Perimenopause is the time in a woman's life leading up to menopause. Women in their mid-40s start to experience hormonal changes and fluctuations, resulting in heavier or lighter menstrual cycles, mood swings, weight gain, hot flashes and general irritability.
By definition, a woman doesn’t enter menopause until she’s had no menstrual cycle for 12 full months, and some women have cycles that come and go for several years, skipping several months at a time. Once she reaches true menopause, some symptoms like hot flashes can last anywhere from seven to 11 years, making many women very uncomfortable.
While women suffer through these symptoms, perimenopause and menopause are not disease states; they are natural changes that every woman goes through. Most women start to experience symptoms somewhere in their mid-40s. On average in this country, most women are fully in menopause by about age 51.
If perimenopause and menopause symptoms are making you feel bad, know that you don’t need to suffer alone. Understanding the symptoms of perimenopause and menopause is the first step toward managing them — and finally finding relief.
Treating Menopausal Symptoms with HRT
When I have really symptomatic patients, whether they're experiencing mood swings, hot flashes, or sometimes joint pain and stiffness, we regulate that by manipulating hormones with birth control, if they’re still in the perimenopausal phase. Sometimes, antidepressants can be used to relieve some symptoms, including hot flashes. Various minor surgical procedures can provide relief for women who experience excessive bleeding.
Once a woman is menopausal, however, hormonal manipulation is no longer an option, but we can do hormonal replacement therapy (HRT), if needed. Anymore, HRT is only used for women with severe menopausal symptoms that reduce their quality of life and daily functioning.
At one point in time, HRT was used for disease prevention because we thought it reduced the risk of heart attacks, strokes, chronic heart disease and Alzheimer's disease. Now we know it actually increases the risk for all of those things, so I would never recommend HRT for anyone in menopause unless they were having extreme symptoms that dramatically affected their quality of life. Even then, HRT is not a good option for patients who smoke or have a family history of breast cancer, heart disease, blood-clotting disorders, etc.
Some patients mistakenly believe bioidentical hormones are all-natural, but they are still synthetic hormones made in a lab. The biggest difference between bioidentical hormones and pharmaceutical hormones is the doctor’s ability to tailor the dose to your exact symptoms. Bioidentical hormones are custom-made in a compounding pharmacy, so we can tailor the exact amount of estrogen, progesterone or testosterone needed, depending on your symptoms.
If we put you on bioidentical HRT and you're still having some hot flashes, then we know you may need a little more estrogen. We can make an identical hormone to what your body needs to suppress the symptoms versus pharmaceutical hormones, which come in a standard dose that you take every day until the HRT is complete. Pharmaceutical hormone replacement therapy is FDA-approved, while bioidentical HRT is not.
Can I Treat My Perimenopausal Symptoms without HRT?
If you’re experiencing severe symptoms with perimenopause, there are multiple options for treatment. You don't need to use hormones to treat perimenopausal symptoms.
We can use antidepressants to treat some of the mood swings, irritability, anxiety, insomnia and even hot flashes. Antidepressants are not quite as powerful and effective for hot flashes as hormones are, but they also don't come with some of the risks. Insomnia can be a big problem in perimenopause, so sometimes we use progesterone for sleep. You can get progesterone in topical creams that absorb into your skin or in oral forms, such as lozenges that absorb under your tongue. We also suggest non-addictive prescription sleep aids when required.
Understand Your Health Risks with HRT
Hormone replacement therapy comes with its own pros and cons. It can improve a woman’s quality of life when it provides relief for symptoms like hot flashes, irritability, foggy brain and joint pain. But there are risks associated with HRT.
If you smoke cigarettes, you definitely cannot use hormonal replacement therapy because it dramatically increases the risk of blood clots. It also increases the risk of breast cancer, Alzheimer's disease and heart disease. If you're already a high-risk patient for those diseases, then the drawbacks by far outweigh the benefits. If you're considering HRT, get a proper health screening with a physician or nurse practitioner to make sure it's safe for you.
Menopause is not a disease. It's just a bummer! But, there is a light at the end of the tunnel. The symptoms will improve, but it may take a long time and sometimes it's something you just have to struggle and suffer through until you start to come out of it. We can help ease that suffering, though.
If you're struggling with the symptoms of perimenopause or menopause, or simply have questions about bioidentical hormone replacement therapy or pharmaceutical grade hormones, come and see me at Olp Family Medicine, and I can help you find relief.