Foreshadowing the Change

It has no regard for body clocks. It doesn’t punch in at the same time for every woman.
It does not sound an alarm that awakens you to its presence. Before
the onset of fullblown menopause you can be visited by its not-so-friendly
precursor—perimenopause. Here’s how to identify its untimely arrival and
how you can deal with it.

By Claire Sykes

September 2006

First come the wonky periods, heavy one month and absent the next. And what’s with this flush of heat rushing through you with no warning? Sweat drips onto your desk by day and soaks through your sheets at night. Then there are the mood swings, never knowing when you’re going to lash out in a rage or collapse into a puddle of tears. And if all this isn’t enough, you’re having trouble sleeping at night. What in the world is going on?

Welcome to perimenopause. Wait, not so fast, you say. You’ve barely entered your 40s. You’re just now hitting your prime. The last thing you’re thinking about is the M word. That may be, but even though your mind isn’t occupied with menopause, your body is, since you may start to experience signs of it a good decade before you reach it. But don’t worry. You needn’t go through all this the way your mother or grandmother did, suffering the sensations or stifling them with drugs. With all the information and alternative treatments out there—from diet to stress management to herbal remedies—you can take positive, healthy steps to turn perimenopause into one of the most powerful times of your life.

Instead of resisting, make friends with it by getting to know it. Perimenopause means “around menopause.” (Menopause is defined as the day you haven’t had a period for 12 months in a row because you’re no longer ovulating.) It marks the transitional phase from those first pre-menopausal signs (not symptoms, since perimenopause is not a disease) to a year afterward. Most women reach perimenopause between ages 40 and 55, but it can begin as early as your mid-30s and end as late as darn near 60.

While you’re giving that sales presentation or driving the kids to soccer, your body is busy depleting its supply of eggs on a monthly basis just as it has ever since you started menstruating. But during the two to 12 years before menopause, you have fewer eggs than ever, so ovulation occurs less regularly. Less eggs means less progesterone, one of the hormones that control your cycle. Estrogen, the main female hormone, also decreases and follicle-stimulating hormones (FSH) increase (to make up for the estrogen lack). Along the way, estrogen and progesterone fluctuate until they trickle to a stop at menopause. “Early in perimenopause, there may be an excess of estrogen in relation to progesterone,” says Jane Guiltinan, ND, clinical professor at Bastyr University in Kenmore, Washington. “It’s this hormonal imbalance plus lower estrogen and higher FSH that cause many of the signs of perimenopause.”

Other changes also start to take place (without your consent!). Not enough (or any) estrogen, in particular, increases your bad LDL cholesterol and decreases your good HDL, putting you at greater risk for heart disease. Your bones begin to weaken, upping your chances of osteoporosis. And glandular tissue decreases in your breasts, which, to your horror, now start to sag. “Headaches and bladder problems, such as urinary urgency, incontinence and infection, are also linked to estrogen depletion,” says Mary Jane Minkin, MD, clinical professor of Yale University School of Medicine Department of Obstetrics and Gynecology and author of A Woman’s Guide to Menopause & Perimenopause (Yale University Press).

Follow the Signs

Don’t look for any reliable diagnostic tests for perimenopause. There aren’t any, because your hormone levels are always changing. Your age and any signs are your only clues. “However, some signs masquerade as symptoms for health conditions, such as those related to the thyroid, uterine fibroids, emotional stress, food allergies and intestinal bacteria overgrowth,” says Sharon Norling, OB-GYN, owner/founder of Mind Body Spirit Center in Westlake Village, California. If you have doubts, check with your health care provider.

Perimenopausal signs—from the merely annoying to the downright disruptive—are experienced by up to 85% of women, says Guiltinan. If you’re one of them you’re likely to first face irregular menstrual cycles. Says 58-year-old Jane Peters of Portland, Oregon: “I’ve gone three months without a period, but when I do have one, it’s pretty normal.”

Lucky her. Some women bleed for most of the month and/or go through the tampons and pads like there’s no tomorrow. But one thing’s certain: A change in the pattern of your periods is the norm during perimenopause. Periods may become heavier or lighter, longer or shorter. You may bleed for two to three weeks in a row and then zip—nothing for months. And then your periods may return, barely leaving a mark for the next year, until suddenly, hello again.

In Peters’ case, whenever she doesn’t have a period, she gets hot flashes. Like your menstrual cycle now, don’t expect them to follow any rules. About 75% of women receive the surprise visit of a sensation of heat rushing through the upper torso to the head. Good thing hot flashes last only a few minutes, but will you have them just once in a while or 50 times a day? Who knows? It’ll be just your luck to suddenly start sweating during that important business meeting. “Hot flashes are one of the most dreaded perimenopausal signs, because they’re so visible,” says Minkin.

