Navigating the Perimenopause and Menopause Transition

A panel of expert OB/GYN providers from Trinity Health Michigan, all certified as Menopause Practitioners by the North American Menopause Society, came together to share their specialized knowledge and expertise in delivering this vital information: Kelly Wiersema, MD, Trinity Health Medical Group, Grand Rapids and Muskegon; G. Bridget Long, MD, Trinity Health IHA Medical Group, Plymouth and Ann Arbor; and Maureen Westfall, CNP, Trinity Health IHA Medical Group, Ann Arbor.

PERIMENOPAUSE
The onset of perimenopause is typically after age 35. It is difficult to determine the average length of perimenopause because there is no “test” for it; however, the data suggests four to eight years. Perimenopause is divided into two stages:

1.    Early Stage: When you see your first changes in your period. Your cycles may be heavier or vary in length.
2.    Late Stage: When there is a long time between your periods, sometimes 60 days or more.

Perimenopause Symptoms
These are similar to those of menopause: weight gain, sleep changes, joint aches, hot flashes, fatigue, anxiety, and mood changes. There are ways to reduce the intensity of these symptoms and self-care is critical:

•    Protect your sleep time.
•    Eat 20-40 grams of protein per meal.
•    Drink lots of water.
•    Make an appointment with a professional who can customize a treatment plan for you, if necessary.

MENOPAUSE 
There are three types of menopause:

1.    Natural menopause: When a woman goes 12 consecutive months without a period. 
2.    Surgical menopause: When a woman’s ovaries have been surgically removed.
3.    Induced menopause: A result of chemotherapy or radiation therapy.

Menopause is actually a moment in time — the moment of completion of your final period, which isn’t officially diagnosed until you have gone a year (12 months) with no menstruation.

You are post-menopausal when your period has been gone for longer than 12 consecutive months.

The Symptoms of Menopause
The average age of menopause in the U.S. is 51. Generally, a woman experiences menopause symptoms for seven years. What follows is a list of common symptoms.

If you have post-menopausal bleeding — after 12 months without a period — we recommend you see your provider, as this is not a common experience for women.

Urinary Tract Infections (UTIs) can be common during menopause due to a decrease in the hormone levels in the lower urinary tract and vaginal tissues. In addition, the pH (acidity) of the vagina changes, allowing bacteria there to increase the risk of a UTI. The good news is that UTIs can be treated.

Hot Flashes/Night Sweats are a sudden onset of heat in the body. In addition to hormone changes, our human circadian rhythm (sleep/awake cycle) affects these symptoms. It’s important to note that some medications cause night sweats. Treatment can include hormone and non-hormone therapies.

Daily Discharge can be normal or abnormal. We recommend that your check with your provider to see if you have an infection or if there is another reason for the discharge.

Brain Fog can be addressed by improving your sleep and possibly using hormonal therapy.

Fatigue can be related to your sleep hygiene. It’s important to have a consistent bedtime, to keep the room cool, and to turn off all electronics. If your sleep is disrupted due to night sweats or hot flashes, then treating them will help to reduce fatigue. In addition to menopause, fatigue can be caused by your thyroid, hemoglobin, and iron and vitamin D levels.

Incontinence can be due to a lack of estrogen, your diet, and thinning of tissue in the area. It should be discussed with your provider. Treatments include hormone and non-hormone treatments and sometimes surgery.

Mood Swings and Irritability are often due to a reduction in estrogen, so you are not crazy. The good news is that these symptoms do not last forever.

Joint Pain can be short-lived, but not always. Get exercise and maintain a good weight. A provider can best discuss the possibility of hormone therapy for your situation. You should consult your provider if this pain interferes with everyday living.

Itching can be the result of overgrowth of yeast and bacteria or auto-immune changes that are associated with menopause. Seek treatment from your provider, which may include anti-fungal or steroid medications.

Acne is the result of a reduction in estrogen and progesterone, and an increase in testosterone during menopause. The testosterone makes oil that mixes with dead skin cells and bacteria on the skin, causing acne.

Hair Loss and Hair Thinning can be addressed with topical treatments and oral medications.

Osteoporosis is bone loss that increases the risk of fracture. A Dexa scan (bone scan) is used to diagnose osteoporosis. You can reduce your risk by getting enough calcium and vitamin D, and by doing weight-bearing exercises. Medications are available for treatment.

HORMONE REPLACEMENT THERAPY (HRT)
Recently, the name of this therapy has been changed to Menopause Hormone Therapy (MHT). This therapy is a combination of estrogen and progesterone to control symptoms mentioned above and may come in the form of a pill, skin patch, ring, gel, cream, or spray.

Before beginning MHT, review your entire health history with your provider to ensure there are no red flags about your starting this therapy. There is a slightly increased risk of developing breast cancer when both estrogen and progesterone are in the MHT medication. You might need to update some tests or screenings prior to beginning MHT. Your provider will help you determine if you are eligible and monitor your health while using MHT.

Is there a natural alternative to MHT for managing symptoms and maintaining hormone levels? Practicing a healthy lifestyle — regular exercise, weight management, sleep management, and eating a mediterranean diet — is the best way to accomplish this goal.

Before beginning herbal supplements to relieve hot flashes and sleeplessness, we recommend that you meet with your provider who will make recommendations following a thorough review of your health and medications.

If you don’t qualify for MHT or don’t want to take it, there are options. Cognitive behavioral therapy and clinical hypnosis have been shown to improve symptoms. In addition, two FDA-approved drugs consist of an antidepressant and a medication that helps regulate body temperature.

WEIGHT GAIN AND NUTRITION
Belly fat can result from increased insulin resistance due to decreased estrogen. Another cause is that poor sleep that can increase cortisol levels and increase the hunger protein. A healthy lifestyle is the best way to reduce belly fat. Dietary recommendations are to eat more lean protein and complex carbohydrates, stay hydrated, and increase fiber intake.

SEXUAL HEALTH AND GENITOURINARY SYNDROME OF MENOPAUSE (GSM)
If you've gone 12 months without a period and experience bleeding after intercourse, it's important to contact your provider.

Painful intercourse is related to the thinning of the estrogen tissues related to GSM. It is important to use lubricants during intercourse once you are in menopause. Often this symptom will not get better on its own. For this condition, there are over-the-counter moisturizers as well as estrogen treatments for the vagina. We recommend using a vaginal moisturizer on a regular basis for better quality of life.

Hormonal changes can lead to no feelings of arousal: hypoactive sexual desire disorder. Because there can be other causes of low libido, we recommend that you contact your provider for treatments that may work for you.

Learn more about our specialized care for women in perimenopause and menopause by visiting TrinityHealthMichigan.org/Menopause.