Menopause

What is the difference between perimenopause and menopause?

You may think that you are experiencing menopause when you are actually in a “menopause transition” phase known as perimenopause. Many women say they are “in menopause” but they are actually in perimenopause.

Perimenopause is characterized by symptoms such as hot flashes, weight gain and moodiness—it is a slow biological process that can begin many years before entering menopause. During this transition period, your body is moving toward the end of your reproductive stage as your ovaries begin to produce less estrogen and progesterone. Perimenopause usually begins in your 40s, but some women experience changes as early as their mid-30s. On average, perimenopause lasts about 4-5 years, but someone women experience perimenopause for 10+ years.

Menopause is a diagnosis that occurs when a woman has not had a menstrual period for exactly 12 consecutive months. Menopause is officially the end of perimenopause. The time after menopause is postmenopause, a stage that lasts the rest of your life. Menopause usually occurs around the age of 51. Premature menopause happens when the ovaries fail before the age of 40.

Removal of the ovaries with or without the uterus will initiate immediate menopause. Menopause can also be caused by chemotherapy or radiation of the pelvis.

What are the symptoms of perimenopause (or menopause transition)?

Perimenopause symptoms can include:

• Irregular periods
• Decreased fertility
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Mood swings
• Weight gain and increased abdominal fat
• Thinning hair
• Loss of breast fullness
• Lack of interest in daily activities; lack of motivation
• Withdrawal from friends/family
• Loss of energy or slowed movement
• Difficulty concentrating
• Forgetfulness
• Changes in appetite
• Changes in sexual function and/or painful sex
• Joint and muscle pain
• Restlessness, agitation
• Feelings of guilt, worthlessness or inadequacy
• Thoughts or ideas about suicide, even if in passing (seek immediate medical care)

These symptoms are due to the fluctuations of your hormones during menopause transition. Some medical issues, medication, stress and other environmental factors can influence hormone shifts and can therefore affect perimenopause. Severity of symptoms varies. If you are experiencing these symptoms and would like to discuss them with your healthcare provider, please reach out to your primary care physician, gynecologist or OB/GYN.

How are perimenopausal symptoms managed?

Your doctor may recommend:

• Non-hormonal medications
• Hormone therapy, including bioidentical hormone therapies or lower dose oral contraceptives
• Integrative medicine practices such as acupuncture (link to Hoag For Her)
• Cognitive behavioral therapy
• Counseling, psychotherapy and support groups
• Antidepressants and anti-anxiety medications
• Lifestyle & behavioral consulting such as the following changes that may reduce perimenopausal symptoms
  • Weight loss if you are overweight
  • Daily exercise (in moderation: strenuous activity can trigger hot flashes) 
  • Avoiding caffeine, alcohol, spicy foods and nicotine 
  • Wearing cool breathable layers, wicking pajamas 
  • Maintaining good sleep hygiene 

What happens after menopause?

After 12 months without a period, you will be in the postmenopausal stage of life. Your menopausal and perimenopausal symptoms like hot flashes will lessen or go away entirely. Your hormone levels will remain low, and you will no longer ovulate, get your period or be able to get pregnant. During this time, you are at increased risk for conditions such as osteoporosis and heart disease. Working with your doctor is more important than ever to maintain your health and quality of life.

What are the risks associated with postmenopause?

A woman’s risk of developing certain conditions rises after menopause, including:

• Cardiovascular disease, including stroke
• Osteoporosis
• Weight gain
• Urinary incontinence

When is hormone replacement therapy (HRT) recommended?

Estrogen replacement therapy relieves hot flashes and other symptoms of menopause. It may be helpful in reducing the risk of osteoporosis and heart disease, as well as some cancers.

Talk with your doctor about hormone replacement therapy. Your doctor may not recommend estrogen replacement therapy if you have a history of estrogen-dependent endometrial cancer or breast cancer, blood clots or inflammation of the veins, uterine bleeding without a diagnosed cause or liver disease.

Currently, hormone replacement therapy is not recommended for women after menopause. Speak with your doctor to determine what is right for you.

Can I still enjoy sex postmenopause?

Yes, though some women lose interest in sex during and after menopause due to drier genital tissues and lower estrogen levels. Remedies to this include:

• Estrogen creams and estrogen pills
• Vaginal lubricants

Women who experience sporadic periods during perimenopause may need to continue using some form of birth control. Talk with your doctor about which form of birth control is best for you.

If you are having pain during sex, speak with your doctor . If you’re experiencing sexual problems, you and your partner may benefit from individual or couple sessions with a licensed sex therapist to help maintain intimacy as you age. The Hoag for Her Center for Wellness offers sexual health & counseling with a licensed marriage and family therapist (LMFT). Our sex therapist will support you in navigating your emotions, while providing proven strategies and counseling to address conditions such as sexual health and relationships.

What are some treatment options for postmenopausal incontinence issues?

Urinary incontinence affects 50% of postmenopausal women. Hoag is a leader in surgical and non-surgical options for treating incontinence. Learn more about incontinence here.