The perimenopause, the transition to the menopause, can be an extremely turbulent time that brings difficult symptoms as well as health concerns. How can you recognize it in yourself, and what should you know about going through the menopause?

The menopause is a natural and normal part of life that around 1.5 million women go through each year. Though it has its good sides (no more periods!), however, many women find it tough to cope with the symptoms associated with the menopausal transition. The menopause also comes with new health concerns that every woman should know about as she reaches this stage. 

This overview of everything you need to know about the menopause should get you started on this "journey". 

What is the menopause, and when does it happen?

The menopause marks the end of a woman's reproductive age — the ovaries stop releasing eggs and producing the hormone estrogen, and menstrual periods come to an end. This point is officially reached when a woman has been period-free for 12 months following the perimenopausal transition, which is basically the road to menopause. (To state the obvious, we'll add that women who don't have period for 12 months or more for other reasons — such as pregnancy, breastfeeding, or certain kinds of hormonal birth control — have not entered the menopause!)

Perimenopause, which announces itself with symptoms many women experience as unpleasant, typically starts between the ages of 45 and 55. Having these symptoms doesn't mean you'll enter menopause in no time, as this transition can go on for a very long time — the perimenopause can last anywhere from a few months to 14 years, with the average being about seven years. The average age at which a woman enters the menopause is 51 in the United States. 

The circumstances surrounding a woman's transition to menopause can be different, too, however:

  • If you naturally enter the menopause before age 40, this is considered a premature menopause. This happens to about one percent of women. 
  • The menopause can also be induced surgically — woman who have their ovaries and/or uterus removed surgically for whatever reason and do not take hormone replacement therapy will make the menopausal transition overnight. 

Common menopausal symptoms to watch out for

The most common symptoms women experience as they go through the perimenopause include:

  • Changes within the menstrual cycle. What can you expect from your periods before you enter the menopause? Well, it is common for periods to become less regular, to miss a period here and there, or to have early periods now and then. Your menstrual flow can also become lighter, heavier, longer, or shorter. (Not that the combination of being older and now also having irregular menstrual periods in no way means that it is not possible for you to become pregnant. Perimenopausal women who would like to avoid pregnancy still need to use reliable birth control methods before they actually reach menopause proper.)
  • Hot flashes. This phenomenon, described as a sudden sensation of warmth or heat around the face and upper body, is very common during the perimenopause; up to 85 percent of women experience them. It is associated with profuse sweating and a faster heartbeat, and can be very uncomfortable. When they strike at night, hot flashes are called night sweats. Some women notice perimenopausal "cold flashes" or chills, in which they feel cool rather than hot sensations, instead.
  • Mood swings. As you go through this time of big hormonal fluctuations, you will likely experience mood swings just as you did during puberty or PMS. 
  • Fatigue and insomnia are also common in women going through perimenopause, affecting around half of those in this stage.
  • Women going through the perimenopause and beyond may notice they have more hair in places where men typically grow it, such as the face and chest. This is called hirsutism. At the same time, they may experience thinning hair on the scalp
  • Dry skin. Hormonal changes can lead to dry skin during perimenopause
  • Some women will also notice vaginal dryness. This can, in turn, lead to pain during sex if not managed adequately. Up to 60 percent of women are believed to experience vaginal dryness or pain during intercourse during this stage of life. 
  • A lowered libido is another possible perimenopause symptom. 
  • As women get closer to the menopause, and during the menopausal years, many gain weight, especially around the abdomen (which is called central obesity). 

If you notice these symptoms and see your doctor about them to confirm that they're caused by the menopause, as research indicates most women do, they'll most likely diagnose you with perimenopause without running additional tests if you are in the "right" age group. It is also possible for doctors to medically diagnose menopause by looking at your levels of follicle stimulating hormone (FSH), estrogen, and doing a lipid profile. In some cases, your doctor will want to check your kidney and liver function as well. 

Health concerns menopausal women should be aware of

If you're currently in the midst of those nasty perimenopause symptoms, you'll want to know what's available to send them packing or at least reduce them a bit. We should first take a look at the health concerns the menopause brings, however, as this also impacts the steps you decide to take to help cope with menopause symptoms. 

  • Prior to the menopause, women have a lower risk of heart disease than men, because of the protective effect of the hormone estrogen. Your risk of heart disease after the menopause is about equal to the risk seen in men, however. 
  • Your risk of stroke also goes up, which it continues to do as you age. 
  • Women may experience urine incontinence after the menopause, and can be at risk of a uterine prolapse
  • As your hormones change, so does the composition of your saliva. This means you are more at risk of tooth decay and gum disease after the menopause. 
  • Osteoporosis, brittle bones pron to fracturing, is a major health concern after the menopause. Women who experience severe hot flashes have, according to research, a higher risk than others. 

