Early signs of menopause (sometimes called “peri-menopause”) can occur as early as late 30’s to early 40’s, however the average age of complete menopause is around 53. Menopause is defined as “not having a menstrual cycle for one full year”. This occurs because the ovaries decline in their hormone production – a process can be abrupt, or one that has a slow decline over a few months to several years. There is no way to predict how hormone levels will fall therefore, the time before this year-long lack of menstruation and all the symptoms associated with this change is what we refer to as “peri-menopause”. This time course can be from one to seven years depending on the individual and has been referred to as a “mirror image” of puberty.
If we think of puberty and peri-menopause, we see similar changes in mood, menstrual cycle behavior, weight changes, appetite, sleep cycles, cortisol levels, hair and skin changes and memory. This is unfortunately for some mothers of young women, a time of clashing because of several “wild card” physiological changes going on at the same time. Understanding why these symptoms are occurring can go a long way in preventing un-necessary discord between mother and daughter. Immature ovaries in the adolescent are just getting started in consistent hormone production, and aging ovaries are slowing down in production of all hormones (estrogen, progesterone, testosterone, DHEA and pregnenolone).
Menstrual cycles for both ages can be irregular with inconsistent levels of flow. For the peri-menopause women and the adolescent, typically cycles tend to get heavier. For the peri-menopause woman her cycles also can become shorter in-between. This phase can last for up to 1-2 years and may be aggravated by other common conditions such as uterine fibroids or endometrial polyps. Mood changes, weight changes, sleep disorders, memory lapses, fluid retention, headaches and breast tenderness are present for many women in both age ranges but tend to improve naturally in adolescents due to maturing hypothalamus/pituitary communication. The bad news for peri-menopause women is that the symptoms tend to be prolonged and can get worse!
When peri or post-menopausal women have symptoms, the changes can affect their quality of life especially when accompanied by hot flashes, insomnia, brain fog, decreased libido, irritability and vaginal dryness. Hormone replacement and/or herbal therapies can be options to help relieve these symptoms during this transition. The Women’s Health initiative study, (using non bio-identical hormones), conducted in 2005, recommended that replacement hormone therapy be the “smallest amount for the shortest duration” to control symptoms. This is, on average, around 5 years of hormone treatment with the greatest benefit being in the early phase of peri and post menopause. The recommendation to limit the duration of hormone therapy to the shortest period possible focuses on decreasing the potential development of hormone related complications such as heart attack, stroke and breast cancer that have been linked to prolonged hormone replacement therapy. Many women who feel improved symptoms with hormone replacement wish to continue their treatment beyond this time frame as they feel “better” on replacement therapy. Warnings regarding the risk of blood clots, stroke and increased risk of breast cancer are present for all forms of hormone replacement including “bio-identical” hormone therapy (BHRT). New research is needed to conclusively define the risk of prolonged BHRT.
There are several options for hormone replacement therapy for pre and post menopause symptoms. Some women have heard that they do not need hormone replacement before they are “post menopause” but, many women benefit from personalized hormone therapy. BHRT compounding allows better, more precise dosing and is one solution along with other natural treatments that can be prescribed by a physician or nurse practitioner to assist in managing symptoms associated with the spectrum of menopause.
Melinda Poland, Board Certified Nurse Practitioner