I was prompted to write this newsletter about perimenopause and menopause after reading the article “Women Have Been Misled About Menopause” by Susan Dominus, published in the New York Times, February 1, 2023. This is a must-read for all women! I continue to regularly have conversations with our female patients regarding their perimenopause and menopausal symptoms and I want you to know you are not alone and there is no need to remain in a state of suffering. At the end of the article, I will list contact information for a few local practitioners who specialize in perimenopause and menopause and can perform appropriate hormonal testing and guide you on the right therapies to assist you.

Here is the link to the article: https://www.nytimes.com/2023/02/01/magazine/menopause-hot-flashes-hormone-therapy.html

Perimenopause and menopause are two stages in a woman’s life that are related to the natural decline in reproductive hormones as she ages.
Perimenopause is the transitional period leading up to menopause. It typically starts in a woman’s 40s but can start earlier or later. During perimenopause, a woman’s body begins to produce less estrogen, which can cause irregular periods, hot flashes, night sweats, mood swings, and other symptoms.

Menopause is defined as the point in time when a woman has not had a menstrual period for 12 consecutive months. At this point, a woman’s ovaries have stopped producing eggs and her levels of estrogen and progesterone are significantly lower than they were during her reproductive years. Menopause can cause a variety of symptoms, including hot flashes, vaginal dryness, mood changes, and sleep disturbances.

Both perimenopause and menopause are normal and natural parts of a woman’s life, but they can be challenging for some women to manage. There are a variety of treatments available to help manage symptoms, including lifestyle changes and hormone therapy.

Common misconceptions:

Perimenopause and menopause are natural transitions that every woman experiences as she ages. However, there are many misconceptions about these transitions that can cause confusion and anxiety. Here are some common misconceptions about perimenopause and menopause:

  1. Menopause happens suddenly: Many people believe that menopause happens suddenly, but in reality, it is a gradual process that can last for several years. Perimenopause, the period leading up to menopause, can last for several years and is characterized by irregular periods and other symptoms.
  2. Menopause only affects older women: While menopause typically occurs in women over the age of 45, it can occur earlier in some women. Premature menopause, which occurs before the age of 40, affects about 1% of women.
  3. Menopause means the end of fertility: While menopause marks the end of a woman’s reproductive years, it is still possible for women to become pregnant during perimenopause. Women who wish to avoid pregnancy should continue using birth control until they have gone 12 months without a period.
  4. Menopause is the same for every woman: Menopause affects every woman differently. Some women may experience few symptoms, while others may experience more severe symptoms that interfere with their daily lives.
  5. Hormone therapy is the only treatment for menopause symptoms: While hormone therapy can be an effective treatment for menopause symptoms, there are many other treatments available, including lifestyle changes, over-the-counter medications, and non-hormonal prescription medications.
  6. Menopause only affects women’s reproductive health: Menopause can affect many aspects of a woman’s health, including bone health, heart health, and cognitive function.

Addressing symptoms naturally:

There are several natural ways to decrease perimenopause and menopause symptoms. These include:

  1. Regular exercise: Regular exercise, such as walking, swimming, or yoga, can help reduce hot flashes, improve mood, and promote better sleep.
  2. Healthy diet: Eating a healthy diet that includes plenty of fruits, vegetables, whole grains, and lean proteins can help manage weight gain and reduce the risk of chronic diseases, such as heart disease and osteoporosis.
  3. Stress management: Managing stress through relaxation techniques, such as deep breathing, meditation, or massage, can help reduce symptoms of anxiety, irritability, and mood swings.
  4. Supplements and herbs: Some women find relief from perimenopause and menopause symptoms by taking supplements and herbs, such as black cohosh, soy, and red clover. However, it is important to speak with a healthcare provider before taking any supplements or herbs, as they may interact with other medications or have side effects.
  5. Acupuncture: Acupuncture, a traditional Chinese medicine technique that involves the insertion of thin needles into the skin, has been shown to reduce hot flashes and improve sleep in some women.
  6. Avoiding triggers: Avoiding triggers that can worsen symptoms, such as spicy foods, caffeine, and alcohol, may also help manage symptoms.

Addressing symptoms with Menopausal Hormone Therapy:

Menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), can provide a range of benefits for women experiencing symptoms of menopause. These benefits include:

  1. Relief from hot flashes and night sweats: MHT can effectively reduce the frequency and severity of hot flashes and night sweats, which can significantly improve quality of life.
  2. Improved bone health: MHT can help prevent bone loss and reduce the risk of osteoporosis, a condition in which bones become brittle and fragile.
  3. Reduced risk of colon cancer: Studies have shown that MHT can reduce the risk of colon cancer.
  4. Improved vaginal health: MHT can help relieve vaginal dryness, itching, and pain during intercourse, which can improve sexual function and overall quality of life.
  5. Reduced risk of cardiovascular disease: MHT has been shown to reduce the risk of heart disease and stroke in some women.

It is important to note that the benefits of MHT may vary depending on a woman’s individual circumstances, such as her age, health history, and the type and duration of therapy. Additionally, there may be some risks associated with MHT, such as an increased risk of breast cancer and blood clots, which should be discussed with a healthcare provider.

Addressing symptoms with Bio-identical Hormone Therapy:

Bio-identical hormone therapy (BIHT) is a type of hormone therapy that uses hormones that are chemically identical to the hormones naturally produced by the human body. In the context of menopause, BIHT involves the use of bio-identical hormones to treat the symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness.

Proponents of BIHT claim that it is a safer and more effective alternative to traditional hormone therapy, which uses synthetic hormones that are not identical to those produced by the body. However, there is limited scientific evidence to support these claims.

While BIHT may offer some benefits, it is important to note that it is not without risks. Like traditional hormone therapy, BIHT can increase the risk of blood clots, stroke, and breast cancer in some women.

How to determine if you need hormone therapy:

When determining if hormone therapy (HT) is necessary during perimenopause and menopause, healthcare providers may conduct several tests to evaluate a woman’s hormone levels and overall health. The specific tests may vary depending on the individual’s symptoms, health history, and other factors.

Here are some tests that may be used to determine if hormone therapy is necessary:

  1. Hormone levels: Blood tests can measure the levels of various hormones, such as estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), which can provide information about a woman’s hormonal status and help guide treatment decisions.
  2. Bone density test: A bone density test can evaluate a woman’s risk of osteoporosis, which is a common condition that can occur during and after menopause. This test may be recommended for women who are at risk of osteoporosis or who have other risk factors, such as a family history of the condition.
  3. Lipid profile: A lipid profile is a blood test that measures cholesterol and triglyceride levels, which can provide information about a woman’s risk of heart disease.
  4. Pelvic exam: A pelvic exam may be recommended to evaluate vaginal health and rule out other conditions that can cause similar symptoms, such as infections or pelvic organ prolapse.
  5. Pap smear: A Pap smear is a test that checks for abnormal cells in the cervix, which can be a sign of cervical cancer. Women may need to continue getting Pap smears even after menopause, depending on their age and health history.
  6. Mammogram: A mammogram is an X-ray of the breasts that can detect early signs of breast cancer. Women over the age of 50 should have regular mammograms, and those with a family history of breast cancer may need to start earlier.

Practitioners specializing in perimenopause and menopause:

Diana E. Hoppe, M.D.
OBGYN & Women’s Health Specialist

Linda R. Olafson, M.D.
North Coast Integrative Medicine

Elizabeth Winter. N.D.
Mosaic Integrative Medicine