Millions of women go through perimenopause without knowing that they are at this stage, confusing symptoms with stress, depression or simply with the aging process. We detail the manifestations specific to this period and what helps women who go through this normal stage of life.
Perimenopause represents the transition period to menopause that can take from several months to eight years. At this stage, the ovaries produce fluctuating quantities of estrogen and progesterone, creating a phenomenon that the specialists call the “area of the chaos”. The actual menopause is installed only after 12 consecutive months without menstruation, when hormonal levels become constantly low.
Clear differences between perimenopause and menopause
Perimenopause precedes menopause, usually starts between 35-50 years and lasts on average 4 years, but can extend up to 8-10 years. At this stage:
- Hormones fluctuates chaotic and unpredictable;
- Menstruation becomes irregular but does not completely disappear;
- Ovulation is still produced, so the pregnancy remains possible;
- Symptoms vary from one month to another due to hormonal fluctuations.
Menopause is diagnosed after 12 consecutive months without menstruation, around the age of 51. Characteristics include:
- Constantly low (not fluctuating) hormonal levels;
- The complete absence of menstruation and ovulation;
- More stable and predictable symptoms;
- The impossibility of becoming naturally pregnant.
Treatment applied wrong
Steven Goldstein, a professor of obstetrics and gynecology at Nyu Grossman School of Medicine, warns that many doctors use hormonal substitution (HRT) therapy, although it is designed for menopause.
“At menopause, the hormonal level is constantly low. HRT works by increasing the general amount of estrogen and progesterone, alienating the symptoms. But during perimenopause, hormones fluctuates unpredictable, and hormonal substitution therapy can exacerbate these fluctuations,” Prof. Steven Goldstein said.
A commonly used solution is to suppress this irregular hormonal activity and to replace it with stable doses of hormones by administering contraceptive pills in small doses. They contain amounts of hormones about 2-4 times higher than those in hormonal substitution therapy (HRT) and act by blocking unstable natural production, providing a constant and predictable hormone intake. This explains why many women who take contraceptive pills to prevent pregnancy go through perimenopause without feeling the unpleasant symptoms associated with this stage.
Jessica Kassis, a gynecologist in San Francisco, says he personally experienced this confusion. At the beginning of the age of 40, he began to have cardiac palpitations, extreme fatigue, persistent headaches and increased anxiety. Although he was a specialist doctor, he did not realize that the symptoms indicated perimenopause. He went to several specialists, but each treated the symptoms isolated, until he met a large group of patients with similar stories. Only then did he realize that he needed contraceptives, not hrt.
The difference was visible after the pills were administered, he said. After feeling bad for more than a year, the quality of life was almost instantly improved with the correct treatment.
Misleading symptoms
The symptoms of perimenopause vary quite from one person to another. In addition to changes in the menstrual cycle (with bleeding that lasts too little or too much and can be more abundant) cardiac palpitations can occur, extreme fatigue, headaches, anxiety, dry eyes, sudden mood changes, buffets, nocturnal sweating, vaginal drying and sleep problems.
According to Cleveland Clinic, these symptoms resemble those of other conditions, which is why the correct diagnosis requires careful evaluation. Hormonal tests are not always useful in perimenopause due to daily hormone fluctuations. A consistent FSH (folliculostimulating hormone) test may indicate menopause, but the results can be misleading, especially if the woman takes on hormonal contraceptives, according to studies.
Preparation for menopause begins a few years before
Carrie Karvonen-Gutierrez, an associate professor of epidemiology at the University of Michigan, draws attention to the fact that the health with which a woman reaches the perimenopause decisively influences the way she will cross this stage and subsequently menopause.
According to the American Heart Association, poor cardiovascular health and smoking in the reproductive period are associated with an early onset of menopause and with more intense symptoms. For her part, Dr. Stephanie Faubion, Medical Director of North American Menopause Society and Mayo Clinic's Center for Women's Health, warns that the transition to menopause increases cardiovascular risk, regardless of their medical history.
Concrete actions:
- Monitors lipids, blood sugar and tension annually (the values worsen after menopause);
- Maintains a healthy body mass index (weight gain accelerates to menopause);
- Give up smoking (smoking speeds menopause and aggravates symptoms).
The myth of hormonal balancing
However, training does not mean falling into the trap of hormonal balancing promoted intensely on social networks. Dr. Stephanie Faubion calls this approach an industry that exploits women's anxiety, without a scientific basis. Hormonal fluctuations are a natural process in the life of any woman, they also occur during puberty, pregnancy or stressful periods and as a rule, the body manages them without expensive interventions.
Prof. Carrie Karvonen-Gutierrez points out that there is no miraculous solution for perimenopause. The best strategy remains the balanced diet that includes many fruits and vegetables, weak proteins and whole grains.
What really works:
- Mediterranean diet or dash;
- Quality proteins (prevent muscle loss);
- Omega-3 of fatty fish (reduce inflammation);
- Vitamin D natural by sun exposure 15-20 minutes daily.
What to avoid:
- Expensive supplements for hormonal balancing;
- Extreme or restrictive diets;
- Excessive alcohol (aggravates buffets and sleep)
Calcium deserves special attention, according to the National Institutes of Health in the US, which recommends 1,000 mg for women before menopause and 1,200 mg after 51 years, preferably from food, not supplements.
Movement is important
Menopause is associated with an accelerated decrease in bone mineral density, the highest losses taking place in the first years after installation. To slow down this degradation, the exercises that require the skeleton are very important.
“Walking is more effective than cycling, and cycling is more effective than swimming to maintain bone health,” explained Dr. Stephanie Faubion. Activities such as dance, light running or tennis can also help preserve bone mass.
In addition, hormonal changes during the perimenopause accelerate the loss of muscle mass. Even if body weight does not change visibly, the proportion between fat and muscle changes. Therefore, hard -working or elastic strength training become indispensable for maintaining long -term muscle and bone mass.
What really works for perimenopause
Contraceptive pills in small doses are hormonal treatment for perimenopause, not hormonal substitution therapy (HRT). However, women with history of blood clots, high blood pressure or aura migraines cannot take contraceptives. For them and those who prefer to avoid hormones, there are scientifically validated alternatives. SSRI and SNRI antidepressants in small doses can reduce the buffets, according to a recent analysis. Gabapentina, an antiepileptic drug, works for night sweats. Cognitive-behavioral therapy relieves insomnia associated with perimenopause as effective as drugs.
For mood and anxiety changes are indicated:
- Regular exercises of moderate intensity;
- Stress management techniques;
- Specialized psychotherapy.
