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HEALTH MATTERS: Navigating perimenopause

By Luc J. Lemmerling, M.D. Princeton HealthCare System
    You’re sitting at your desk in your air-conditioned office when all of a sudden it feels like someone turned up the heat.
    You start sweating and can’t shed your sweater fast enough.
    Could this be it? Is this the “change of life” coming on?
    While every woman is different, hot flashes are one of the most common signs that hormonal changes are happening and your body is entering perimenopause, the transitional years before your menstrual cycles end.
    Perimenopause can last four to five years and begins — on average — at about age 46. During this time your body begins to produce less estrogen and menstruation becomes less predictable and less frequent. Once you have gone a full year without having a period you have officially entered menopause.
    For many women, the years leading up to menopause can be rough sailing, marked by one or all of the following symptoms:
    • Irregular periods. Skipping periods, longer or shorter periods, maybe lighter or heavier because ovulation becomes erratic.
    • Hot flashes. Hot flashes cause your body to get warm and may result in flushing on your face and neck, red blotches on your chest, back and arms, and heavy sweating. Flashes tend to last anywhere between 30 seconds and 10 minutes.
    • Trouble sleeping. Night sweats — hot flashes while you sleep — will often keep you from getting a good night’s rest.
    • Mood changes. Feeling crabby or irritable? Crying more? Moody? These mood changes can often be associated with perimenopause.
    • Vaginal and urinary problems. Fluctuations in estrogen levels can cause vaginal dryness, which can make intercourse uncomfortable. Hormone changes also can lead to urinary problems, such as infections and incontinence.
    • Decreased libido.
    • Bone loss due to declining estrogen.
    If you experience symptoms of perimenopause, see your doctor for a complete medical exam. And don’t assume a few missed periods are the start of menopause. Irregular bleeding also can be caused by polyps, fibroids, and in some cases precancerous thickening of the uterine lining (hyperplasia), or uterine cancer. These potential conditions make it all the more important to see your gynecologist if you experience changes in menstruation, including an increase in the amount, frequency, duration, or bleeding after intercourse.
    Fortunately, your doctor can help you navigate perimenopause through lifestyle changes and, depending on the severity of your symptoms, low-dose, short-term hormone therapy.
    Hormone therapy is not for everyone. In some women, it can increase the risk for blood clots, stroke, breast cancer and gall bladder disease. If you smoke, have a personal history of stroke or heart disease, or have had breast or uterine cancer, you should not take hormones to address perimenopause symptoms. Talk to your doctor about the pros and cons of hormone therapy and whether you are a candidate.
    Often symptoms of perimenopause can be managed with simple behavioral changes. The U.S. Department of Health and Human Services Office on Women offers these helpful tips to deal with perimenopause:
Hot Flashes:
    • Avoid triggers like spicy foods, alcohol, caffeine, stress, or being in a hot place.
    • Dress in layers and remove some when you feel a flash coming on.
    • Use a fan at home and at work.
    • If you still get your periods, ask your doctor about low-dose birth control pills, which may help.
Problems Sleeping:
    • Be physically active, but not too close to bedtime because exercise might make you more awake.
    • Avoid large meals, smoking and working right before bed. Avoid caffeine after noon.
    • Keep your bedroom dark and quiet.
    • Try to go to bed at the same time every night. Avoid napping.
Mood Swings:
    • Get enough sleep and stay physically active.
    • Minimize stress.
    • Consider seeing a therapist or joining a support group.
    • Talk to your doctor to see if you may have depression, a serious illness that can be treated.
    For women whose bleeding cannot be managed medically, surgical options include minimally invasive procedures such as endometrial ablation and laparoscopic or da Vinci robotic hysterectomy, all available at UMCP.
To find a physician with Princeton HealthCare System, call 888-742-7496 or visit www.princetonhcs.org.
Luc J. Lemmerling M.D., F.A.B.O.G., is board-certified in gynecology and is a fellow of the American Board of Obstetrics and Gynecology. He is a member of the medical staff at University Medical Center at Princeton.