9 things you will want to know about menopause and perimenopause

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FEATURE — Many women, as well as the men who live with them, have questions when it comes to perimenopause and menopause.

Often called the “menopausal transition,” perimenopause literally means “around menopause” and refers to the time when a woman’s ovaries start producing less estrogen in preparation for menopause. Once a woman has reached menopause, the ovaries stop producing eggs entirely, signalling the end of the reproductive years.

With the basic biology out of the way, here are nine more details about perimenopause and menopause to help ease the transition.

Perimenopause can be a bumpy ride.

Menstrual cycles can get heavier or lighter, closer together or farther apart. Mood changes are very common – especially depression. Hot flashes, decreased libido and altered sexual function also are common. This perimenopausal time typically lasts less than five years but can be longer. All of these symptoms of perimenopause are treatable now, and this transition can be made much easier. Talk to your doctor.

Menopause is permanent.

Once a woman is menopausal, she is menopausal until the end of her days. The average age of menopause is around 52, give or take a few years. For some women, the transition is seamless, and for some, it is very challenging. The only other animal we know of that goes through menopause is the whale.

Hormone replacement therapy is safe and effective for most women.

Over-the-counter remedies for menopausal symptoms are unfortunately not any better than placebo. Fortunately, there is now very solid evidence that the use of hormone replacement therapy (estrogen +/- progesterone) is very safe for the vast majority of women who are perimenopausal or entering menopause. Like any medication, the lowest dosage possible should be used, and the goal is to wean off of the hormones within 5-7 years.

The jury is still out on compounded hormones.

This is a difficult (and somewhat controversial) area of medicine. The American College of Obstetrics and Gynecology has stated it does not recommend their use because there is no standardization in the preparation, dosing, testing or comparative studies with standard hormone therapy and no evidence that compounding is any safer or more effective.

However, there is no evidence that it isn’t, either. There are inexpensive, well-tolerated traditional hormone therapies available. My advice in making a personal decision on the subject is that you keep that in mind.

As far as bone density concerns, when should I be tested?

In general, bone density testing is being done too early and too often. As of 2018, it is recommended that low-risk women be tested at age 65 and repeated no sooner than every 3-5 years. Calcium (1200 mg daily) and vitamin D (800 mU daily) are recommended, along with exercise and weight training to promote healthy bone matrix turnover.

Besides those, you probably don’t need extra vitamins or supplements.

If you eat a well-balanced diet, you probably don’t need extra vitamins or minerals after menopause. An enormous amount of money is wasted by consumers who feel they need extra supplements or vitamins as they age, and there simply is no proof of this whatsoever. It is a huge business in the entire world, but it has no scientific basis.

Do I need to have Pap smears after menopause? What about ovarian cancer screening?

Current recommendations are to be tested for HPV every five years between 30-65. But I recommend pelvic exams after 50 because we are more prone to break down and disease as we get older. Fortunately, cervical cancer risk drops considerably for women after age 50.

However, paps don’t pick up uterine, ovarian, or vulvar cancers so those are still things to keep up on. Unfortunately, there is not currently any screening for ovarian cancer after menopause. For women at average risk, there is no cost-effective, reliable screening test available.

Why is sex painful after menopause?

The vaginal tissues shrink and lose their elasticity and ability to lubricate after menopause. Sometimes a good lubricant is all that is needed. When that fails, vaginal estrogen (creams, tabs, rings) are available and effective. And now, a new medication has been approved called “Intrarosa” which is a DHEA derivative.

There is als0 some data that radio frequency and vaginal LASER therapies can improve vaginal health. So there are options. Talk to your doctor.

Bladder issues are not a part of aging you just have to get used to.

All bladder problems should be addressed and not just “lived with.” This includes symptoms of urgency as well as leaking with activity (stress incontinence). Your quality of life as you pass through this change of life is as important now as it ever was. It is not something that you just have to live with.


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