What is Peripause vs. Menopause?
Written by Michele Hendon.
Menopause is the stage in a woman’s life when she is no longer capable of bearing children. Menopause is often misunderstood. Women may say that they are going through menopause, when in reality, what they are actually referring to is known as perimenopause. Menopause is, in actuality, only one day in a woman’s life. Menopause marks the one year anniversary date of a woman’s final menstrual cycle. The average woman will experience menopause at age 51. (“Perimenopause: Rocky road to menopause.”
Perimenopause, on the other hand, is the period of time prior to menopause. Perimenopause can be difficult to diagnose because its symptoms can vary significantly from woman to woman. On average, women will begin to experience symptoms of perimenopause in their forties. The duration of perimenopause varies, with the average being three to four years. Some women will only experience perimenopause for several months, while others may have symptoms for ten years or more. (“Perimenopause: Rocky road to menopause”.)
There are several different symptoms that can occur during perimenopause. Some of these symptoms include, irregular periods, hot flashes, vaginal dryness and/or discomfort during sex, sleep disturbances, mood swings, worsening premenstrual symptoms, urine leakage, fatigue, breast tenderness, and decreased libido. (“Perimenopause”)
Some women may feel an urgent need to urinate frequently. Urinary leakage during coughing or sneezing is not uncommon. Due to the decrease in estrogen production, some women may experience vaginal dryness. Vaginal dryness can lead to painful intercourse. Over the counter lubricants may provide relief, or one may choose to speak to a physician about prescription medications. (“Perimenopause”) Difficulty falling or staying asleep are commonly caused by hot flashes or night sweats. Hot flashes, night sweats, and sleep problems occur in approximately 65-75 percent of perimenopausal women. Mood swings, irritability, and fatigue, are also possible side effects of sleep disturbances. (“Perimenopause”)
Irregular periods are quite common during perimenopause. A woman’s period may become heavier than normal. It is not uncommon to spot between periods or following sexual intercourse. Periods may last longer than usual, or they may come closer together. Changes in a woman‘s menstrual cycle are often the first sign that perimenopause has begun. (“Perimenopause”) Which symptoms, as well as, the severity of symptoms, varies greatly from woman to woman. Some women may choose to seek medical attention, depending upon the severity of their symptoms, while others may experience little or no symptoms whatsoever.
Menopause is a life stage that all women will eventually encounter. However, the age at which perimenopause sets in, as well as, which symptoms, if any a woman may experience are dependent upon many factors and, impossible to determine with any degree of accuracy. Despite these facts, there are certain elements that appear to have an impact on premature perimenopause. Some of these include, smoking, heredity, never having given birth, childhood chemotherapy treatments, and surgical hysterectomy. Evidence suggests that smokers display symptoms of perimenopause one to two years earlier than women who don’t smoke. Most women will begin perimenopause around the same age as their mothers and sisters. Childhood cancer treatments and never having given birth, are both linked to early onset of perimenopause. Receiving a hysterectomy normally doesn’t bring about perimenopause, however, it is possible that it will cause perimenopause to begin sooner than the average age. (“Perimenopause”)
Although irregular periods are the most common symptom of perimenopause and usually nothing to become alarmed about, there are certain cases where a physician’s opinion should be sought. Women who experience extremely heavy bleeding, cycles lasting longer than a week, bleeding between periods, or regular periods coming less than three weeks apart, should see a doctor. There are tests that can be performed to check hormonal levels and thyroid functions, which affect hormone levels. There is no test to check for perimenopause. This is determined on an individual basis. A doctor will take many factors into consideration before discussing possible treatment options. It is important to keep track of menstrual cycles, as well as keeping a detailed log of symptoms. These steps will enable the doctor to diagnose the situation, with as much accuracy as possible. (“Perimenopause”)
There are several treatment options for women suffering with perimenopausal symptoms. Some of these include, oral contraceptives, progestin therapy, endometrial ablation, partial or complete hysterectomy, as well as, alternative medicine. Lifestyle choices, such as, good nutrition, regular exercise, and stress reduction may also aid in the symptoms of perimenopause. Oral contraceptives, or birth control pills, are a man-made form of hormones that regulate the menstrual cycle, as well as aid in reducing hot flashes and vaginal dryness. (“Perimenopause”) Oral contraceptives are frequently the most effective method of treating perimenopause symptoms. Oral contraceptives are not recommended for smokers over age thirty-five, overweight women, or women with a history of diabetes or high blood pressure. It is reported that long-term oral contraceptive use fifteen years or longer may reduce the risk of ovarian cancer by up to fifty percent. (“Birth Control Over 40”)
