Menopause and Perimenopause

We look forward to the opportunity to serve your needs as you transition through this phase in a woman’s life. 

No treatment is necessary for perimenopause or menopause unless the symptoms you are having are affecting your ability to function normally and enjoy life. However, many women may experience symptoms that do affect their quality of life. If you are one of these women, we are here to help you with the transition.

Perimenopause is a gradual transition associated with changing hormone levels. There is not a test to see if you have entered perimenopause. During your appointment, we will take many factors into consideration including your menstrual cycle, your age and your symptoms and body changes. These symptoms and changes can occur over many years leading into menopause, often starting in the early 40’s.

Menopause is the complete cessation of menstrual cycles for one full year. There are laboratory blood tests that can help to determine if you have transitioned into a menopausal state.

Lifestyle Changes

There are a variety of lifestyle and home remedies that can help with some symptoms and promote overall health as you progress through perimenopause:

• Eat Healthy – Adopt a low-fat, high-fiber diet that is rich in fruits, vegetables and whole grains. Add calcium-rich foods to your daily intake. Discuss if calcium and vitamin D supplementation is appropriate for you. Avoid alcohol and caffeine as they can trigger hot flashes.
  
  
• Be Active – Regular exercise helps prevent weight gain, improves sleep and elevates the mood. Try to exercise for 30 minutes or more most days of the week. Add some days of weight training to decrease the risk of bone fractures and strengthen bone density. Try to avoid exercising just prior to bedtime as this can negatively affect sleep.
  
  
• Sleep – Try to have a consistent sleep schedulewith at least 7 hours of sleep each night. Use good sleep hygiene techniques such as setting a consistent bedtime, avoiding the use of electronic devices and TV for the hour prior to bed.
  
  
• Practice stress reduction techniques – Regular meditation, breathing exercises and/or yoga can promote relaxation and good health. This can be particularly helpful in the perimonepausal transition.
  
  
• Ease vaginal discomfort – You may experience vaginal dryness or discomfort with normal daily movement and activity or with intercourse. Use over-the-counter water-based lubricants for intercourse such as Astroglide, KY Jelly and others. Continuing sexual activity promotes blood flow to the vaginal tissues which keeps them healthier. Vaginal moisturizers such as Rephresh and Replens can be helpful for day-to-day dryness. Avoid products with glycerin as this may be irritating. 

Complementary Medicine

Many women are interested in alternative or complementary medicine options as they navigate the perimenopausal years. These therapies are still being evaluated for their safety and effectiveness. Please always discuss potential therapies at your visit to evaluate the best options for you individually. 

• Black Cohash – This is an herb extract that has been used to treat hot flashes. Safety and effectiveness are uncertain with this remedy.
  
  
• Phytoestrogens – These are naturally-occurring estrogens in some foods. The main types of food they occur in are soybeans, chickpeas and other legumes as well as in flaxseed, whole grains and some fruits and vegetables. The studies on these have been conflicting as far as safety and effectiveness. They could increase the risk of breast cancer and reduce the effect of some breast cancer treatments.
  
  
• DHEA – This is a natural hormone that has been said to increase sexual interest. Again, the evidence to support this is mixed. There are some concerns there may be harmful effects as well.

Low-risk complementary therapies include acupuncture, yoga and relaxation techniques or classes.

Medical Treatment

• Hormone Therapy: Commonly called hormone replacement therapy or HRT. This comes in pills, patches, creams and gels and remains the most effective way to relieve the hot flashes and night sweats associated with menopause and perimenopause. At your appointment we will discuss if this is an option for you based on your medical history and personal desires.
  
  
• Vaginal estrogen: This is commonly used to relieve vaginal dryness and can be administered in cream, pill, or ring form directly in the vagina. It is a low dose of estrogen working directly on the vaginal tissues and can help with discomfort with intercourse and some urinary symptoms.
  
  
• Antidepressants: Certain antidepressants in the serotonin reuptake inhibitor (SSRI) category may reduce hot flashes. These can be useful in patients that cannot take or desire to avoid traditional hormone therapy.
  
  
• Gabapentin (Neurontin): Gabapentin is traditionally used to treat seizures but has been shown to decrease hot flashes as well. This can be helpful in women who cannot take hormone therapy and in women with a history of migraines.

Preparing for your appointment

• Bring a record of your menstrual cycles. Keep a journal or use a phone app to track your cycles for several months. Include the first and last day of your bleeding as well any other bleeding episodes in the month. Make a record of whether the flow was heavy, light or medium.
  
  
• Document any symptoms you are having and the timing of those during the cycle. Include details of these symptoms.
  
  
• Make a note of any stressors or recent life changes.
  
  
• Record all medications and supplements you are taking or have tried. Note whether any remedies were helpful.
  
  
• Consider bringing a friend or family member. Sometimes remembering all the information in an appointment is difficult. A second person may be able to remember a detail you missed or forgot.
  
  
• The time you have at your visit is limited so prepare a list of questions to make the best use of your time together