chapter 20 perimenopause and menopause
TRANSCRIPT
Chapter 20:Perimenopause and Menopause
Catherine Lemelin HE 210-OL
What is the difference between Perimenopause and Menopause?
Perimenopause Menopause
The ovaries function erratically and hormonal fluctuations may bring a range on changes.
Can be a one-to-ten year stretch.
Changes include: Hot flashes, night sweats, trouble sleeping, and heavy menstrual bleeding.
Each woman is affected to the transition differently.
Ovaries settle down and the reproductive hormones have declined to low, steady levels.
Marked by the final menstrual period (final after one year with no periods).
Midlife PerimenopauseBrings the end of
the childbearing years.
Involves emotional, social, and physical changes.
Everything from a new sort of loneliness to a profound sense of new freedom may emerge.
The menopause transition may fill our minds with all sorts of questions:
What do I want to do? What am I not able to
do?
What can I control? How do I want to live?
Have I reached Perimenopause?
Transition can begin from late 30’s to 60 and can last from 1-10 years
Smokers tend to reach menopause earlier than nonsmokers
Women typically begin the transition at the same age as their mothers
According to Endocrinologist, Jerilynn Prior, if you apply to any three of the list below, you can assume you have begun perimenopause:
1. New-onset heavy and/or longer flow2. Shorter menstrual cycles (less than 25 days)3. Newly sore, swollen, or lumpy breasts4. New midsleep wakening5. Increased cramps6. Onset of night sweats (esp. around menstrual
flow)7. New or markedly increased migraine headaches8. New or increased premenstrual mood swings9. Weight gain without changes in exercise or eating
Non-medical self help approaches to alleviate discomforts
MeditationYogaRelaxationRegular exerciseHealthful foodEnough sleepSupport from family and friends
Perimenopausal SignsPremenstrual Syndrome (PMS)
◦ Swollen/tender breasts, bloating, anxiety, etc
Menstrual Cycle Changes◦ Shorter cycles, skipped periods
Abnormally Heavy Bleeding◦ 25% of women in perimenopause
experience heavy bleeding
Facts about Perimenopause
Contrary to popular belief, you can still become pregnant during perimenopause.
20-30% of women never experience hot flashes during perimenopause.
Sleep disturbances are common in both perimenopause and postmenopause.
Ways to Eliminate Sleep Disturbances Cut out
caffeinated beverages
Avoid smoking Avoid or limit
alcohol consumption
Go to bed at approximately the same time each night
Exercise regularly Before bed, take
a bath, listen to music or read
Filter out noise and light
Vaginal Changes Urinary ChangesVaginal dryness is a
common change in early perimenopause
Estrogen and progesterone levels decline and the vaginal walls frequently become thinner, drier, less flexible, and more prone to tears and cracks
Finding the need to urinate more often
Urge incontinence (sudden strong urge to urinate followed by involuntary flow)
Urinary incontinence Incontinence can be
successfully managed, treated, and sometimes cured (i.e. kegal exercises, bladder training, medications, vaginal estrogen)
Tips to Relieve Vaginal Dryness and Sexual DiscomfortLubricants and
vaginal moisturizers
Regular sexual activity
Wait until fully aroused before penetration
Drink more fluids
Graduated dilators
Low-dose local vaginal estrogens
Hormone therapy
PostmenopauseThe ratio of body fat to muscle mass
increases as we grow older, so it is very important to exercise to maintain muscle mass.
Weight gain is common due to a combination of slower metabolism, decreased activity, and increased caloric intake.
Eating well can help prevent/manage chronic diseases and enhance sexuality.
Bone Loss and OsteoporosisOsteoporosis is a condition of
significantly low bone density.As we get older, we start to lose
bone faster than we replace it.Prevention includes: yoga, jogging,
strengthening with weights, avoiding harmful habits, eating healthy, etc.
Vitamins that limit bone loss and reduce fractures are Calcium, Vitamin D, and Magnesium.
Care and Treatment for Perimenopauseal DiscomfortsAlternative therapies such as herbs or
botanicalsWestern medicine of drugs or surgeryEstablishing a relationship with a
healthcare practitioner or clinician whose philosophy is similar to yours and is open-minded
Possessing insurance and access to health care
Nonhormonal medications such as bisphosphonates, anti-depressants, or sleeping pills
Hormone TherapyHormone Therapy is the process
which women receive treatments and medications to help the body replace hormones that are no longer produced after menopause
Pros: Relieves discomfort of menopause (hot flashes, night sweats, vaginal dryness)
Cons: Causes health risks (breast cancer, stroke, blood clots)
Debate over Hormone Therapy
There is a current debate regarding the use of hormone therapy. Some feel that because perimenopause and menopause are not diseases, then treatments should not be pushed on women. Although HT may provide negative effects, others who suffer during this time are happy to know that there are treatment options and are willing to take the risks.
Various HormonesProgestogensMedroxyprogesterone
Acetate (Provera)Progestin-Releasing
IUD (Mirena)Bioidentical
Micronized Progesterone
PremProEstrogen/Progestin
PatchesEstrogens
◦ Estradiol, Estriol, and Estrone
Discussion Question
What are your thoughts on the debate over hormone
therapy?
“ Intellectually, I know some of my physical and mental capacities will diminish as I age, but I want to deal
with this with a sense of self-acceptance [and] not lower
expectations. I hope my generation of feminist boomers will not deny the
limits of aging and not give in to internalized ageist attitudes towards
others and ourselves as we age” (546)
ResourceThe Boston Women’s Health Book
Collective.“Chapter 20: Perimenopause and Menopause” (pages 505-546). 2011. Our Bodies, Ourselves. New York, NY: Simon & Schuster.