Could This Be

A generation ago, hot flashes, irregular periods, and mood swings would have been labeled menopause or “the change of life.” Today, your doctor is more likely to call this perimenopause, a new term for the transitional years leading up to the end of menstruation.

Perimenopause often begins around age 47 and lasts for about five years. During this time, the ovaries gradually become smaller and fertility declines. At the same time, the levels of the hormones estrogen and progesterone become unstable, rising and falling randomly. This triggers hot flashes, changes in menstrual flow, and other symptoms as periods taper off.

When a woman’s periods have stopped completely for a full year, she has officially reached the stage of menopause. Generally, this happens around age 51.

Hot flashes

These are sudden surges in body heat, causing flushing and sweating. Hot flashes that disrupt nighttime sleep are called night sweats.

Try this: Keep your cool by dressing in easy-to-shed layers, keeping the room temperature cool, drinking cold water, avoiding spicy foods, and keeping a small fan handy. Logging hot flashes in a journal may help you identify things that trigger them.

Irregular menstrual cycles

Your period may change in frequency and flow, either heavier or lighter. You may have spotting between periods.

Try this: Your doctor may recommend low-dose birth control pills. These can regulate periods, decrease any heavy bleeding, and help minimize hot flashes.

Vaginal problems

These include dryness, itching, or irritation of the vagina and genitals, which can make sex uncomfortable.

Try this: Water-based over-the-counter vaginal lubricants and moisturizers can help. Talk with your doctor about using prescription estrogen products, such as suppositories, creams, or vaginal rings.

Urinary issues

You may have sudden or frequent urination or leakage. You also may have more frequent urinary tract infections (UTIs).

Try this: Daily Kegel exercises can help strengthen pelvic muscles and increase bladder control. Wiping from front to back, urinating within an hour of feeling the urge, and wearing cotton underwear can all help prevent UTIs.

Hormonal or stressed out?

About the time of perimenopause, many women report feeling more tearful, sad, or angry. Some say they have difficulty concentrating and their moods swing from one extreme to another. The issue is often more complicated than changing hormones.

Typically, these hormonal changes hit when a woman already has other stress in her life, says JoAnn Pinkerton, M.D., an obstetrician/gynecologist.

You may have teenagers to parent, aging parents to care for, and new stresses in your marriage. If you are having hot flashes at night, you may be sleep-deprived. All this can create a cycle of fatigue and irritability.

Lee Shulman, M.D., professor of obstetrics and gynecology at Northwestern University, agrees. “To dismiss emotional changes as ‘just hormonal’ is a disservice to women. Your doctor should help you evaluate your stress levels and assess whether there is an underlying emotional disease.”

He adds, “This is a great opportunity to become more self-aware and focus on taking good care of yourself emotionally and physically.” Exercising, eating right, and getting enough sleep are all healthy steps in the right direction.

Treatment Options

Talk with your doctor at About Women Ob-Gyn to learn more about treatment options. There are a number of possible medications depending on the source of your condition. Some options include:

  • To relieve night sweats or hot flashes, estrogen therapy can be an effective treatment option. It is administered either in as a pill, skin patch, or gel.
  • To address vaginal dryness or discomfort with intercourse, vaginal estrogen can be taken in tablet, ring or cream form. This treatment releases supplemental estrogen into the vaginal tissue.