Many women say they are “in menopause” when they are actually in perimenopause, also called the menopause transition.

Perimenopause is the time leading up to menopause, when hormone levels (estrogen and progesterone) fluctuate and begin to decline. This natural process can start in your 40s—or even mid-30s—and often lasts 4 to 5 years, though for some women it can continue for more than 10 years. Common symptoms include hot flashes, weight gain, mood changes, and irregular periods.

Menopause is officially diagnosed when you have gone 12 consecutive months without a menstrual period. The average age of menopause in the U.S. is 52. Once you reach menopause, perimenopause ends, and you enter postmenopause, which lasts for the rest of your life.

Other causes of menopause include surgical removal of the ovaries (with or without the uterus), chemotherapy, pelvic radiation, or certain autoimmune conditions. If menopause happens before age 40, it’s considered premature menopause.

Perimenopause symptoms can include:

These symptoms are caused by fluctuating hormone levels during the menopause transition. Certain medical conditions, medications, stress, and environmental factors can also influence these hormonal shifts and may affect your perimenopause experience. The severity of symptoms varies from person to person.

If you are experiencing bothersome symptoms and want to explore options, contact your primary care provider, gynecologist, or OB/GYN to discuss the best approach for you. FUTURE LINKS HERE

How are perimenopausal symptoms managed?

Your doctor may recommend:

• Hormone therapy (for appropriate patients)
• Nonhormonal therapy
• Integrative medicine practices such as acupuncture (Hoag for Her Center for Wellness)
• Cognitive behavioral therapy (Link TBD)
• Counseling, psychotherapy and support groups (Hoag Mental Health Team)
• Antidepressants and anti-anxiety medications

Lifestyle Changes and Recommendations

It is recommended to follow a comprehensive lifestyle-focused treatment plan to help manage your menopausal symptoms. This plan emphasizes healthy living practices that can promote overall well-being.

Recommendations

Dietary

• Balanced Diet: Focus on a diet rich in fruits, vegetables, whole grains, lean proteins, andhealthy fats.
• Calcium and Vitamin D: Ensure adequate intake of calcium (1,200 mg/day) and vitamin D (600–800 IU/day) to support bone health. Calcium supplements should be taken 2 hours before orafter any iron or high fiber foods/supplements for optimal absorption.
• Phytoestrogens: Incorporate foods high in phytoestrogens (e.g., soy products, flaxseed)which may help reduce symptoms like hot flushes.
• Hydration: Drink plenty of water to stay hydrated, especially if experiencing hot flushes or night sweats.

Physical Activity

• Exercise Routine: Engage in regular physical activity, including both aerobic exercises (e.g.,walking, swimming) and strength training, to improve overall health and reduce the risk of osteoporosis.
• Weight-Bearing Exercises: Activities such as weightlifting, walking, jogging, or dancing are particularly beneficial for bone health.
• Flexibility and Balance: Incorporate yoga, Pilates, or tai chi to improve flexibility, balance, and stress reduction.

Sleep Hygiene

• Sleep Routine: Establish a consistent sleep schedule, aiming for 7-9 hours of quality sleep per night.
• Relaxation Techniques: Practice relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation before bedtime.
• Sleep Environment: Keep the bedroom cool, dark, and quiet, and avoid screens before bedtime.

Stress Management

• Mindfulness Practices: Engage in mindfulness practices such as meditation, deep breathing, or journaling to reduce stress and anxiety.
• Social Support: Maintain strong social connections with friends, family, or support groups to enhance emotional well-being.
• Hobbies and Interests: Dedicate time to activities you enjoy, which can provide a sense of fulfillment and relaxation.

Symptom Tracking

• Journal: Keep a daily journal of your symptoms, lifestyle changes, and how you feel. This will help in identifying patterns and discussing progress during follow-up visits.

Follow-Up Appointments

• Schedule your follow-up appointment as recommended.
• For lifestyle changes and support, Hoag for Her Center for Wellness is here for you. Please seethe menu of services in your folder for more information. To schedule an appointment please call 949-764-7239.

Warning Signs

• Contact your healthcare provider if you experience:
  • Persistent or severe menopausal symptoms despite lifestyle changes
  • Significant mood changes or depression

At this phase, your menopausal and perimenopausal symptoms like hot flashes will lessen or go away entirely. Your hormone levels will remain low, and you will no longer ovulate, get your period or be able to get pregnant.

During this time, you are at increased risk for conditions such as osteoporosis and heart disease. Working with your doctor is more important than ever to maintain your health and quality of life.

• What are the risks associated with postmenopause?
• When is hormone replacement therapy (HRT) recommended?
• Can I still enjoy sex postmenopause?
• What are some treatment options for postmenopausal incontinence issues?

A woman’s risk of developing certain conditions rises after menopause, including:

• Cardiovascular disease, including stroke
• Osteoporosis
• Weight gain
• Urinary incontinence

When is hormone replacement therapy (HRT) recommended?

Estrogen replacement therapy relieves hot flashes and other symptoms of menopause. It may be helpful in reducing the risk of osteoporosis and heart disease, as well as some cancers.

Talk with your doctor about hormone replacement therapy. Your doctor may not recommend estrogen replacement therapy if you have a history of estrogen-dependent endometrial cancer or breast cancer, blood clots or inflammation of the veins, uterine bleeding without a diagnosed cause or liver disease.

Currently, hormone replacement therapy is not recommended for women after menopause. Speak with your doctor to determine what is right for you.

Can I still enjoy sex postmenopause?

Yes, though some women lose interest in sex during and after menopause due to drier genital tissues and lower estrogen levels. Remedies to this include:

• Estrogen creams and estrogen pills
• Vaginal lubricants

Women who experience sporadic periods during perimenopause may need to continue using some form of birth control. Talk with your doctor about which form of birth control is best for you.

If you are having pain during sex, speak with your doctor . If you’re experiencing sexual problems, you and your partner may benefit from individual or couple sessions with a licensed sex therapist to help maintain intimacy as you age. The Hoag for Her Center for Wellness offers sexual health & counseling with a licensed marriage and family therapist (LMFT). Our sex therapist will support you in navigating your emotions, while providing proven strategies and counseling to address conditions such as sexual health and relationships.

What are some treatment options for postmenopausal incontinence issues?

Urinary incontinence affects 50% of postmenopausal women. Hoag is a leader in surgical and non- surgical options for treating incontinence. Learn more about incontinence here.