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Hormonal Update Volume 2 Number 6 Healthcare During Perimenopause Perimenopause, often called the next frontier in
women's health, has become an important concern for millions of women. Literally, the word perimenopause means surrounding menopause. Generally occurring during a woman’s forties and lasting from one to three years, or sometimes even longer, perimenopause is the transition from normal ovulatory menstrual cycles to menopause. Erratic fluctuations in hormone levels during this time can cause symptoms very similar to menopause. (See Hormonal Update V2N5) Currently, nearly twenty million American women are between the ages of 45 and 54. With our increasing knowledge about perimenopause, more and more women want to know what treatment options are available for this hormonally challenging time of life.
Where to Begin
As hormone levels decline, health risks increase. Hypertension, diabetes, hypothyroidism, and heart disease become more prevalent in perimenopausal women. One out of every four women is affected by osteoporosis. The perimenopausal transition can be looked upon as an opportunity, for a thorough health assessment, including a complete medical history, physical exam, and lab evaluation. A mammogram, pap smear, serum cholesterol/lipid profile, blood glucose, hormone level test, as well as bone resorption and bone mineral density screening are all important aspects of a perimenopausal health evaluation and should be performed regularly throughout both the peri and post menopausal
years.
Making Lifestyle Changes
Sometimes the physical changes you experience during perimenopause can signal a time to re-evaluate certain aspects of your life. It is an opportunity to make sure you are getting enough rest and exercise, eating a well-balanced, healthy diet, managing your stress effectively and having enough fun. And, if you are smoking, perimenopause is a good time to quit. Smoking is associated with many chronic diseases, including osteoporosis and heart disease. It can also contribute to the early onset of menopause.
Regular exercise, both aerobic and weight bearing, performed at least three times a week helps maintain healthy weight, minimize symptoms and reduce the risk of heart disease and osteoporosis.
Low Dose Oral Contraceptives
There are a number of ways to regulate perimenopausal menstrual cycles and bleeding. Low dose birth control pills are among the most widely prescribed. They contain small amounts of synthetic compounds that mimic estrogen and can effectively regulate the
cycle.
Despite erratic
cycles perimenopausal women often still ovulate and are fertile. For women not eager to produce a midlife child, low dose birth control pills not only help regulate menstrual cycles but also help prevent pregnancy. In addition, oral contraceptives can also eliminate or reduce hot flashes, vaginal dryness and mood
swings.
When considering oral contraceptives as a treatment option, it is important to remember that they are prescribed in standardized dosages. If the dosage is right for you, it could work quite well. If the dose is too high, you may experience side effects very similar to the symptoms you are trying to relieve. Side effects of oral contraceptives can include those that resemble PMS - anxiety, nausea, bloating, breast tenderness and depression.
Also of note:
Individualized Hormone Replacement There are numerous forms of hormone replacement available now to help alleviate the symptoms of perimenopause. Because perimenopause is such a unique experience for each woman, and because there is a considerable difference in how various hormonal delivery systems are absorbed and utilized by the body, an individualized approach to hormone replacement is among the most effective. Figure 2 below vividly illustrates the wildly erratic fluctuation of hormones during perimenopause as compared to the more rhythmic flow during normal menstrual cycles as seen in figure 1.
Figure 1
Figure 2 Individualizing hormone replacement begins with determining precisely which hormones you need. Because perimenopausal hormone levels can be so erratic, hormone testing during this phase of life can be challenging. A comprehensive portrait of your hormone levels during perimenopause may require a series of hormone level tests done over thirty days - such as Aeron LifeCycles’ Peri-Panel. This multiple testing can help determine your particular hormonal pattern throughout a month. By pinpointing hormonal fluctuations, treatments can be customized and symptoms better understood, maybe even anticipated. For example, if you have migraines consistently during the first part of your cycle, saliva testing your hormones throughout the month could reveal that your estradiol is spiking at that time. A prescription for progesterone, to be used during your estradiol spike, could help restore hormone balance and relieve your migraines. When hormones fluctuate as shown in the perimenopausal woman’s hormone profile in figure 2, intense mood swings can be the result. Individualized HRT may help to regulate and balance hormone levels, and lessen the need for anti-depressants or anxiety medications so often prescribed during perimenopause. If you are considering hormone replacement, discuss your symptoms and health history with your healthcare practitioner. Once a decision is made about therapy and hormone replacement begun, saliva hormone level testing can then help your practitioner tailor your dosage to your body’s specific needs and continue to monitor how you are responding to treatment. Perimenopause Action Plan:
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