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Perimenopause: When Symptoms are a Sign to Ask for Help

I often get asked “how will I know if I need help with my perimenopause/menopause symptoms?”

Now, I’m sure you’ve heard the old saw that women have been going through menopause for millennia and haven’t needed help from hormones, but remember that until the 20th century, less than 25% of women lived past the age of 50 and the women that did, well let’s just say that women’s health hasn’t been on the front burner of societal awareness until very recently.  I don’t have the space in this article to cover the pros and cons of hormone therapy so I want to stick to the situations where it might be in your best interest to reach out to a menopause specialist.

  1. Hot flashes/night sweats: There is no absolute number of hot flashes that dictates intervention. I’ve had patients with one or two per day and have absolutely wanted them gone, and I’ve had patients with more than 15 per day who are doing beautifully and don’t feel they need treatment. My first piece of advice when someone presents with hot flashes/night sweats is to try avoid or limit the more common hot flash triggers: Stress, low blood sugar, hot ambient temperatures (keep your living spaces cool if you can/layer clothing), hot drinks especially hot caffeinated drinks (ice and decaf your coffee or tea), red wine (I know, bummer) and spicy foods.
  2. Poor sleep: I consider this a big one. Heck, we torture prisoners by sleep-depriving them. The hormone shifts that come with menopause/perimenopause can definitely wreak havoc on a woman’s ability to get a good night’s rest. Poor sleep causes many of the symptoms often associated with menopause such as fatigue, mood swings, memory issues and trouble concentrating. Besides this, it affects how well our immune system functions, is a potent adrenal stressor, is implicated with weight gain, especially weight gain in the waist, and is a sure-fire sex drive killer.
  3. Painful sex: The low estrogen environment associated with menopause decreases blood flow to the vagina and clitoris, decreases vaginal lubrication and makes the vaginal tissues more inelastic. Sometimes, in the early stages of menopause, a lubricant or vaginal moisturizer is enough to keep sex comfortable. However, as menopause progresses, the vaginal tissue can become so inelastic and thin that when a woman attempts intercourse, those tissues don’t stretch to allow penetration, they tear. This is a particular problem for women who haven’t had a vaginal birth. Estrogen works beautifully for this and it’s one of the only things that will reverse these changes. (There are some interesting studies being done looking at DHEA vaginally for this same condition.) The good news is that, if you are doing well with your menopause and don’t need systemic hormone therapy, the topical application of estrogen just for the vulva and vagina work great.

I think it can be very useful, no matter where you are in the transition, to speak with a menopause specialist. Information on the hormone changes, and the changes in your body and mind that come with these hormone shifts, can help answer questions and calm fears, helping you make the decision that is just right for you. My best advice—find a practitioner who specializes in women’s health and in particular, perimenopause and menopause.  Don’t accept answers that start with “always” or “never”. You are an individual and decisions about your healthcare during this transition should be individualized. You deserve nothing less.

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