Then again, you may not sweat at all, and only feel hot. Or, you may have cold sweats, instead, sweating while shivering. Many women ping-pong between hot and cold. As you go through perimenopause, hot flashes, night sweats and cold sweats may increase in frequency and intensity, and peak in the year you reach menopause. Gradually, they do taper off.

If hot flashes don’t drive you crazy, mood swings might. “Most women going through perimenopause don’t experience significant and lasting emotional changes, though,” assures Minkin. Don’t be surprised, however, if you feel depressed, anxious and irritable at the drop of a hat, or worry excessively (about nothing) and have low energy. It all comes with the territory. Other signs include:

• Sleep problems. Night sweats, or nothing in particular, may rouse you from your dreams, and you may have trouble falling back to sleep.
• Fuzzy mental state. Slowed thinking, trouble concentrating and short-term memory loss are irritating, but nothing serious.
• Lower libido. You’re not alone if your interest in sex has dried up, along with your vaginal walls, which have thinned, making intercourse painful.
• Dry skin and eyes. Your skin tends to become thinner and dryer during perimenopause, with dry eyes affecting 62% of women, reports the Society for Women’s Health Research.
• In addition...Achy joints and muscles, swollen and tender breasts, heart palpitations and weight gain are also common problems during perimenopause.

Getting Comfortable

But who has to tolerate all this? Natural remedies abound, generally in combinations that may change over time. “Treatment depends on the signs you experience, and your health risks and personal values,” says Guiltinan. “You don’t need anything if you aren’t bothered by perimenopausal signs.” Start by visiting an open-minded health professional who can help you develop a personalized treatment plan.

If you are getting hot and bothered (and soaked), Guiltinan recommends what she calls “a ladder of intervention.” It begins at the first rung with diet, exercise, behavior and stress management (including a positive mindset) and tops off at the fifth rung with conventional hormone therapy. “Move to the next level only if you’re not getting relief,” she advises.

Drink bottled or filtered water and eat organic foods, including grains and legumes along with plenty of colorful fruits and vegetables. Essential fatty acids such as omega-3, found in coldwater fish and flax seed, may help reduce breast pain. (Evening primrose is another healthy oil source.)

Soybeans and soy products, pinto beans, red lentils and sesame seeds contain plant-based estrogenic substances called isoflavones. Their estrogen-like properties have helped relieve hot flashes for some women. To help prevent flashes, avoid alcohol, caffeine, hot drinks and spicy foods.

Keep moving. Not only does exercise improve your heart, bones and sleep, but “studies showed that women who exercised aerobically for 30 minutes a day, five days a week reduced the frequency and intensity of their hot flashes,” says Guiltinan. Norling adds that the right diet and ample exercise alleviate stress, which “can exacerbate perimenopausal signs, especially hot flashes.”

Begin your day with a good-quality multivitamin. Joint pain responds well to glucosamine, and vitamin B complex helps tackle stress and depression. Though no supporting scientific studies exist, Minkin says that some women find vitamins B, C and E helpful in suppressing hot flashes.

Herbs may also help.

Diet and exercise are only the beginning of a comfort-enhancing lifestyle. Do yoga, meditation and guided imagery. Treat yourself to a massage, and see an acupuncturist to help restore the yin-yang balance thrown off by all the physical and mental changes. Dress in layers (for when that hot flash strikes), use a natural vaginal lubricant if you need it to make lovemaking more comfortable, get early morning and late afternoon sunlight (for vitamin D) and stop smoking and other bad habits.

Most importantly, find some time every day to relax and have fun.

Only if you’ve tried everything and nothing works should you consider hormone therapy (HT). “Plant-based and synthetic estrogen replacement should be a last resort,” urges Guiltinan. Although HT has helped many women, conflicting research has cast doubt on its previously believed benefits—now outweighed by possible dangers that include slight increases in breast cancer and cardiovascular disease risk, as well as risks of blood clots in the veins and cancer of the uterine lining.

So if you can avoid hormones, do! Concentrate on natural treatments. And while you’re at it, cultivate and nurture a positive attitude towards perimenopause. Think about it. This time of life can be one of the most constructive for a woman now free of childbearing and childrearing responsibilities. What a chance to examine your life and consider where you can make changes, without buying in to our culture’s obsession with youth and beauty. “Aging can become ‘saging,’” suggests Guiltinan. “And instead of ‘hot flashes,’ how about ‘power surges?’”

Perimenopause is a great opportunity for you to become healthier than ever. As Jane Peters puts it, “It’s a good time to take care of yourself, because your body is reminding you that it’s present.”

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