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Published October 29, 2012, 11:34 PM

Perimenopause can be a confusing, frustrating time for women

FARGO - Developmental psychologist and women’s mental health expert Deborah Wagner says contrary to popular belief, menopause is the calm after the storm. “While there are a number of unpleasant aspects of menopause, the true storm erupts in perimenopause,” she says.

By: Meredith Holt, INFORUM

FARGO - Developmental psychologist and women’s mental health expert Deborah Wagner says contrary to popular belief, menopause is the calm after the storm.

“While there are a number of unpleasant aspects of menopause, the true storm erupts in perimenopause,” she says.

Wagner says it’s during perimenopause that women experience symptoms like unpredictable mood swings, sleep disruptions and sexual difficulties.

“These challenges, in turn, impact relationships, jobs, productivity, and one’s ability to cope and function,” the author says.

Her book, “The Fifth Decade,” explains what perimenopause is, how it affects mental health, and how women can maintain their personal well-being and confidence during the transition.

Perimenopause, or pre-menopause, is the time between normal menstruation and the end of menstruation.

Terrie Wold, an ob-gyn physician’s assistant with Sanford Health, says a woman enters menopause after 12 months without a bleed, but she can still get pregnant during that time.

“If you want to ensure you don’t get pregnant, you should stay on hormonal contraceptives for one year after your last period, and then you could consider switching to hormone replacement,” she says.

While some women become menopausal “overnight,” for others, the process takes years.

“Some women start as early as in their 30s, and some women go until their 60s,” Wold says.

The North American Menopause Society says the average age of menopause is 51.

Unfortunately, there’s no “test” to determine whether you’re in perimenopause.

“The only accurate way for a woman to know if she is in perimenopause is to know the signs and tune in to her own body,” Wagner says.

You can’t look to your mother’s experience for what to expect, either, Wold says. Nor does there seem to be an association with the age of a woman’s first period or her use of hormonal birth control.

When perimenopause begins, symptoms can be so subtle they fly under the radar.

“Initially, women may not differentiate between typical anxiety, stress, depression, low libido or insomnia, and the beginning of the menopausal transition,” Wagner says.

The first signs may be physiological, psychological or both.

Changes in a woman’s menstrual cycle, including changes to PMS symptoms, may be early indicators of perimenopause.

“You’re in the early transition when your menstrual cycle varies by greater than seven days, so it’s either seven days shorter or seven days longer, before it completely stops,” Wold says.

According to the North American Menopause Society, 90 percent of women have four to eight years of irregular cycles before they stop for good.

Pathological problems such as infections, cysts, polyps, fibroids, adenomyosis and endometriosis should be ruled out first.

“There are all kinds of things that can cause irregular bleed patterns besides perimenopause and menopause,” Wold says.

Wagner says a woman doesn’t usually begin to suspect perimenopause until her symptoms intensify.

“When she begins to feel moody, short-tempered, or she finds herself reacting and overreacting and feeling in unfamiliar ways, she will be more likely to question what’s going on,” she says.

The infamous hot flash varies greatly in severity, frequency and duration.

“For a lot of people, it’s just the neck up, but I’ve had women say that they have to go home from work and change their clothes because they sweat so profusely,” Wold says.

According to the North American Menopause Society, 75 percent of women have hot flashes in perimenopause for three to five years.

Kim Anderson started getting hot flashes about a month after she stopped taking hormonal birth control. They’d last a few minutes and occur every hour.

“It happened day, it happened night, it happened all the time,” the 47-year-old Fargo woman says.

Wold says poor sleep is probably the third most common sign of perimenopause, and it’s not always related to night sweats.

“If you don’t sleep well, then that triggers more weight gain, and then you’re at more risk for heart disease, and more women die of heart disease than they do of various cancers,” she says.

However, Wagner says the influence of the drastic hormonal change that occurs in perimenopause goes far beyond changing menstrual cycles and hot flashes.

She lists difficulty concentrating, memory loss, widely vacillating mood swings, depression and anxiety among the other challenges perimenopausal women may face.

“Women need to understand that the 40s and 50s is a time of tremendous internal and external change, both physiological and psychological,” Wagner says.

It wasn’t until Anderson mentioned her symptoms to her hairstylist about a year after they began that she decided to seek help.

“You have all these questions, but you don’t know where to go for answers,” she says.

Wold says women are often too embarrassed to ask about symptoms like hot flashes, problems urinating or pain during sex.

“They need to not be afraid of it. They need to kind of take charge of it and be assertive and say, ‘I want my life to have some quality,’ ” she says.

Common problems associated with perimenopause

  • Irregular menstrual cycles and bleed patterns

  • Decreased fertility

  • Hot flashes

  • Vulvovaginal symptoms

  • Sleep disturbances

  • Headaches

  • Memory or concentration problems

  • Mood swings, lack of energy, depression, anxiety

  • Decreased sexual desire

  • Urinary troubles

  • Weight gain

  • Joint pain

  • Skin changes

  • Hair changes

  • Eye changes

  • Mouth and dental changes

  • Hearing changes

Source: North American Menopause Society


Readers can reach Forum reporter Meredith Holt at (701) 241-5590

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