Perimenopause

And the importance of this stage in facing menopause

It could be said that there is no single medical specialty to which the treatment of menopausal and perimenopausal women belongs, since the symptoms affect many different systems and parts of the body, and therefore it must be addressed jointly according to the symptoms reported by the woman.

It is very important to know that symptoms do not begin with menopause, a term used to define the end of a woman's reproductive life, which is officially reached after more than 12 months without menstrual bleeding, but rather during the transition toward it, or what is medically known as perimenopause.

The average age is around 47, and it usually ends at 51, but it can start much earlier.

For many women, it is a real surprise to discover that all these conditions can begin to manifest many years before they stop menstruating.

Symptoms can appear during the transition period and persist for years after menopause. Among the most frequent are:

• Irregular periods: menstruation may become less or more frequent, with heavier or lighter bleeding, until it finally disappears





• Hot flashes and night sweats: A feeling of sudden and intense heat that mainly affects the face and head and spreads to the rest of the body, lasting for a few minutes until it disappears as quickly as it came.





• Genitourinary atrophy: A problem that 80% of women suffer from, which causes vaginal dryness and can cause pain and irritation during intercourse, as well as an increase in urinary infections





• Decreased fertility





• Loss of bone density and weight gain: The body loses bone mass faster than it regains it, thus increasing the risk of osteoporosis. On the other hand, there is weight gain without an increase in food intake or a decrease in physical exercise. At the same time, there is a change in the distribution of adipose tissue, which accumulates in the central area





• Increased hair loss, brittle nails, muscle and headaches, heart palpitations, and cramps may also occur

All these changes are the result of hormonal variations, especially the decrease in estrogens, a hormone crucial in a woman's reproductive cycle whose levels do not recover after menopause. Levels rise and fall unstably, and it is these fluctuations that give rise to the aforementioned symptoms. Some symptoms are associated with an excess of this hormone, and others respond to its deficiency. Many women suffer more during the transition stage than in postmenopause, as hormone levels tend to stabilize from that point on.

And although symptoms tend to improve with hormonal stability, this is not always the case; very few women go through this stage of their life without consequences if they do not undergo any treatment.

Experts agree that Hormone Replacement Therapy (HRT) is, in the vast majority of cases and under medical supervision, the best treatment to follow. The sooner it is started, the greater the benefits it will provide. In cases where it is indicated, not all women will want to undergo Hormone Replacement Therapy, but at the very least, they should all be informed of the symptoms linked to menopause. There are no proven benefits to this therapy if there are no symptoms.

Hormonal volatility does not only lead to physical changes and symptoms, but it also has an effect on the mood and brain of a woman going through this stage. These women have a certain vulnerability to depression. Irritability, anxiety, lack of sexual desire, memory loss, and so-called brain fog (a mixture of confusion and a decline in verbal and cognitive skills) are other characteristic traits.

Individual variation is immense. We cannot tell women that this is a natural phenomenon and that it passes later. If symptoms affect quality of life, they must be treated.

Beyond Hormone Replacement Therapy—and no less important—there are many other things a woman can do to improve her general condition during the perimenopause phase. Among others, physical exercise, yoga, and meditation, as well as cognitive behavioral therapy; ultimately, we can state that changes in lifestyle can also be of great help.

For a long time, there has been negative cultural baggage regarding everything related to menopause and the transition stage that precedes it.

Given the complexity of the subject, women immersed in this transition stage might ask themselves the following question: Should I throw in the towel and accept what is happening to me as normal?

The answer is a resounding no. You must seek help and find an informed doctor who does not downplay what is happening to you, since, although perimenopause presents with many different symptoms, treatments are available.

And, if finding a qualified and empathetic doctor is sometimes a challenge, changing the cultural narrative is just as important.

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