How can you ease your menopause symptoms?

You see now that you don't just want to alleviate the symptoms you're experiencing, but also take steps to protect your general health. Lifestyle changes you can implement yourself are among the best things you can do at this time, and they include:

  • Being physically active as you go through menopause. Regular exercise will fight menopause-related weight gain, lift your mood, and help you attain a better quality of sleep. In terms of general health, it also protects your heart. 
  • Eating a healthy and balanced diet. Not only will eating well do your general health a lot of favors, it again also helps combat weight gain, which could in turn have a detrimental effect on your health. As you get older, you actually require fewer calories. 
  • If you smoke, stop. Smoking raises your cancer risk by a lot, is really bad for your heat health, and also increases your risk of osteoporosis. Smoking was always bad, but it's even worse, now. 
  • Drinking too much increases your risk of breast cancer, as well as making those menopausal sleep disturbances even worse. Drink very moderately or not at all. 
  • Consider supplementing with vitamin D and calcium to help prevent osteoporosis. 
  • Do Kegel exercises to strengthen your pelvic floor and reduce your risk of incontinence and prolapse. 

In the fight against menopause symptoms, these remedies that aren't hormone replacement therapy may help you:

  • Soy isoflavones — which you can get by eating soy products — have been shown to reduce the number of hot flashes women experience. They may also help fight osteoporosis. 
  • We've already talked about the importance of maintaining a healthy weight for general health, but this also, again, reduces hot flashes. 
  • Meditation, yoga, and other relaxation techniques that work for you can play a role in keeping those mood swings under control, lessening hot flashes, and also improving the quality of your sleep. 
  • Antidepressants, particularly SSRIs, can of course help perimenopausal and postmenopausal women who are struggling with depression, but they may also combat hot flashes. 
  • You can fight vaginal dryness with lubricants.
  • Many women additionally turn to herbal or alternative remedies to help them ease menopause symptoms. Examples of these are evening primrose oil, kava kava, black cohosh, and red clover. Because herbal medicines can indeed interact with other medications you may be taking (for the menopause or other reasons) and because they can produce side effects just like conventional medications, it is always a good idea to check in with your doctor before deciding to try any of these. 

What do you need to know about hormone replacement therapy?

Once routinely offered to women going through the menopause, because it really does alleviate symptoms, hormone replacement therapy has been found to carry serious health risks in more recent times. What is the truth about HRT and your risk of cancer? Taking combined estrogen and progestin therapy was found, in a very large-scale study, to increase your risk of:

  • Breast cancer
  • Stroke
  • Heart attack
  • Blood clots

The odds of developing breast cancer were found to go up by a pretty shocking 75 percent in women taking this combined hormone replacement therapy, and not just if they're on it for a long time, either. What's more, women taking HRT have a lower chance of catching breast cancer in its earlier stages, when the prognosis is better. Estrogen-only HRT is also available, and while this doesn't appear to increase a woman's risk of developing breast cancer, it in turn contributes to her odds of ovarian and endometrial cancer. 

Does this mean that you should not consider hormone replacement therapy at all? Not necessarily. Though HRT increases your risk of developing certain adverse outcomes statistically, your individual absolute risk may be acceptable to you depending on the severity of your symptoms. Not everyone can take hormone replacement therapy. 

HRT isn't suitable for women who:

  • Have had breast cancer
  • Carry the BRCA1 or BRCA2 genes
  • Have risk factors for ovarian, endometrial, and other cancers
  • You have a higher risk of developing blood clots, heart disease, or having a stroke

If, however, you suffer from pretty unbearable menopause symptoms that have a severe impact on your quality of life and you do not have any of these risk factors, you may be considering hormone replacement therapy. Discuss the risks and benefits, and how they relate to you personally, with your doctor in detail before proceeding. Should you opt to take HRT, your doctor will work out the lowest possible dose that still offers you symptom relief, and advise you to take it for as short as possible. While taking hormone replacement therapy, check in with your doctor for health screenings as often as you're advised to. 

Women who suffer from menopausal vaginal dryness may instead opt to use topical estrogen creams or rings, but their doctor may advise them to also take progestin treatment afterward. 

In conclusion

The menopause is sometimes referred to as "the change" for good reason — it can be a turbulent time during which you don't only have to deal with new and unpleasant symptoms, but also worry about potential new health challenges.

While the decision to use hormone replacement therapy will depend on the severity of your particular symptoms, as it has health risks as well as clear benefits in terms of symptom relief, all women will want to reevaluate what a healthy lifestyle means to them during the perimenopause.

By eating well, maintaining a healthy weight, exercising regularly, taking vitamin D and calcium supplements, and making your emotional health a focus, you can minimize health risks and maximize your quality of life. 

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