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Judy Lane, NP, is a longtime practitioner at PMCM and our Woman’s Health Specialist. Here she gives an overview of Perimenopause, Menopause and the integrative approaches that we offer that the clinic.
What is the Peri-Menopause and Menopause and How Can We Manage this Important Transition?
As we age, our hormones go through changes as a gradual transition (usually) from having regular menstrual cycles into, eventually, not having any. Occasionally this change can be hardly noticeable, but for 80% of women, this transition comes along with symptoms, ranging from mild to quite disruptive.
The Peri-Menopause can last from 2-10 years and usually begins in our 40s with our biological clock ticking along to be complete at about 51 1/2 on average. Once the ovaries stop producing eggs altogether and a woman hasn’t had any menses for 12 months, she is then considered post-menopausal.
Commonly, symptoms begin in the second half of the menstrual cycle with new or worsening PMS. That’s because the first hormone to decline is usually progesterone, which dominates this phase of the cycle. Symptoms can include over-emotionality, pelvic cramping, abdominal bloating, fatigue, breast tenderness, food cravings, headaches, lack of libido, and sleep disruption. Cycles can get closer together, and then later, farther apart, and bleeding can be irregular as hormone production can vary from its predictable pattern.
As transition progresses, symptoms can appear at the start of the cycle and include heavier bleeding and cramping, headaches, hot flashes, night sweats, fogginess, fatigue, insomnia, weight gain, and more. One of the less recognized symptoms can be irregular heartbeats. Studies suggest that with untreated menopause, symptoms can last 2 years, with smaller percentages lasting 5 or more years. Hot flashes are quite common, with triggers being spicy foods, hot drinks, alcohol, and stress.
As women, we can live about a third of our lives in the post-menopause phase. There can be issues as we age associated with the lack of estrogen, including loss of bone density, changes in vaginal, vulvar and urinary tissues, hair loss, moodiness, and skin changes.
Treatment can be hormonal or non-hormonal. It’s always an individual choice and there’s no one size fits all. Some women prefer to start with herbal therapy, or acupuncture, for symptoms and some women choose hormones from the start. There are many products that are herbal and nutraceutical that help relieve symptoms. It’s fine to start with one approach and then change to another if results are not ideal.
If one chooses hormones, it’s ideal to use hormones that are bio-identical, meaning that both the chemical structure of the hormone and its function are the same as what the ovaries have always produced. Estrogen can help protect bones as well as relieve the symptoms.
Using estrogen in a transdermal (applied to skin) form usually has less side effects than when taken orally, but progesterone used orally is fine, and taken at night it often helps with sleep. Women who have their uterus intact need both hormones. Women who have had a hysterectomy can take estrogen safely without progesterone. Some women can mix and match, using herbal treatments orally, and vaginal estrogen. When using vaginal estrogen, one doesn’t need to take progesterone as well.
Sometimes, women can add testosterone or adrenal support to the program for additional balancing. These may help energy levels and libido. Conventionally, hormone levels are not measured, but it can be very helpful to know where the numbers are and follow them to make sure we don’t overshoot the mark, and the hormones are balanced together. Even low doses can make a difference.
When women start hormones within 10 years of menopause and before age 60, benefits usually outweigh the potential risks. There’s some evidence that there are heart benefits when started early. When women are older than 65, or more than 10 years post-menopause, risks are higher although still relatively low. These options are always decided on an individual basis and can be fully discussed with your practitioner.
If you’d like to consult with Judy Lane on this topic, or any woman’s health issue, please call PMCM at 415-472-2343 to schedule an appointment
Integrative Family Medicine Physician, Author and Educator