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Perimenopause

A time of change

Many women are familiar with the concept of menopause. However, fewer are familiar with its predecessor, perimenopause. The term perimenopause describes the three to five years (approximately) before a woman's final period. During this time, the ovaries are reducing the amount of hormones that they produce. Some women have no symptoms (or minimal symptoms) during this time.

Others experience any of a number of symptoms, including:

  • Irregularity of the menstrual cycle
  • Decreased fertility
  • Changes in the amount of menstrual bleeding, both heavier and lighter
  • Increased cramping with menstruation, including lower back pain
  • Hot flashes, typically occurring in the upper body and face and lasting from a few minutes to an hour
  • Flushing, usually associated with hot flashes
  • Sweating
  • Sleep disturbance
  • Vaginal dryness
  • Mood swings

Treatment

The treatment of these symptoms is varied. Hot flashes, and their associated flushing and sweating, can often be reduced by behavioral or environmental changes, such as decreasing the temperature in the home or office, wearing lighter clothing, avoiding hot beverages and alcohol, minimizing the consumption of spicy foods and quitting smoking. For more severe symptoms, several prescription medications are available. The most effective treatment for hot flashes is estrogen, but it may not be right for everyone, depending on their medical history and comfort with any potential side effects.

Other treatment options include certain antidepressants, such as venlafaxine (brand name Effexor), fluoxetine (Prozac) or paroxetine (Paxil), which may reduce the frequency and severity of hot flashes, as well as mood swings. In addition, certain anti-seizure medications such as gabapentin (Neurontin) and blood pressure medications such as methyldopa (Aldomet) and clonidine (Catapres) have been shown to provide a benefit. Like hormones, these medications carry their own side effects and may conflict with other medications or be contraindicated based on the woman's health.

Numerous herbal remedies, such as phytoestrogens and black cohosh, have been suggested to help with perimenopausal symptoms, but the scientific evidence is lacking to support their widespread use.

Perimenopausal Health Tips

Although there are no specific strategies to prevent perimenopausal symptoms entirely, a healthy lifestyle can greatly reduce the severity of symptoms. Quitting smoking, following a healthy diet and engaging in regular exercise have all been shown to improve a woman's quality of life during perimenopause. In addition, these habits can lead to improved health during menopause and beyond.

Perimenopause is a time of transition, and in the words of Richard Hooker: "Change is not made without inconvenience, even from worse to better." However, with lifestyle modifications and help from the medical community, the changes associated with perimenopause can be made less problematic.

By Turi Mcnamee

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