Issue link: http://digital.copcomm.com/i/857677
1 8 | PULSE S u m m e r 2 0 1 7 M any women talk about their difficulties with the change-of-life process known as menopause. But menopause does not come on suddenly—it can be a slow process. We also hear the term perimenopause— but how is it related to menopause? ree Torrance Memorial Medical Center obstetricians/ gynecologists, Cheryl Sanders, MD, H. Elena Rodriguez, MD, and Ricardo Huete, MD, give us the facts on perimenopause. WHAT IS PERIMENOPAUSE? "Peri" means "around" so perimenopause means "around menopause." HOW IS PERIMENOPAUSE DIFFERENT FROM MENOPAUSE? "During this transitional time of perimenopause, menstruation becomes irregular," says Dr. Sanders. "is is when menstrual periods can occur for example one month, then not again until five months later, then not again for another nine or 10 months. is is perimenopause." Dr. Rodriguez adds, "Perimenopause can occur over a four-year span before the final menstruation and is associated with changes in the body that can affect a woman's quality of life." "Menopause means a woman has not had a menstrual period for at least 12 months. When this occurs, she is considered menopausal," Dr. Sanders notes. "Symptoms can vary between women. Some women have a smoother transition than others because estrogen levels can fluctuate during the perimenopausal period," explains Dr. Rodriguez. AT WHAT AGE DO WOMEN EXPERIENCE PERIMENOPAUSE? "For some women this transition and being perimenopausal can occur as early as 35 to 40 years of age," says Dr. Huete. "However from 40 to 45 years of age, most women become more symptomatic. Perimenopause can last from approximately one to three years." WHAT ARE THE SYMPTOMS? "When we think of 'symptoms,' we tend to think of a disease, and perimenopause and menopause are normal and not diseases," Dr. Sanders says. "Perimenopause is a transition just as puberty is a transition. In addition to menstrual irregularity, other indicators are hot flashes, night sweats, mood changes, food cravings and sleep difficulties." "Many women experience heavier, longer menstrual cycles, as well as breast tenderness, irritability, vaginal dryness, water retention (bloating ) and weight gain," says Dr. Huerte. "Excess estrogen, or estrogen dominance condition, and the subsequent hormonal imbalance is what causes these symptoms." "Other symptoms," according to Dr. Rodriguez, "are memory loss, weight gain and difficulty losing weight. Menstrual irregularity occurs as the intervals between cycles are prolonged. In the reproductive years, cycles range from 25 to 35 days. In perimenopause there can be two or more months between cycles. And periods may shorten from an average of seven days in the reproductive years to three or four days during perimenopause." SHOULD HORMONE REPLACEMENT THERAPY BE STARTED? Dr. Huete is a strong supporter of hormone replacement therapy (HRT), unless a woman has a medical contraindication for using it or is opposed to using it. "Hormones are involved in our bodies from our heads to our toes. ere has been a lot of misinformation about HRT in the last 15 years." Much of this he believes, stems from the Women's Health Initiative (WHI) study that used one particular drug combination that showed an increase in blood clots, heart attacks and breast cancer in patients using this formulation. "Estrogen will not cause breast cancer but it can stimulate the growth of cancer cells in the breast that are already present and hormone dependent. Estrogen is related to one type of cancer and that is of the uterus, not the breast." Dr. Huete uses bioidentical hormones (different from the drugs used in the WHI study), which have been shown to be safer if used in the right way. He says there is evidence that transdermal (through the skin) delivery of estrogen may have a positive effect on cholesterol. Dr. Sanders adds that HRT can help women get through the transition of perimenopause and move them to the next stage, which is menopause. "Perimenopause does not 'have' to be treated because it's not a disease. However HRT does have some benefits. For example, women have an increased risk of heart attacks aer menopause, and studies have shown that HRT can have a protective effect on the heart." "If a patient still has a uterus, progesterone must be given along with the estrogen to protect ASK THE DOCTOR: WHAT IS PERIMENOPAUSE? WRITTEN BY CAROLE JAKUCS, BSN, RN, PHN