Prior to 2002, hormone replacement therapy was routinely prescribed to women suffering from the ill-effects of perimenopause. Hormone replacement therapy, or HRT, consists of a man-made estrogen and progestin combination. Estrogen and progestin are hormones that a woman’s body produces efficiently throughout her child-bearing years, yet begins to lose as she ages. In 2002, a large clinical study revealed that health risks of long-term HRT outweighed the benefits. Some of these risks included increased incidence of heart disease, breast cancer, stroke, and blood clots. However, short-term estrogen use may protect women from osteoporosis, heart disease, and colorectal cancer. Regardless of the health risks, women who have severe hot flashes, cessation of menses prior to age 40, or loss of bone mass may find that HRT is the best solution for their symptoms. (“Hormone Therapy”)
Another possible treatment option is endometrial ablation. It is a procedure that destroys the lining of the uterus via, laser beam, radiofrequency, microwave, or freezing. Endometrial ablation is for women who have finished having children, and suffer from heavy bleeding that has not responded to other forms of treatment. Up to fifty percent of women that have had endometrial ablation will stop having periods altogether. The other half will have reduced menstrual flow. Endometrial ablation treatment is more successful in older women, than it is in younger women. Younger women will often have to have the treatment repeated a second time in order to alleviate their symptoms. Some of the risks involved in endometrial ablation are severe, yet rare. These risks include, puncture of the uterus, burns to the uterus, pulmonary edema, and pulmonary embolism. Some milder and more common risks include, nausea, cramping and vaginal discharge. These effects are quite common and generally dissipate after 1-2 weeks. (“Endometrial Ablation”)
Other possible treatment options for perimenopausal women to consider are hysterectomies. A partial hysterectomy is the surgical removal of the uterus, while the cervix is left in place. A total hysterectomy removes the uterus and cervix. Having just the uterus removed will not cause menopause, because it is the ovaries that produce the hormones responsible for menstruation. Removal of just the uterus is a relatively low-risk operation. Some of the possible side effects of uterus removal include, chronic pain, urinary incontinence, fistula formation (abnormal connection between vagina and bladder), or vaginal prolapse (part of the vagina falls out of the body!) (“Hysterectomy”) Bilateral oophorectomy, is the scientific term that refers to the removal of both ovaries. Many perimenopausal women choose to have their ovaries removed at the time of uterus removal. A doctor can help a woman decide if having the ovaries removed is a viable option. There are serious possible side effects from having any type of major surgery. Some of the possible side effects of having the ovaries removed before age 45 include, an increase in the severity of perimenopausal symptoms, they are twice as likely to die during ovary removal, and are at a greater risk of developing cognitive problems later in life, such as dementia and Parkinsonism, depression and anxiety. (Parker et al. 2-7)
In summary, menopause is really just one day that celebrates one year without having a menstrual cycle. When women state that they are going through the change they are actually referring to the countless and miserable symptoms of perimenopause. Perimenopause is the period of time leading up to menopause. While there are many uncomfortable symptoms associated with perimenopause, it is not a life threatening disease but, rather a natural phase in a woman’s life. There are several options available to women during this time. Oral contraceptives are the most common as well as an effective method of controlling the symptoms. Hormone replacement therapy is another option; it has its risks, yet is a viable option for some women. Endometrial ablation, partial, and total hysterectomies are surgical options available to women. It is best to consult a physician to discuss the best possible options.
“Birth Control for Women over 40.” Abclocal.go. Health & Fitness, 19 Mar. 2008. Web. 17 Nov. 2010.
“Endometrial Ablation.” WebMD.com. WebMD, Web. 9 Feb. 2010. Web. 17 Nov. 2010.
“Hormone therapy: Is it right for you?.” MayoClinic.com. MayoClinic, 19 Feb. 2010. Web. 17 Nov. 2010.
“Hysterectomy.” WebMD.com. WebMD, 2005-2007 Web. 17 Nov. 2010.
Parker, Jacoby, Shoupe, and Rocca. “Effect of bilateral oophorectomy on women’s long-term health.” Women’s Health 5.5 (Sep. 2009): 1-9.
GALE CENGAGE Learning. Web. 19 Nov. 2010.
“Perimenopause.” MayoClinic.com. MayoClinic, 16 Sep. 2010. Web. 17 Nov. 2010.
“Perimenopause.” WebMD.com. WebMD, 2005-2007. Web. 16 Nov. 2010.
“Perimenopause: Rocky road to menopause.” Harvard Women’s Health Watch 12.12 (Aug. 2005 1-4)