Everything You Need to Know About Perimenopause

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Important Q&As, cont'd.

Q. I'm on a birth control pill, so how will I know when I'm really in menopause?

A. Birth control pills stop ovulation, so the bleeding you experience each month while on the pill is from hormone withdrawal and is not a real period. Because of that, you may actually go through menopause while still bleeding every month. So how do you know if your real, ovulation-based periods have stopped for good? "As you approach your early to mid-50s," says Dr. Schiff, "you might consider stopping the oral contraceptives for about 10 days and having your doctor test your level of FSH, which can confirm if you're in menopause or not." At that point, especially if you're having bad symptoms, you may want to discuss hormone therapy with your doctor. (Check out "Should You Try Hormone Therapy?" below.) Or see how you feel just staying au naturel.

Q. Can I still get pregnant in perimenopause?

A. The simple answer is yes, as long as you're ovulating. But after age 40 your fertility drops dramatically. It becomes harder to get pregnant, you're more likely to miscarry, and the chance of complications increases for you and the baby, says Jan L. Shifren, MD, director of the Vincent Menopause Program at Massachusetts General Hospital. Of course, every woman is different, and chronological age doesn't always track with ovarian age. Some women stay fertile well into their mid-40s. If you don't want to get pregnant, use birth control until you've gone a year without a period.

Q. Is weight gain just a fact of life during these years?

A. Yes -- your metabolism slows as you age, so you have to increase your exercise and decrease calories just to stay even. If you do nothing you'll likely add a pound or two a year -- and the fat will go more to your belly, too. Add weight-bearing exercise such as lifting weights or walking stairs to encourage your metabolism to speed up. And try cutting your caloric intake by controlling portions and decreasing sugary drinks and simple carbs.

Q. Are there any natural and safe remedies for perimenopause symptoms?

A. Despite much research on soy, vitamin E, red clover, black cohosh, dong quai, and other herbal supplements, there's little evidence that these are effective in reducing hot flashes or other symptoms compared to a placebo -- and they may cause harmful side effects or drug interactions. Acupuncture has been shown to help some symptoms. Exercise and yoga may be the safest and most effective natural remedies you can try.

Q. I never used to be forgetful, but I feel as though I can't concentrate or remember anyone's name these days! Is this just a phase?

A. Yes it is, says Baltimore neurologist and author Majid Fotuhi, MD, a member of the LHJ Medical Advisory Board. Many women have difficulty with concentration during perimenopause. It's not necessarily from low estrogen, he says, but more about all the crazy hormone fluctuations going on (it can happen during pregnancy, too). "It's probably due to the ratio of different hormones and their rate of change that affects the brain -- sort of a fog that comes and goes," he says. Verbal memory is often affected, too, so you may find yourself searching for a word that seems to be on the tip of your tongue. But don't worry: This type of forgetfulness is common during perimenopause and usually goes away after menopause. There's no long-term brain damage from it and it generally doesn't mean you're developing Alzheimer's or dementia. Exercise can help by actually increasing the size of the memory part of the brain.

Q. What happens to your skin and hair during perimenopause?

A. As your estrogen declines, so does oil production and collagen in your skin. You probably need to use a richer moisturizer now. You may notice your hair getting a little thinner on top, too. That can happen when your testosterone doesn't decrease at the same rate as your estrogen. The balance shifts and the relative rise in testosterone causes your hair to thin. This hormonal shift can also cause hairs to sprout in unexpected places such as your chin or upper lip. You can take care of those with tweezers, waxing, electrolysis, or laser hair removal.

Q. Why does my sex drive seem to have gone missing lately? And is there anything I can do to get it back?

A. Let's face it: Hot flashes, night sweats, sleep disruption, fatigue, and vaginal dryness resulting from low estrogen aren't exactly sexy. Medications like oral contraceptives and antidepressants can also reduce your sex drive. Of course, so can relationship problems, stress, worry, and changes in your health or even your weight. And there's no easy take-a-pill solution as there is for men. Testosterone therapy has been shown to help some women but has not yet been approved by the FDA. The relationship between your hormones and your sex drive is complex, and while hormones can contribute to low libido, there can be other factors as well. (See our article from November 2010 at LHJ.com/libido.) Figuring out the cause can be tricky, so start by making a list of what's going on in your life that may be contributing to your lack of libido and schedule a talk with your doctor.

Q. Is there anything good about perimenopause?

A. Perimenopause is nature's early warning system, designed to alert you that the next phase of your life will soon begin. You may feel sad if you were hoping to have another baby. But many other women are relieved to hear that they won't have to worry about contraception, PMS, cramps, or tampons much longer. Women plagued by fibroids and hormonal migraines usually see both problems disappear in menopause. Many women live more than a third of their life after menopause, Dr. Streicher reminds us, and it can be the most productive and interesting time. Your kids are often grown and on their own and you probably have more time to pursue the things you love. Why not make yourself as healthy as possible now so that you can maximize this next great chapter in your life?

Continued on page 3:  Should You Try Hormone Therapy?


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