Menopause & Perimenopause 101: Everything you need to know (and were afraid to ask)

Although menopause brings menstruation to a welcomed close for many, the transition before, during and after menopause can cause troubling symptoms – from dreaded hot flashes and night sweats to unwanted belly weight and painful intercourse. Bryan Jick, MD, OB-GYN, and Jennifer Park, OB-GYN, at Fair Oaks Women’s Health, recently shared more about the stages of menopause and how to relieve symptoms (and how not to!).

Defining menopause and perimenopause  

Menopause marks the end of menstruation, ovulation, the production of the hormone estrogen, and fertility. It is technically defined as occurring 12 months after the final menstrual period, with women considered “post-menopausal” at this point. However, women can experience symptoms consistent with loss of estrogen for years prior to the onset of menopause.

Gynecologists and other physicians call this time leading up to menopause perimenopause, or the menopausal transition, when estrogen levels decrease but also fluctuate. This phase can begin on average four years before complete cessation of menses and is marked by irregular periods and other symptoms such as hot flashes and night sweats that can disappear and reappear, and which continue into the post-menopausal time.

Periods skipped during perimenopause don’t count toward the overall 12-month transition to menopause. “We often see women going a few months without menses and then find themselves unexpectedly having a period,” Dr. Jick explained. “This is because estrogen is still being produced, so it’s not real menopause yet. We then start the clock all over again to reach that full 12-month transition.”  

Dr. Jick refers to this phase as the “hormonal roller coaster.” Both perimenopause and menopause can have the same disruptive symptoms.

Symptoms of menopause and perimenopause

• Hot flashes/night sweats
• Poor sleep
• Tiredness, fatigue
• Weight gain, redistribution of body fat
• Hair loss
• Joint pains
• Headaches
• Less interest in sex (low libido)
• Feeling anxious, irritable
• Brain fog
• Mood swings
• Memory and concentration problems
• Depression
• Lack of motivation
• Vaginal dryness/painful sex
• Urinary urgency      

Hot flashes and night sweats (i.e., hot flashes when you’re sleeping) are a sudden, intense sensation of heat in the upper body that can cause sweating, flushing, chills and rapid heartbeat, and occur due to hormonal changes. Night sweats often interfere with sleep. “Sleep disturbances are a very common symptom of menopause and can lead to a lot of the other symptoms – tiredness, fatigue, brain fog, mood swings, memory and concentration issues and depression – which are not directly due to loss of estrogen (i.e., menopause).” Dr. Park explained.

Weight gain also isn’t directly related to menopause. With age, we burn less calories, which can cause weight gain – but studies show that weight distribution is hormone-related: With the loss of estrogen, particularly a few years after menopause occurs, weight can shift from the thighs and hips to the stomach. “That’s because estrogen affects where body fat tends to be located,” said Dr. Jick.      

Lastly, vaginal dryness, painful intercourse and urinary issues are often the result of the vaginal wall thinning and losing elasticity, also caused by the loss of estrogen. These symptoms don’t always show up right away with menopause. Dr. Jick explained that a lot of his patients – even those who had pretty minor perimenopausal or menopausal symptoms – two or three years later might complain of vaginal dryness, painful intercourse and urinary urgency.

Symptom relief

According to the North American Menopause Society, patients found the following recommendations for hot flashes/night sweats (and the resulting symptoms associated with sleep disturbances) to be beneficial: weight loss, mindfulness, hypnotherapy and avoiding triggers, like alcohol, stress, heat and spicy foods.

For vaginal dryness, Dr. Jick recommended moisturizers or lubricants to improve intercourse issues. For symptoms associated with the thinning of the vaginal wall, like urinary issues and painful intercourse, he has found vaginal hormone therapy (e.g., vaginal estrogen creams or suppositories) to be very effective. This therapy can be considered in many women after discussion with their physician about risks and benefits.

Use of hormonal therapy for perimenopausal and menopausal symptoms dropped significantly after the publication of the Women’s Health Initiative study in 2002 because of concerns about their impact on breast cancer and cardiac risks. However, those risks can be very low in women just entering menopause or perimenopause and the benefits associated with taking hormones often outweigh the risks.

“Women should speak to their physician about hormone therapy,” said Dr. Park. “For many years, people moved away from hormones during menopause, and we are now seeing a more balanced approach to using hormone therapy. Many women do not need it, but for those suffering severe symptoms, hormones are safe, and the benefits can be profound including relief of hot flashes, night sweats, sleep deprivation and improvement of the brain fog, mood and memory problems often caused by lack of sleep.”

Park added that many women in this stage of menopause are prescribed sleeping pills or other medications that are often not effective, when they could benefit from low dose hormone therapy.

“Everyone is different,” Park said. “We encourage women to speak to their doctors about their symptoms to identify the best treatment through this stage.”

For more information about Fair Oaks Women’s Health, visit: www.fowh.com.