Perimenopause

And the importance of this stage in coping with menopause

It could be said that there is not a 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, so it must be addressed jointly according to the symptoms reported by the woman.

It is very important to know that the 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 during the transition to it or what is medically known as perimenopause.

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

Many women are genuinely surprised to discover that all these conditions can begin to manifest themselves many years before they stop menstruating.

Symptoms can appear during the transition period and persist for years after menopause. The most common include:

• Irregular periods: menstruation may become less frequent or spaced out, with heavier or lighter bleeding, until it finally stops.





• Hot flashes and night sweats. A sudden and intense feeling of 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 affects 80% of women and causes vaginal dryness, which can lead to pain and irritation during intercourse, as well as an increase in urinary tract 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. Furthermore, there is weight gain without any increase in food intake or decrease in physical activity. And there is also a change in the distribution of adipose tissue, with fat accumulating in the central area.





• Other possible side effects include increased hair loss, brittle nails, headaches and muscle pain, palpitations, and cramps.

All these changes result from hormonal variations, especially the decline in estrogen, a crucial hormone in a woman's reproductive cycle, the levels of which do not recover after menopause. Estrogen levels fluctuate erratically, and these fluctuations give rise to the symptoms we've mentioned. Some symptoms are associated with excess estrogen, while others are due to a deficiency. Many women experience more discomfort during the transition period than in postmenopause, as hormone levels tend to stabilize after that point.

And although symptoms tend to improve with hormonal stability, this is not always the case; very few women go through this stage of their lives without consequences and without undergoing any treatment.

Experts agree that Hormone Replacement Therapy (HRT) is, in the vast majority of cases and under medical supervision, the best treatment option. The earlier it is started, the greater the benefits. While not all women will want to undergo HRT when it is indicated, all should be informed about the symptoms associated with menopause. There are no proven benefits to this therapy if there are no symptoms.

Hormonal volatility not only leads to physical changes and symptoms, but also affects the mood and brain of women going through this stage. These women are more vulnerable to depression. Irritability, anxiety, decreased libido, memory loss, and brain fog (a combination of confusion and a decline in verbal and cognitive abilities) are other characteristic features.

Individual variation is immense. We can't tell women that this is a natural phenomenon that will pass. If the symptoms affect their quality of life, they must be treated.

Beyond Hormone Replacement Therapy, and equally important, there are many other things a woman can do to improve her overall well-being during perimenopause. These include physical exercise, yoga, meditation, and cognitive behavioral therapy. Ultimately, we can say that lifestyle changes can also be very helpful.

For a long time there has been a negative cultural baggage surrounding menopause and the transitional stage that precedes it.

Given the complexity of the issue, 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 should seek help and find an informed doctor who doesn't downplay what you're going through, because although perimenopause presents with many different symptoms, there are treatments available.

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

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