An Introduction to Menopause and Perimenopause

Menopause is a significant transitional phase, typically occurring around the age of 50, although timing can vary widely among individuals. It is marked by the cessation of menstruation (no periods for 1 year) and a decline in ovarian function, signifying the end of reproductive capacity. Preceding menopause is perimenopause, a gradual process that can span 10-15 years. It is characterized by hormonal fluctuations and the decline in reproductive hormones, particularly estrogen, produced by the ovaries. Perimenopause is often accompanied by a range of symptoms, from subtle changes to more pronounced manifestations.

Vasomotor symptoms:

• hot flashes
• night sweats
• temperature dysregulation

Sexual and urinary dysfunction:

• Vaginal dryness
• Urinary tract infections
• Decreased libido

Sleep and mood changes:

• Insomnia
• Irritability
• Mood swings
• Depression
• Anxiety

Other functional changes:

• Joint pain
• Bone loss
• Tinnitus
• Weight gain (especially in the abdomen)
• Bloating and bowel changes,
• Cognitive function (brain fog)

Understanding these changes and their potential impact on your daily life is essential for navigating this transitional phase with confidence. There are treatment options available to help manage symptoms and improve your quality of life during this transition.

Speaking to a qualified health care provider is an important part of transitioning into this new phase of life. Your health care provider can work with you to tailor a treatment plan that addresses your specific needs and concerns.

Lifestyle Modifications

1. Balanced Nutrition: Focus on a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Incorporate foods high in vitamin D and calcium to support bone health. Limiting processed foods and refined sugar can reduce inflammation, hot flashes, and mood fluctuations.
2. Exercise: Engage in regular physical activity, including aerobic exercises, strength training, and flexibility exercises aiming for at least 150 minutes of moderate intensity per week can help manage weight, improve mood, and reduce risk of chronic diseases associated with menopause.
3. Sleep: Prioritize quality sleep by establishing regular sleep schedules and a relaxing bedtime routine. Avoid caffeine, alcohol, and electronic devices before bedtime as these will disrupt sleep patterns.
4. Limit alcohol and tobacco: Excessive alcohol consumption and tobacco use can exacerbate symptoms and increase the risks of various health problems, including osteoporosis and cardiovascular disease.
5. Stress Management: Practice stress-reduction techniques such as mindfulness meditation, deep breathing exercises, yoga.
6. Social Support: Seek support from friends, family, or support groups to navigate the emotional and physical changes associated with perimenopause. Connecting with others who are going through similar experiences, can provide comfort and validation.
7. Hormone-Balancing Activities: Incorporate activities that support hormone balance, such as acupuncture, massage therapy, and herbal supplements.  Examples include black cohosh, red clover, and evening primrose oil. However, it's essential to use caution with herbal supplements and consult with a health care provider, as their safety and efficacy are not well-established.

Medications

Hormone Replacement Therapy (HRT) involves the use of estrogen and sometimes progesterone (if you have a uterus) to supplement declining hormone levels and may be recommended for several purposes:

• Relief of menopausal symptoms: HRT may diminish symptoms of hot flashes, night sweats, vaginal dryness, and mood swings, enhancing overall quality of life during perimenopause and menopause.
• Prevention of bone loss: Estrogen, a component of HRT, helps sustain bone density, decreasing the risk of osteoporosis and fractures associated with hormonal changes during menopause.
• Enhancement of vaginal health: Vaginal estrogen formulations can reduce discomfort associated with vaginal dryness, itching, recurrent urinary tract infections and improve vaginal health and sexual function

However, it's important to note that HRT carries potential risks, such as an increased risk of breast cancer and blood clots. Therefore, it's essential to discuss the potential benefits and risks of HRT with a qualified healthcare provider before starting treatment.

Non-Hormonal Medications: such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRI’s) and gabapentin, may also be considered as alternative treatments.  These have been found to effectively alleviate hot flashes, mood disturbances, and weight changes associated with menopause, offering additional options for symptom management tailored to individual needs and preferences.

Although navigating menopause and perimenopause can be challenging, with the right information and support you can manage your symptoms and improve your quality of life during this transition. Remember to consult with a qualified health care provider to develop a personalized treatment plan that meets your specific needs and concerns. By incorporating healthy lifestyle habits and exploring available treatment options, you can embrace this new phase of life with confidence and vitality.

Dr. Kimberley Sampson, MD, MSc, FACOG, dipABLM, dipABOM, MSCP is an Obstetrician & Gynecologist, Lifestyle Medicine and Obesity Medicine Specialist and Menopause Society Certified Provider at SVMC in Bennington.