2. Perimenopause
“Perimenopause is the 1-10 year stretch during which the
ovaries function erratically and hormonal fluctuations may
bring a range of changes” (Our Bodies, Ourselves, p. 506).
In 1 out of every 5 women, the symptoms of perimenopause
can be so disruptive to their everyday life and functioning
that they need supports and medical interventions and
treatment (Our Bodies, Ourselves, p.506).
3. Changes that occur during perimenopause
may include:
Hot Flashes
Migraines
Night Sweats
Tender or Swollen Breasts
Shorter Menstrual Cycles
Unexplained Weight Gain
Sleep Disturbances
Fatigue
Heavy Menstrual Bleeding
*The key to remember is that every woman’s
body is different and therefore every woman
experiences perimenopause differently.
(Our Bodies, Ourselves, p.506)
4. Midlife Happenings during
Perimenopause
Around the time that women are going through
perimenopause, they are generally speaking at an
extremely busy time in their lives, physically and
emotionally. They are raising teenagers, and sending them
off to college or the job force during this time, as well as
caring for aging parents. On top of these very emotional
and sometimes difficult times, women also are juggling all
of their other responsibilities, such as their careers,
relationships, and home responsibilities.
(Our Bodies, Ourselves, p. 508)
5. How to tell when you will reach or have
reached Perimenopause
Women who smoke generally are earlier reaching
their perimenopause stage than nonsmoking
women.
However, women usually reach menopause around
the time that their mother reached menopause.
(Our Bodies, Ourselves, p.508)
6. Treatment and Relief of Perimenopausal Symptoms
Nonpharmacological Approaches:
Relaxation Techniques
Yoga
Meditation
Healthy Diet
Regular Exercise
Increased Sleep
Important: Support from Family/Friends
(Our Bodies, Ourselves, p. 512)
7. Birth Control during Perimenopause
Myth!
Once you enter perimenopause and your periods are irregular,
there is no need for birth control anymore. The belief is that
once this happens, you cannot get pregnant any longer.
Fact!
Even with irregular periods, you can still potentially get
pregnant as you still may be fertile.
Reality:
Women need to use birth control until they have had no period
for 1 entire year.
It is recommended that women who have reached
postmenopause in their 40’s to wait 2 years.
(Our Bodies, Ourselves, p. 512)
8. Hot Flashes Relief
Hot Flashes are one of the most common symptoms in
perimenopausal women. Women have tried many ways in
which to relieve this very uncomfortable symptom and have
found several ways in which to decrease this distress in the
moment such as:
*Dress in layers, then take them off as needed
*Identify personal triggers and eliminate such triggers (spicy
food, caffeine, hot drinks, anxiety, alcohol, etc).
*Drink cool water frequently
*Avoid stress as much as possible
*Regular daily exercise
*Quit smoking
*Cold pack under your pillow at night in order to relieve
nighttime hot flashes
(Our Bodies, Ourselves, p. 514)
9. Hot Flashes Relief (cont’d)
Nutritional Supplements:
Soy products
Botanicals (red clover)
Antioxidant vitamins (Vitamin E)
Herbal preparations (St. John’s Wort, black cohosh)
Hormonal Supplements:
ESTROGEN
”Taking estrogen has been shown in multiple randomized
trials to relieve hot flashes in postmenopausal women, and
progestins such as medroxyprogesterone are effective as
well. However, recent research shows that the most widely
used estrogen-progestin preparation increases the risk of
stroke and other serious illness” (Our Bodies, Our Selves, p.
515).
(Our Bodies, Ourselves, p. 514-515).
10. Administering Antidepressants, Antiseizure, and
Antihypertensive Medications for Hot Flashes?
Research has shown that giving low doses of
antidepressants such as Effexor, Prozac, and Paxil work
about 70% as effectively for treating hot flashes as estrogen.
Gabapentin, an antiseizure medication has also shown some
positive results in reducing hot flashes.
Clonidine, an antihypertensive medication, has proven to be
helpful in decreasing hot flashes among women.
