I feel on edge. I can’t sleep or think clearly. My husband is tired of my forgetfulness. Sometimes I just fly off the handle for no reason. I am having trouble with sex. I don’t know what is happening to me? Could this be menopause?

Nancy, age 52, sat in my office looking frustrated, worn-out, and depressed. I have counseled many women with complaints like hers. Women come in with overwhelming symptoms of perimenopause and menopause, which impair their emotional, physical, mental, and spiritual health.

Surprisingly, a recent BBC news article quoted a Jubilee Report that stated that 76% of post-menopausal women said their health was better, 75% said they had more fun, and 93% said they had more independence and more choice in everything from work to leisure pursuits.

There is light at the end of the tunnel, but if you are currently in perimenopause, odds are you are feeling more like Nancy and are looking for answers to help you cope with this uncertain territory. Informing yourself about what to expect when you begin experiencing menopausal symptoms and how you can more effectively handle this new stage of life is the first step towards feeling better.

Perimenopause facts

Perimenopause, the time our mothers referred to as “the change,” can start as early as 40. The closer a woman gets to 50, the more symptoms she will have. Common symptoms include hot flashes, erratic and often painful periods that may be extremely heavy, or too light, or skipped altogether; forgetfulness; insomnia and night sweats; headaches, and, given the other symptoms, a hardly surprising tendency to mood changes and depression. This transition period is a unique experience for each woman. Late symptoms consist of vaginal dryness, urinary problems, and muscle and joint aches.

“The most notable thing about these symptoms is that they can be very erratic. After months of problems, a woman can become symptom-free for six months or more,” said Dr. Paul Lucca, an obstetrician/gynecologist with Advanced Healthcare.

The biological origin

The cause of all these diverse symptoms is the slowing down of the function of the ovaries. “Ninety-eight percent of the time, a woman is fine physically, but the ovaries are starting to falter in their production of good eggs,” Dr. Lucca said. As a result, women will begin to have anovulatory cycles in which eggs are not released. This may result in a lighter period, similar to those a woman may have had while taking the birth control pill, or one that is skipped altogether. However, the ovaries are still producing estrogen, which causes the lining of the uterus to thicken. Progesterone, released by the egg, causes the uterus to slough off that lining, resulting in a menstrual period. When no egg is released, the lining continues to thicken until the next “normal” cycle, when a woman’s bleeding can become very heavy. It is advisable to consult your doctor whenever symptoms cause concern, such as heavy bleeding.

What women can do for themselves

“Some of the general things women can do during perimenopause include watching what they eat and exercise. These are clichés, but clichés become clichés for a reason. Women’s metabolism is slowing down, and they start putting on weight. They may have the same diet and exercise program as earlier in life, but they begin to gain weight. Watching the diet and doing more exercise not only keeps off weight but it’s also good for the heart and bones,” said Dr. Lucca.

Some doctors recommend hormone replacement therapy (HRT). You should manage your medical care and determine what is best for you. There are some risks with HRT, and there are risks associated with the use of uncontrolled over-the-counter or ‘natural’ treatments. Inform yourself of the benefits and risks of any treatment you are considering.

Application:

• What physical changes have you noticed and dealt with?
• How have you coped? What has worked and what has not worked for you?

What is Menopause?

Menopause begins a new phase in a woman’s life when she stops having periods, often sometime in her 50s. Menopause is a natural biological event in which the menses stop when the function of the ovaries begins to cease. Menopause does not occur overnight; it is a gradual process. A woman is in menopause when she has had no menstrual periods (menses) for 12 months and has no other medical reason for her menses to stop.

What makes menopause so difficult? The decrease in estrogen also affects serotonin — a brain (neurochemical) chemical — which causes women to feel good, energetic, and able to focus more clearly. This is called the “serotonin-estrogen” dance. Less estrogen = less serotonin. When serotonin decreases, women begin to feel “blue” or experience depressive-like symptoms.

The following are physical signs and symptoms associated with menopause. Let me assure you that these symptoms are not experienced by all women going through menopause and are not experienced to the same degree.

• Hot flashes — sudden waves of heat that can start in the waist or chest and work their way to the neck and face and sometimes the rest of the body. They are more common in the evening and during hot weather. They can hit as often as every 90 minutes. Each one can last from 15 seconds to 30 minutes, though five minutes is the average. Seventy-five to eighty percent of women going through menopause experience hot flashes, some more bothered by them than others. Sometimes heart palpitations accompany hot flashes.
• Irregular periods – this varies and can include: periods that get shorter and lighter for two or more years. Periods that stop for a few months and then start up again and are more widely spaced. Periods that bring heavy bleeding and/or the passage of many or large blood clots. This can lead to anemia.
• Vaginal dryness — this results from hormone changes. The vaginal wall also becomes thinner. These problems can make sexual intercourse painful or uncomfortable and can lead to irritation and increased risk for infection.
• Loss of bladder tone which can result in stress incontinence (leaking urine when you cough, sneeze, laugh or exercise).
• Headaches and dizziness.
• Skin and hair changes. Skin is more likely to wrinkle. Growth of facial hair, but thinning of hair in the temple region.
• Muscles lose some strength and tone.
• Bones become more brittle, increasing the risk for osteoporosis.
• Risk for a heart attack increases when estrogen levels drop.
• Emotional changes associated with menopause: irritability and mood changes, lack of concentration, difficulty with memory, tension, anxiety, and depression.
• Insomnia which may result from hot flashes that interrupt sleep.

These symptoms can seem unbearable. Women are fortunate to live today in a world which provides much guidance and many resources for understanding and managing menopause.

This article was written by: Lynette Hoy, NCC, LCPC