Dr. Jennifer Su offers key facts and insights for a healthier transition with perimenopause.
Women’s health follows a cyclical pattern from the time of birth all the way into later life. As a woman approaches ages between 45 and 54, she goes through perimenopause. This is a time of transition in a woman’s life, bridging the gap between her child-bearing years and menopause. Perimenopause can be a rather strange journey for a woman. She’s no longer in her prime child-bearing years, yet she’s still sporadically menstruating and navigating new symptoms as they pop up. Some things that seem inevitable about growing older might feel daunting and overwhelming at first, but perimenopause is simply another rotation through the many cycles of female life. By welcoming proper testing, symptom management, and stress reduction, women can usher in this new phase in their lives feeling prepared.
Dr. Jennifer Su, MD, FACOG, is a board-certified gynecologist with Whole Health JC. She explains perimenopause as the time when a woman’s ovaries essentially “quit their jobs” of releasing an egg every month. Think of it as retirement for the female reproductive system.
“Because of this natural progression in life, our hormone levels start to fluctuate in a different way than when we were younger.” Dr. Su says.
It’s a common understanding that women’s hormones fluctuate drastically when they’re premenstrual, pregnant, or menopausal. While the perimenopausal stage isa normal progression of a woman’s reproductive health, it can be triggered by other things such as surgical removal of one or both ovaries, after tubal ligation, fallopian tube removal due to disruption of blood supply to the ovaries, after radiotherapy for cancer treatment, or due to extreme stress on the body. Much like the symptoms that occur during menstruation, some of the symptoms that accompany perimenopause can be unpleasant.
“Symptoms include hot flashes, insomnia, irregular periods (either closer together or further apart, or heavier or lighter flow), moodiness, weight gain or difficulties losing weight, irritation or dryness of vaginal skin, painful sexual intercourse, urinary tract infections, breast tenderness, muscle pains, headaches, brain fog, even tinnitus,” Dr. Su says.
The first thing to do to help manage these symptoms is to talk to a healthcare provider about getting lab work to test FSH levels. This will help see if a patient has already gone through “the change of life,” which means they are already past perimenopause and into menopause. This blood draw can be done on day 21 of a woman’s cycle if she’s still menstruating or any day of the cycle of a woman who has stopped.
After this, hormone levels can be drawn to gain more details about how to balance hormone levels. Screening mammograms are also recommended every year fromage 40 and on.
“This is also a great time to check for prediabetes, thy-roid function, vitamin D levels, liver and kidney function, chemistries, and a fasting lipid panel,” Dr. Su says.
All women go through perimenopause. But, the symptoms are not the same for every woman, and hormone balance and hormone optimization does not always mean that hormones are prescribed.
“Because of this natural progression in life, our hormone levels start to fluctuate in a different way than when we were younger.”
Brian Hill, Hill Rehab
Supplements in the form of vitamins, herbs, botanicals, foods, and essential oils, such as lavender, geranium, clary sage, peppermint, and ylang-ylang, are available and can help manage symptoms. Diluted essential oils can be applied to pulse points, like the wrists, temples, neck, the back of the ears, and the sole of the foot, or they can be used in a diffuser.
If hormones are needed, then it’s important that the hormone levels are checked first to see what specific hormones are needed. Bioidentical hormones are typically prescribed since they have the same chemical structure as the hormones that women make naturally and can help replace the declining levels of estrogen, progesterone, and testosterone in the body.
Doing a diet audit can also be helpful. There have been some cases where women found that not drinking wine made their hot flashes resolve and limiting inflammatory foods such as sugar has proven to be very beneficial.
What many women may not know is that the extent of severity of their symptoms can stem from the stress they encounter. If a woman is under great stress, she is more likely to experience more severe symptoms. As a result of the impact that stress causes, women as young as 27 year sold can experience perimenopause symptoms, even though their ovaries are not actively shutting down and they are regularly having a period. Mind-body medicine techniques, such as acupuncture, Tai Chi, Qi Gong, yoga, and meditation, can be effective in managing this stress and helping to reduce the severity of premenopausal symptions.
It is also important to note that once a woman enters perimenopause, her periods can be very irregular for four to five years after her ovaries have “closed for business.” However, it is still possible for a woman to get pregnant during this stage of life.
“If a woman has not gone more than a year without a period, she is still fertile,” Dr. Su Explains. “If at any point a woman is unsure if she’s still in perimenopause or has fully transitioned to menopause, she can consult her healthcare provider.”
There’s no one-size-fits-all solution to managing the symptoms. Some women might require hormone optimization and balancing with prescriptions. Others may be able to manage symptoms with proper nutrition, essential oils, acupuncture, yoga, or meditation. It is truly about finding the right solution for each woman.