**The important note to consider before administering these
medications is that it is advised that only women that have
depression, seizures, or hypertension should be receiving
these medications in the treatment of hot flashes, due to the
potential effects and side effects of these medications.
(Our Bodies, Ourselves, p.515)
11. Vaginal Changes during Perimenopause
Vaginal dryness is a common and very uncomfortable symptom
associated with perimenopause.
Relief Methods:
Lubricants or vaginal moisturizers
Regular sexual activity (causes increased blood supply to
vagina)
Wait until fully aroused before participating in intercourse
Drink more liquids (8 glasses or more/day)
Graduated dilators used in intercourse
Low dose local estrogen
(Our Bodies, Ourselves, p. 517)
12. Changes in Sexual Desire and Satisfaction during
Perimenopause
Common complaints: lack of arousability, vaginal
dryness, decreased sexual interest, or even
aversion towards sex.
Key: Many women associate these changes in
sexual desire to be related to perimenopause when
in fact they could be due to a multitude of other
factors such as a medication (many medications
such as antidepressants decrease sexual desire and
libido), other health problems (hypertension and
diabetes can alter sexual function or desire) or just
the significant amount of stress in a woman’s life
at this time can alter sexual desire.
Remember: Before you blame it on the
perimenopause, consider any other factors that
may be contributing to this problem and attempt
to fix those problems first.
(Our Bodies, Ourselves, p. 520)
13. Preventing Bone Loss and Osteoporosis
Bone loss begins in women at around the mid-30s, and
may pick up increasingly from the start of perimenopause
until 4 years into postmenopause. Because of this rapid
bone loss, osteoporosis (significantly decreased bone
density) is a common problem among middle-aged women.
Prevention Techniques:
*Weight-Bearing Exercises (yoga, jogging, weight-lifting,
water exercises, back exercises, and physical therapy)
*Avoid smoking and alcohol
*Avoid medical interventions which contribute to bone
thinning if possible (oophorectomy-removal of the ovaries)
*Caution with steroid use, SSRIs (antidepressants),
methotrexate, proton-pump inhibitors, aluminumcontaining antacids, and high doses of thyroid
medications.
(Our Bodies, Ourselves, p. 529)
14. Preventing Bone Loss and Osteoporosis
(cont’d)
Nutritional Supplements:
*CALCIUM
-if a patient is lactose-intolerant, other sources
of nondairy calcium are available in eating
dark leafy greens and calcium-fortified
orange juice.
*VITAMIN D
-suggested 800-1200 IU of vitamin D/day
--Sources: sunshine, fortified milk, oily fish
(salmon, mackerel), cereal
*MAGNESIUM
-suggested that calcium is balanced with
magnesium in a 2:1 ratio because if
magnesium levels drop low, then calcium will
not be absorbed as well.
--Sources: fruits, vegetables, calcium
supplements
(Our Bodies, Ourselves, p. 529-530)
15. Hormone Therapy for Treatment of Perimenopausal
Symptoms
Estrogen first tried in order to treat perimenopausal
symptoms and to keep women “feminine forever”, which
meant maintaining youthfulness, preventing agingassociated diseases, and relieving all of those disruptive
symptoms that go along with perimenopause. It was then
realized that estrogen administered by itself caused a huge
increase in endometrial cancer, as well as an increase in
blood clots and risk for stroke. This caused the realization
that estrogen should be administered along with
progesterone in order to counteract the effects leading to
endometrial cancer.
The debates about the pros and cons of taking estrogen
therapy continue today and Hormone Therapy continues to
be a highly researched course of study, as to the
effectiveness of its treatment of perimenopausal symptoms.
(Our Bodies, Ourselves, p. 535-536)
16. Reaching Postmenopause
Postmenopause: the light at the end of the tunnel for most
After the ups and downs of perimenopausal symptoms for
years, many women report the feeling of a new beginning
emerging when they finally reach postmenopause; “Many
women find the evenness of the postmenopausal decades
energizing as they begin a new phase that will last the rest of
their lives” (Our Bodies, Ourselves, p. 522).
