Modern Australian

What is perimenopause and how does it affect women's health in midlife?

  • Written by Gita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of Queensland

All women know to expect the time in life when their periods finish and they reach menopause. Many might even look forward to it. What many women don’t know, however, is they will also experience symptoms in the time leading up to menopause. This is known as perimenopause.

On average perimenopause lasts for three to four years, usually starting in the mid to late 40s. Some women may experience it for only a few months, but for others it can be as long as a decade and can start as early as the mid-30s. During perimenopause a woman’s menstrual cycle will become irregular, they may experience lighter or heavier than normal bleeding, and intermittent spotting.

Women who have never given birth, and those with early puberty, or short menstrual cycles are more likely to experience earlier perimenopause.

What’s happening to my hormones?

The ovaries produce the female hormones oestrogen and progesterone, which control menstruation and ovulation (when an egg is released from the ovary).

From a woman’s late-30s, the number of eggs left in the ovaries decreases more quickly. Leading up to menopausal transition, the level of oestrogen changes, dropping rapidly around two years prior to menopause and stabilising around two years afterwards.

Progesterone also decreases towards menopause as it is produced only if an egg is released. Lack of progesterone can result in irregular, heavier, and prolonged menstrual periods during perimenopause.

Read more: Chemical messengers: how hormones change through menopause

Common symptoms

Women can experience a range of symptoms during perimenopause including:

• hot flushes (a sudden feeling of warmth or intense heat that spreads over the face and upper body)

• night/cold sweats

• anxiety, depressed mood, or mood swings

• sleep disturbance and fatigue

• vaginal dryness; discomfort during sexual intercourse

• frequent or urgent urination.

In the last one to two years of perimenopause, women are more likely to complain of low-oestrogen-associated symptoms, in particular vasomotor symptoms (hot flushes and night sweats) and vaginal dryness.

Some groups of women are also more likely to experience menopausal symptoms, including those who are: overweight or obese, smokers, of low socioeconomic status, and those with anxiety, depressive symptoms, or who feel stressed.

Weight gain

A recent US study found the menopausal transition is accompanied by accelerated gains in fat mass and simultaneous losses in lean mass, and these changes in body composition continue until two years after menopause. It was found weight gain began in premenopause and increased steadily during perimenopause (around 0.4 kg per year).

A lack of exercise, unhealthy eating, lower levels of education, insufficient sleep, the number of births a woman has had, and a family history of obesity may substantially contribute to weight gain in midlife.

What is perimenopause and how does it affect women's health in midlife? Menopause causes weight gain, and extra weight worsens the symptoms of menopause. So maintaining a healthy diet and exercise regimen in midlife is important for women. from www.shutterstock.com

Treatment

For women who seek medical advice for their symptoms, menopausal hormone therapy (MHT, also known as hormone replacement therapy) is the most commonly prescribed treatment. Hormone therapy can help to relieve symptoms by replacing oestrogen levels that fall naturally during perimenopause.

GPs should discuss the short-term (up to five years) and long-term benefits and risks, before women decide to use hormone therapy, according to the college of obstetricians and gynaecologists.

If hormone therapy is not suitable, there are other non-hormonal treatments that can be discussed with the GP. This includes changing lifestyle factors such as improvements in diet, regular physical activity, optimal weight management, and quitting smoking.

Read more: We don't know menopausal hormone therapy causes breast cancer, but the evidence continues to suggest a link

Perimenopause in the workplace

For some women, menopausal symptoms such as vasomotor symptoms and fatigue can impact their performance at work. The Australasian Menopause Society recommends the following improvements to working conditions for women going through menopause which are based on the guidelines produced by the European Menopause and Andropause Society:

• raise awareness

• allow disclosure of troublesome symptoms

• review workplace temperature and ventilation

• reduce work-related stress

• allow flexible working arrangements

• provide easy access to cold drinking water and toilets.

Read more: How to make work menopause-friendly: don't think of it as a problem to be managed

Contraception during perimenopause

Women still experience menstrual cycles during perimenopause and can fall pregnant, so contraception remains important. Contraception is required for two years after the last menstrual period in women aged under 50 years and one year in those over 50.

