Perimenopause: what it is and what happens to women when it starts - Health

With more than 30 symptoms, the list is so extensive that we could write an entire note dedicated to it.

And although most women are familiar with the most common problems associated with menopause (such as hot flashes or irregular periods), they are unaware of many other possible ones, such as the sensation of having insects walking under the skin or burning in the mouth. .

What’s more, many find it a real surprise to discover that all these conditions can start to manifest themselves many years before they stop menstruating.

And it is that the symptoms do not begin with the menopause, the term that is used to define the milestone in the reproductive life of the woman, which is officially reached when a year passes from the last period, but during the transition towards it.

This transition is what is known medically as perimenopause.

“The average woman will start (this process) around the age of 47 and will end at 51, but it can start much earlier,” Nanette Santoro, professor of obstetrics and gynecology at the University of Colorado, in the United States, explains to BBC Mundo. that investigates the symptoms of perimenopause and menopause.

“In my clinical practice, I have seen women in their 30s or 40s who present clear symptoms of menopause, although objective tests (egg count, etc.) do not seem to show that they are so close,” she adds.

Hot flashes and vaginal dryness

The symptoms Santoro refers to are some of the most classic, which can appear during the transition period and last for years after menopause.

The ones that appear most frequently are:

Rirregular rules: menstruation can be spaced out, take place more often, with more or less bleeding, until it finally disappears.
Bochornos: a kind of sudden and intense heat in the face and head spreads to the rest of the body and lasts for a few minutes until it disappears as quickly as it came.
Snight prayers: They cause a woman to wake up in the middle of the night drenched in perspiration.
Aurogenital trophy: a problem that, as Paula Briggs, a specialist in sexual and reproductive health, and president of the British Society for Menopause, explains to BBC Mundo, “80% of women suffer” and “affects the quality of genital tissue”. This causes dryness in the vagina and can lead to pain and irritation during intercourse, as well as an increased need to urinate and urinary infections.
Ddecreased fertility.
Pbone density loss: The body loses bone mass faster than it regains it, which increases the risk of osteoporosis.
Aweight gain and change in their distribution of fat: “There is an increase in weight without an increase in food intake or a decrease in physical exercise. And the distribution of adipose tissue is more similar to how it is distributed in men, accumulating in the central area “, Nicolás Mendoza, professor of Obstetrics and Gynecology at the University of Granada and president of the Spanish Association for the Study of Menopause, explains to BBC Mundo. “It is an apple-type adiposity, when women’s adiposity tends to be pear-type.”
Otros: many women also notice hair loss, brittle nails, headaches and muscle palpitations and cramps.

lack of estrogen

All these changes are the result of hormonal fluctuations and, above all, the decrease in estrogen, a crucial hormone in the monthly reproductive cycle, whose levels do not recover after menopause.

The decline in estrogen levels does not occur gradually and progressively. Quite the contrary. Levels rise and fall unsteadily, says Mendoza, and it’s these uneven swings that lead to the symptoms we mentioned earlier.

While some symptoms are associated with excesses of this hormone, others respond to its deficiency. For this reason, some women suffer more during perimenopause than postmenopause, since from that moment on hormone levels tend to stabilize.

But hormonal volatility doesn’t just lead to physical changes and symptoms, it has a profound effect on the mood and brain of a woman going through this stage.

Impact on mood and brain

Pauline Maki, a professor of psychiatry, psychology, obstetrics, and gynecology at the University of Illinois at Chicago and former president of the American Menopause Society, explains that there is a “decline in mood in perimenopausal women” and in many cases a “vulnerability to depression, similar to that experienced by women after pregnancy to postpartum depression”.

“We know that there are certain women who are very sensitive to a negative emotional response when they suffer sudden changes in their estrogen levels,” he tells BBC Mundo.

Irritability, anxiety, lack of sexual desire, memory loss and so-called brain fog (a mixture of confusion and decreased verbal and cognitive abilities) are other characteristic features of this stage.

Although they are caused by hormonal factors, they are also closely linked to other physical symptoms of perimenopause.

“There’s a very intuitive relationship between hot flashes and sleep disturbances and low mood the next day. Research has shown that hot flashes on one day predicted low mood the next day,” says Maki.

“That’s partly because[nighttime]hot flashes interrupt sleep, and I don’t know about you, but when I’m chronically sleep deprived, I get a little cranky,” she adds.

It’s hard for a woman to know what to expect past quarantine, when perimenopause begins to loom on the horizon, as individual variation is immense.

The experience of menstruation in the past (regular or irregular, painful or slightly bothersome, with a lot or little bleeding, with long or short periods) is not an indicator of what may come.

Starting by talking to his mother can be a starting point, says Santoro, since “there is some evidence that it could be something family, although the genetic influence of the father must also be taken into account.”

Treatment

With the stabilization of hormones, after menopause, some of the symptoms (especially those of a shorter term such as hot flashes or difficulties sleeping) become more acute at first, and then improve. But not always and not in all cases.

That is why the experts consulted by BBC Mundo agree that hormone replacement therapy (HRT) is, in the vast majority of cases, and under medical supervision, the best treatment to follow.

“Lack of estrogen can result in a 1% annual loss of bone mineral density and that has a cumulative effect, increasing the risk of fractures, osteoporosis and chronic pain. In addition, lack of estrogen is a cardiovascular risk factor” explains Briggs, who fully believes in the benefits of HRT.

Many women are still hesitant to opt for this treatment, due to a study from the early 2000s that some experts said was misinterpreted and contained numerous errors, and amplified the cancer risks of the treatment.

“I understand that it is not what everyone wants and that is fine, but I think at least every woman should be informed of all the things that are linked to menopause. I think that very few women will go through it without consequences, without following a treatment”, says Briggs, adding that the sooner you start, the greater the benefits.

Santoro, for his part, clarifies that there are no proven benefits of this therapy if there are no symptoms.

“Given what we know about hormone replacement therapy, it is only indicated in case of symptoms. It is not exactly like diabetes or hypothyroidism, which is the analogy that is often made (where the missing hormone is replaced). If not there are symptoms, it doesn’t seem to work to lower the risks (of lack of estrogen).”

Changes in lifestyle

Beyond HRT, there are many other things a woman can do to improve her overall condition in the perimenopausal phase.

“Yoga and cognitive behavioral therapy have shown some improvements for both sleep problems and hot flashes,” Santoro says.

“You have to be kind to yourself. Have self-compassion. Recognize that these are very normal experiences, that you are not alone, and that research today validates your experience. (In the case of depression), it’s just as normal as depression.” postpartum,” says Maki.

According to the expert, changes in daily life can also be of great help.

“Exercise is very important because it has been shown to change brain chemistry,” she says, also recommending yoga and meditation to reduce irritability and anxiety.

“It’s important to limit alcohol intake. Many women, when feeling irritable and stressed, will have one glass of wine or go for the second, when that is actually counterproductive.”

“There is evidence to show that, with the impact of these hormonal changes in the brain, there is an adverse mood response after alcohol consumption.”

When you feel down, you tend to avoid contact with people, and that’s not good for your brain, Maki explains.

“We have to force ourselves to be involved in social activities with people who give us energy. That’s very important.”

In short, in any way, it is essential to address the symptoms.

“We cannot tell women that this is a natural phenomenon – we do not tell them, for example, about the pain of the period – and then it goes away. If the symptoms affect the quality of life, they must be treated without condescension,” he concludes. Mendoza.

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