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Chapter 20 Perimenopause and Menopause
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Chapter 20 Perimenopause and Menopause


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  • 1. Chapter 20: Perimenopause and Menopause Catherine Lemelin HE 210-OL
  • 2. What is the difference between Perimenopause and Menopause? Perimenopause Menopause The ovaries function erratically and hormonal fluctuations may bring a range on changes.  Can be a one-to-ten year stretch.  Changes include: Hot flashes, night sweats, trouble sleeping, and heavy menstrual bleeding.  Each woman is affected to the transition differently.    Ovaries settle down and the reproductive hormones have declined to low, steady levels. Marked by the final menstrual period (final after one year with no periods).
  • 3. Midlife Perimenopause Brings the end of the childbearing years.  Involves emotional, social, and physical changes.  Everything from a new sort of loneliness to a profound sense of new freedom may emerge. 
  • 4. The menopause transition may fill our minds with all sorts of questions: What do I want to do? What am I not able to do? What can I control? How do I want to live?
  • 5. Have I reached Perimenopause?    Transition can begin from late 30’s to 60 and can last from 1-10 years Smokers tend to reach menopause earlier than nonsmokers Women typically begin the transition at the same age as their mothers
  • 6. According to Endocrinologist, Jerilynn Prior, if you apply to any three of the list below, you can assume you have begun perimenopause: 1. 2. 3. 4. 5. 6. 7. 8. 9. New-onset heavy and/or longer flow Shorter menstrual cycles (less than 25 days) Newly sore, swollen, or lumpy breasts New midsleep wakening Increased cramps Onset of night sweats (esp. around menstrual flow) New or markedly increased migraine headaches New or increased premenstrual mood swings Weight gain without changes in exercise or eating
  • 7. Non-medical self help approaches to alleviate discomforts Meditation  Yoga  Relaxation  Regular exercise  Healthful food  Enough sleep  Support from family and friends 
  • 8. Perimenopausal Signs  Premenstrual Syndrome (PMS) ◦ Swollen/tender breasts, bloating, anxiety, etc  Menstrual Cycle Changes ◦ Shorter cycles, skipped periods  Abnormally Heavy Bleeding ◦ 25% of women in perimenopause experience heavy bleeding
  • 9. Facts about Perimenopause    Contrary to popular belief, you can still become pregnant during perimenopause. 20-30% of women never experience hot flashes during perimenopause. Sleep disturbances are common in both perimenopause and postmenopause.
  • 10. Ways to Eliminate Sleep Disturbances     Cut out caffeinated beverages Avoid smoking Avoid or limit alcohol consumption Go to bed at approximately the same time each night    Exercise regularly Before bed, take a bath, listen to music or read Filter out noise and light
  • 11.   Vaginal Changes Vaginal dryness is a common change in early perimenopause Estrogen and progesterone levels decline and the vaginal walls frequently become thinner, drier, less flexible, and more prone to tears and cracks Urinary Changes     Finding the need to urinate more often Urge incontinence (sudden strong urge to urinate followed by involuntary flow) Urinary incontinence Incontinence can be successfully managed, treated, and sometimes cured (i.e. kegal exercises, bladder training, medications, vaginal estrogen)
  • 12. Tips to Relieve Vaginal Dryness and Sexual Discomfort Lubricants and vaginal moisturizers  Regular sexual activity  Wait until fully aroused before penetration  Drink more fluids  Graduated dilators  Low-dose local vaginal estrogens  Hormone therapy 
  • 13. Postmenopause    The ratio of body fat to muscle mass increases as we grow older, so it is very important to exercise to maintain muscle mass. Weight gain is common due to a combination of slower metabolism, decreased activity, and increased caloric intake. Eating well can help prevent/manage chronic diseases and enhance sexuality.
  • 14. Bone Loss and Osteoporosis     Osteoporosis is a condition of significantly low bone density. As we get older, we start to lose bone faster than we replace it. Prevention includes: yoga, jogging, strengthening with weights, avoiding harmful habits, eating healthy, etc. Vitamins that limit bone loss and reduce fractures are Calcium, Vitamin D, and Magnesium.
  • 15. Care and Treatment for Perimenopauseal Discomforts Alternative therapies such as herbs or botanicals  Western medicine of drugs or surgery  Establishing a relationship with a healthcare practitioner or clinician whose philosophy is similar to yours and is open-minded  Possessing insurance and access to health care  Nonhormonal medications such as bisphosphonates, anti-depressants, or sleeping pills 
  • 16. Hormone Therapy    Hormone Therapy is the process which women receive treatments and medications to help the body replace hormones that are no longer produced after menopause Pros: Relieves discomfort of menopause (hot flashes, night sweats, vaginal dryness) Cons: Causes health risks (breast cancer, stroke, blood clots)
  • 17. Debate over Hormone Therapy There is a current debate regarding the use of hormone therapy. Some feel that because perimenopause and menopause are not diseases, then treatments should not be pushed on women. Although HT may provide negative effects, others who suffer during this time are happy to know that there are treatment options and are willing to take the risks.
  • 18. Various Hormones        Progestogens Medroxyprogesterone Acetate (Provera) Progestin-Releasing IUD (Mirena) Bioidentical Micronized Progesterone PremPro Estrogen/Progestin Patches Estrogens ◦ Estradiol, Estriol, and Estrone
  • 19. Discussion Question What are your thoughts on the debate over hormone therapy?
  • 20. “ Intellectually, I know some of my physical and mental capacities will diminish as I age, but I want to deal with this with a sense of self-acceptance [and] not lower expectations. I hope my generation of feminist boomers will not deny the limits of aging and not give in to internalized ageist attitudes towards others and ourselves as we age” (546)
  • 21. Resource  The Boston Women’s Health Book Collective.“Chapter 20: Perimenopause and Menopause” (pages 505-546). 2011. Our Bodies, Ourselves. New York, NY: Simon & Schuster.