be experiencing many life style changes. They’re balancing home, career, children, aging parents and community roles.
Perimenopause [peri means surrounding} is the time 5-15 years before the natural spontaneous end of menstruation. Perimenopause typically occurs between the ages of 35-and 50. Eight percent of women become menopausal prior to age 40 and have their first perimenopausal symptoms as early as their 30’s. Women begin to experience the physical and emotional changes brought on by declining hormone productions.
A woman is often confused as to what is happening. She erroneously believes her changes could not be the start of menopause, she may only be 43 years old.
Not all women experience all the symptoms below. Just as differences were common when we started out periods, we experience some or none of PMS. We mirror those episodes, and may experience none, some or all the symptoms of perimenopause. Until recently, management options had been limited to diet, life style, anti-inflammatory medication and the occasional use of antidepressants.
Changing Hormones
In our 30’s and 40’s the ovaries start running our of eggs. Estrogen levels drop as frequency of ovulation decreases. Progesterone levels decline, as ovulation becomes more erratic. The decline of hormones is likely responsible for some of the perimenopausal symptoms listed.
These early clues are important because women begin to lose the protective effects that estrogen and progesterone have on their heart and bones. In a woman, bone mass peaks at age 35 and lost at a rate of 1% per year after that time, and can be up to 3% per year after menopause. During perimenopause a woman should increase her calcium to 1000 mg. Daily. Natural estrogen protects our hearts by increasing the beneficial HDL (healthy cholesterol). Estrogen replacement also helps prevent the arteries from constricting and helps keep the smooth lining of the coronary arteries elastic.
What helps with perimenopause?
Depending symptoms one is experiencing. Hot flashes, irritability, irregular bleeding identified as resulting from decreasing hormones.
Perimenopausal women often still need safe, effective and convenient methods of contraception due to erratic ovulation. Oral contraceptive pills are now used to regulate menses, decrease hot flashes and lessen insomnia. You must be a non-smoker, with no history of breast cancer and or blood clotting disorders. Monophasic pills {same levels of estrogen & progesterone through out the month} have lower ratio of estrogen to progesterone provide the best relief for perimenopausal women, particular those with mood and migraines.
Women who cannot or chose not to take oral contraceptives may control hot flashes with diet, decreasing spicy foods, eliminating alcohol, hot foods and if you are a smoker, Stop!
Taking vitamin E 400IU twice a day, evening primrose oil 1,000mg. May provide relief.
Irregular bleeding must be identified. Bleeding that occurs in-between periods, or periods lasting longer than 10 day or cycles that are closer than 21 days is irregular. Most often it is due to the imbalance of progesterone/estrogen ratio.
Dilation and curettage is no longer the first for evaluation and treatment of abnormal bleeding. In-office endometrial sampling {EMB} is 90%-95% accurate in detection of endometrial cancer.
Progesterone decreases in perimenopause and estrogen decreases in menopause. Many women have used progesterone creams during this time. Your health care provider may give oral progesterone for 10 - 14 days each month may prevent erratic bleeding.
What's Happening to our bodies at age 40.
- Height reduction begins around age 43. It is the result of weakened skeletal structure in the spine. Not too late to go to the gym! Start strength training to prevent muscle degeneration. Don’t forget calcium 1000 mg.
- Lack of flexibility is becoming apparent- you don’t even try to touch your toes.. Start a yoga class, do stretching exercises.
- Body-fat proportions continue to change. Specially increase in thighs and butt...bummer. By age 40 your body needs 120 fewer calories per day than it did at age 30. Keep fat calories below 30 percent of your daily total, and get five servings of fruit and veggies. Walking 30 minutes' three to five times a week and stay off the elevator and take the stairs. Keep moving!
- Oil in our skin decreases causing dryness. Use nourishing moisturizer.
- Wrinkles become more obvious due to diminishing collagen. Exfoliate skin frequently and continue with alpha-hydroxy acids. Always use sun block!
- Hair decreases in volume and moisture. Deep condition once a week and never brush or comb hair wet. Coloring your hair changes its texture, makes it feel fuller and thicker.
courtesy of OBGYN.net