The use of combined hormonal contraceptives (such as pills, patches, or vaginal rings) until the age of 50 is acceptable if women are not at risk of heart disease or thrombosis. Risk factors include smoking, being overweight or obese, or having high blood pressure.

Hormonal contraceptives should not be used alongside hormonal treatments for menopause. Instead barrier methods (condoms or caps) or other methods (spermicides, implant or intrauterine devices).

Authors: Gita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of Queensland

Read more http://theconversation.com/what-is-perimenopause-and-how-does-it-affect-womens-health-in-midlife-122186

NEWS

Why do many people with Parkinson's disease develop an addiction? We built a virtual casino to find out

We knew people with Parkinson's disease were at heightened risk of developing addictive behaviours like gambling. Our research gives insight into why this is.From shutterstock.comParkinson’s disease is a progressive neurodegenerative...

the $85 million plan to desalinate water for drought relief

The deal to crank up Adelaide’s desalination plant to make more water available to farmers in the drought-stricken Murray-Darling Basin makes no sense.It involves the federal government paying the South...

how sexbots are marketed as companions

Sexbot Emma, from AI Tech, is advertised as a "real AI you can talk to". She offers "warm hugs" and will "feel your feelings".YouTube/ScreenshotWhen thinking of sexbots, companionship might not...

12 simple ways you can reduce bushfire risk to older homes

There are no guarantees in bushfires, but you can improve the odds your house survives a blaze.Photo by Edward Doody, courtesy of Arkin Tilt Architects, Author providedSeventy-five years of Australian...

ancient Egyptians tamed wild ibis for sacrifice

A scene from the Books of the Dead (based at the Egyptian Museum) shows the ibis-headed god Thoth recording the result of "the final judgement".Wasef et al./PLOS ONE, CC BY-SAThese...

how we use music to make ourselves feel at home

Music played through headphones can immerse the listener in a more intimate experience.Stokkete/ShutterstockThe concept of “home” refers to more than bricks and mortar. Just as cities are more than...

the ABC's complex debate over its role as sports broadcaster

ABC once viewed sports coverage as integral to its mission of nation-building. But in recent years, it has grown far more ambivalent about sports.Dean Lewins/AAPThe ABC has announced it will...

How does poor air quality from bushfire smoke affect our health?

New South Wales and Queensland are in the grip of a devastating bushfire emergency, which has tragically resulted in the loss of homes and lives. But the smoke produced can...

here are 5 steps to help them cope

More than 600 schools have been closed, and some damaged, in recent days as bushfires rage across Queensland and New South Wales. Some students have been urgently evacuated while in...

how Australian bushfire writing has changed with the climate

Bushfire writing has long been a part of Australian literature. Tales of heroic rescues and bush Christmases describe a time when the fire season was confined only to summer...

getting to the bottom of the city-country divide

Left, farmer Ian Turnbull being who was convicted of murdering compliance officer Glen Turner. Right, Mr Turner's partner Alison McKenzie outside court. Tensions over land clearing can have tragic consequences.AAP/DAN...

If Australian police officers are allowed to shoot to kill, they should be better trained

There is no clear evidence guns make police safer, but officers feel safer with firearms at their disposal. ShutterstockAustralians woke to the news last weekend that a 19-year-old Warlpiri man...

Popular articles from Modern Australian

Strength Training Tips To Make Your Workout EffectiveTop Fashion Secrets To Look Stylish No Matter The Occasion  How to save money on major home repairsCan I Do Something About My Sensitive Teeth?Climbing Out of a Creative Rut – Strategies for Photographers5 Digital Free Holidays: Take a trek and get back to nature8 Things You’ll Need for a Positive Breast Surgery RecoveryThe Best Sites and Events to See in Melbourne Everything You Wanted To Know About Air CompressorsWhat to Consider When Buying a Home With KidsPlaces to visit on your first trip to North AmericaHow to Choose the Best Driving InstructorMust-Visit US Destinations for AustraliansFive Reasons You Should Consider Concrete Furniture Eat Your Way to a Healthier and Happier You