PERIMENOPAUSE

What is menopause?

Women have a definite number of eggs in their ovaries. With every menstrual cycle, eggs mature and are released thus reducing their numbers. Once all eggs are released, the menstrual cycle ceases. This period in a woman’s life is called menopause.

What is perimenopause?

Perimenopause is the time leading up to and including menopause during which a woman experiences certain physical and mood changes. This can include the last 5-10 years before menopause and may be associated with an unpredictable fluctuation in the level of sex hormones oestrogen and progesterone.

What are the symptoms of perimenopause?

During perimenopause, a woman may experience:

• Hot flushes
• Breast pain
• Migraine
• Night sweats
• Mood swings
• Variation in the menstrual cycle length (19-35 days)
• Variation in menstrual flow (scanty for a few days to heavy with clotting for 2 weeks)

Some of these symptoms may continue for a year after menopause

Do all women experience these symptoms?

About a quarter to half of Australian women do not experience significant symptoms. For the rest, one or more symptoms may be severe and require treatment.

What is normal bleeding and what isn’t?

Irregular menstrual bleeding can occur normally but when a woman is in her forties, she has an increased risk of developing uterine problems such as fibroids (benign tumours), precancerous conditions or even cancer affecting the uterine lining and blood flow. For this reason, periodic screening is recommended for this age group and investigation is always necessary when menstrual bleeding is heavy or irregular.

What are the common diagnostic procedures to investigate abnormal bleeding during perimenopause?

If bleeding continues beyond 8 days, you should consult your doctor who will ensure that screening is up to date and may order an ultrasound scan. A hysteroscopy may be performed to view the lining of your uterus.

What are the natural treatments to alleviate perimenopausal symptoms?

Natural treatments include:

• Agnus castus extracts: Control mood symptoms and breast pain
• Black cohosh extracts: Treats hot flushes and sweats. May be safely used up to 6 months
• Vitamin B6

What are the common medications used to treat symptoms?

Healthy women under the age of 50 may benefit from a low-dose contraceptive pill that not only regularizes the menstrual period but also provides contraception as perimenopausal women can still become pregnant. After the age of 50 a progesterone-only pill may be recommended. Mirena, a hormone-releasing intrauterine device can help control irregular or heavy menstrual periods. Oestradiol (natural oestrogen) patches, gel or tablets can be used to control hot flushes and mood swings. Hot flushes can also be controlled by clonidine, a blood pressure pill; SSRI antidepressants and gabapentin, a drug to treat nerve-related pain.