FAQ: Is THIS Perimenopause??
What is perimenopause, and is it different from menopause? When does perimenopause start?
Perimenopause usually starts in your late 30s to mid 40s. This stage often lasts a decade and is also referred to as “the menopause transition”. Menstrual cycles continue often to be regular in the earlier phase. As the ovarian reserve of follicles (responsible for hormone production) declines with age, there is a gradual decline of progesterone and an erratic response with estrogen production (can drop low, overshoot high, then eventually decline) over the years. In late perimenopause, the periods can become more frequent, then space out over several months.
Menopause is noted when you reach the one year mark from your last menstrual period. It is more of a definition of terms than an acute change in hormones.
What are the symptoms of perimenopause?
What are the symptoms of menopause?
Many of the symptoms overlap between perimenopause and menopause, with the most common being:
Night sweats, hot flashes, (chills for some), and palpitations
Vaginal dryness, low libido, pain with intercouse
Urinary incontinence, frequent urinary tract infections
Mood swings, depression, anxiety, insomnia
Weight gain, resistance to losing weight
Joint pain, muscle aches, fatigue
Regular or irregular periods
Should I start hormone therapy?
This is a personal decision which should be made after a thorough discussion of the benefits, risks, your personal history, and your personal benefits and risks. It is important to counter the long held beliefs about HRT and acknowledge that for most people the benefits of HRT will outweigh the risks. The large trials which used synthetic hormones should not be used as our guide on patient care and risks when we have better options used today.
What are the benefits and risks of hormone therapy?
Below are the benefits and risks documented to be clinically significant in studies.
We have had our patients tell us many other benefits they have seen personally with HRT use regarding improvement in energy, mood, weight, joint pain, and body aches.
Benefits of Estrogen:
Relieves hot flashes (vasomotor symptoms)
Protects against osteoporosis
Improves vaginal dryness and mucosal health
Reduces urinary tract infections
Can reduce cardiovascular disease
Estrogen alone reduced breast cancer risk
Improved cognition: mixed studies on this; certain populations did benefit
Risks of Estrogen (bioidentical transdermal route)*:
Thickening of uterine lining, increased risk of uterine cancer (this can be prevented by taking progesterone to balance the estrogen)
* There are additional risks when using oral estrogen which should be considered if oral is used
Benefits of Progesterone (bioidentical):
Protects uterine lining from overgrowth and cancer – balances the proliferative effects of estrogen
Relieves hot flashes (vasomotor symptoms)
Reduces anxiety and improves sleep
Protects against osteoporosis
Risks of oral Progesterone (bioidentical)*:
Current data has NOT found bioidentical oral progesterone to increase risk of clotting or breast cancer as is noted with synthetic progestins. It is critical to be mindful of the type of progestogen used in studies noting increased associated risks.
*There are additional risks when using synthetic progestins which must be considering if this method is used.
Other hormone therapies to consider: Testosterone, DHEA
Are there other treatments besides HRT?
HRT should never be the only way we are addressing perimenopause and menopause related symptoms. There are many other factors to consider including nutritional support, herbal support, vitamins & minerals which are often deficient and support our hormones, adrenal support, exercise, sleep habits, and alternative approaches for those who opt not to use HRT.
Does menopause affect my sleep? How can I improve my sleep in perimenopause?
The effects on sleep are often noted in the perimenopausal stage. We support this in a multifaceted approach. Often in the later stages, adding oral micronized progesterone can help with the last piece.
Why does menopause and perimenopause affect sleep?
In perimenopause, there is a gradual decline in progesterone over the years. Progesterone works with GABA receptors in our brain, which promote calm, relaxation, and improved sleep.
This is often compounded by erratic fluctuations in estrogen, which can cause intense hot flashes further disturbing sleep. Many of our patients note concurrent histamine overload (various other reasons common today) – histamine will function in our brains to promote wakefulness.
Can I do anything about pain during sex?
Yes! Vaginal HRT provides significant relief and does not carry the same concerns as systemic HRT. Low dose vaginal estrogen and/or vaginal DHEA have both been found to be beneficial. Treatment not only helps alleviate pain with intercourse, but it also improves the health of your vaginal mucosa
What can I do about vaginal dryness or recurrent UTIs?
While there are lubricants which help, the results are not matched by the benefits seen with vaginal low dose estrogen and/or vaginal DHEA.
Should I take natural supplements to treat my symptoms?
Yes. HRT will not replete a significant vitamin or mineral deficiency. These are common with diets and lifestyles today and should be addressed in conjunction with HRT
When should I see a doctor for menopause symptoms?
If you are asking this question, it’s probably the right time. Perimenopause will start while your cycles are still regular. Regular cycles do not mean your symptoms are not hormonal or perimenopausal. You can benefit from support. Support does not always need to start with HRT, but we monitor and when the time comes that HRT is the best option to add on, we make the decision together.
The materials and content mentioned on this site are intended as general information and should not be used as a substitute for personal medical advice, diagnosis, or treatment. This website does not qualify as creating a provider-patient relationship between us and any user of the website
Menopause care- Perimenopause Treatment- Menopause specialists- Menopause clinic