Perimenopause

Perimenopause can occur anywhere from five to 10 years prior to menopause (for most women these changes start in their mid to late 40s). During perimenopause, the ovaries may not release an egg every month (ovulation) and the production of hormones (estrogen, progesterone) may fluctuate. This can lead to irregular periods (i.e. early or late menses with heavy or light flows). As ovulation is less regular, it is more difficult for a woman to get pregnant; however, pregnancy is still possible and contraception should be considered.

Many women can start having symptoms during perimenopause from hormonal fluctuations. Symptoms can include hot flashes, night sweats, sleep problems, mood changes such as depression, anxiety and mood swings, worsening premenstrual syndrome (PMS) such as bloating and breast tenderness, headaches or migraines, difficulty concentrating, vaginal dryness, urinary incontinence, and loss of libido. Symptoms can vary from very mild to debilitating. The decline estrogen levels during this time can also lead to loss of bone, which can increase the risk for osteoporosis.

In women with more severe symptoms, treatment options include low dose oral contraceptives (OCS) and hormonal replacement therapy (HRT). Low dose OCS contain less estrogen (i.e., 20 mcg ethinyl estradiol) than traditional OCS. Low dose OCS can help prevent pregnancy but they can also help relieve perimenopausal symptoms, regulate periods especially if they are irregular or heavy, and prevent bone loss (i.e., reduce the risk of osteoporosis).

HRT refers to the use of estrogen and progesterone to replace the hormones that decrease with time and prevent the extent of fluctuation of these hormones in the body. During perimenopause, woman may be given just estrogen and progesterone if their menstrual cycles have started to change. HRT does not provide any contraceptive protection and women will need to consider other contraceptive methods while on HRT. HRT will help relieve symptoms and also provide other health benefits such as preventation of osteoporosis, and improvement in cholesterol (i.e., reduce the risk of heart disease). There are many options for HRT including oral tablets, transdermal patches or gels, and vaginal creams. Women should talk about these options with her physician or pharmacist.

Alternative approaches during the perimenopause include phytoestrogens ( 'plant-like estrogen' compounds such as soy and flaxseed), herbals, exercise and relaxation techniques. Preventative health care (e.g., healthy diet, regular weight-bearing exercise) is also very important during this time.