Navigating the changes of perimenopause

Originally published in the North Lake Tahoe Bonanza (link), January 26, 2010. The kids are out of the house, you've finally gotten that corner office and you no longer feel the need to change your wardrobe monthly to keep up with the latest fashions. The hard part's over — right? Then why do so many women find these prime years of life fraught with physical and emotional turmoil, symptoms which are often dismissed or quickly camouflaged with antidepressants, anti-anxiety medications, painkillers or even major surgeries?

The years when a woman is transitioning between regular cycles of ovulation and menopause is known as perimenopause. For most women this occurs during their forties, but many notice changes even earlier.

During perimenopause, production of estrogen, progesterone and testosterone begins to decline. Cycles may not always result in the release of an egg, contributing to irregular menses and for some, an increase in PMS symptoms.

As hormone levels drop, many women begin to experience hot flashes, sweats and problems sleeping. Symptoms may also include memory and concentration issues, mood swings, depression and anxiety. All of these are worsened by both loss of sleep and the emotional stressors common during these years.

Other issues that commonly arise are fatigue, dry or itchy skin, hair loss or breakage, palpitations, joint and muscle aches, weight gain, headaches, and vaginal dryness which may progress to cause bladder, yeast and other vaginal infections. Furthermore, as the protective effects of estrogen wane, women have a greater rate of developing osteoporosis, high cholesterol and heart disease.

With a list of problems like that, it's no surprise women want to control their symptoms. For many, a low dose oral contraceptive will provide baseline hormone levels while also minimizing risk of pregnancy, which is still a possibility during this time. Others may choose a customized program of bio-identical hormone support of estrogen, progesterone, and occasionally testosterone or DHEA.

At home, daily lifestyle choices are key. Drink plenty of water to prevent sodium retention. Avoid refined carbohydrates which contribute to insulin spikes and falls, worsening mood swings and contributing to weight gain. Eat multiple small meals per day containing a balanced mix of lean protein, colorful vegetables and healthy oils. For women who aren't already supplementing, now is the time to start a multivitamin regimen with adequate calcium, vitamin D, B vitamins and fish oil — all things you will need more of during this phase of your life.

Both alcohol and caffeine can bring on hot flashes, as can a variety of stressors including spicy foods. If these are an issue, keep a journal to identify and eliminate symptom triggers.

Women who smoke experience ovarian failure and menopause several years sooner than their non-smoking counterparts and often have a greater fall in hormone levels. If you haven't already, do anything you can to cut down or quit.

A regular program of exercise that encompasses cardio, weight-bearing and relaxation elements is one of the best things you can do to minimize symptoms as well as the dangerous changes that come with menopause - osteoporosis, increased visceral fat and heart disease. It can also improve the sleep disturbances common to many women.

Finally, some women benefit from natural remedies including black cohosh, chasteberry, St. John's Wort and a variety of natural phytoestrogens from soy, red clover and flax seed. These can improve your symptoms, lipids and osteoporosis, but be sure to discuss their use with your physician as they can interact with other medications and medical problems.

Your doctor may also need to evaluate you to make sure that other medical issues such as thyroid dysfunction, fibroids, endometriosis, or cancer aren't causing some of your symptoms. Talk with them, both to determine whether other medical problems need to be excluded and also to see if hormones or other medications could help.

Listening to your own rhythms as your body transitions, and making sure that you are meeting your body's changing needs will help you move through these years healthy, balanced and sane.

— Dr. Rebecca Gelber is an Incline Village resident and graduate of The Johns Hopkins School of Medicine. She is an adjunct professor with the UNR School of Medicine and practices locally at Tahoe Aesthetic and Integrative Medicine, 775-298-1750,