PERIMENOPAUSE AND ITS MANAGEMENT 1

Perimenopause and its Management

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Menopause is a significant life-altering transition among women as it comes with several

notable changes in their bodies and consequently, their life. Minkin, (2019), defines menopause

as a period of twelve months characterized by cessation of menstruation without an underlying

condition. This change comes with a mixed reception among women, some viewing it as a

liberating change since they no longer have anxieties associated with the possibility of pregnancy

and childbearing and it also marks the end of discomfort that comes with menstruation.

However, some women welcome this change with a negative perception since menopause is

associated with old age hence the negative connotation, particularly in the Western cultures

(Minkin, 2019).

Perimenopause, surgical menopause, stress menopause, and postmenopause

According to Perimenopause | Johns Hopkins Medicine, (n.d.), perimenopause is the

time around the transition into menopause. This period is marked by alterations of the normal

menstrual cycle in women and significant emotional and physical changes, taking place

anywhere between two to ten years (Perimenopause | Johns Hopkins Medicine, n.d.). Its

diagnosis is often retrospective since it encompasses the entire period of altered flow to the last

menstrual period (Minkin, 2019). Surgical menopause, also known as oophorectomy, is the

bilateral removal of ovaries via a surgical procedure before the onset of natural menopause. It is

mostly conducted on women on grounds of health such as benign ovarian tumors, fibroids, heavy

menses, and as a preventive intervention against ovarian cancer (Surgical Menopause -

Australasian Menopause Society, n.d.). Stress-induced menopause is a byproduct of sustained

stress levels leading to a constant production of cortisol. The high levels of cortisol in a woman's

body lead to faster clearing of progesterone and a resultant progesterone-estrogen imbalance

(Woods et al., 2009). If the body is continuously exposed to high cortisol levels, amenorrhea sets
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in leading to stress menopause. Following 12 consecutive months of amenorrhea, a woman

enters postmenopause, a period characterized by a reduction of the previously frequent

menopausal symptoms such as mood disorders and hot flushes. There is a well-established body

of literature that links this period to a decrease in bone density, also known as osteoporosis. As

such, they are prone to fractures, and (Watts, 2018) also established a link between this phase

and an increase in instances of breast cancer, myocardial infarctions, and stroke.

Signs of menopause

Minkin, (2019), classifies signs of menopause under seven broad categories, which are

vasomotor symptoms, urogenital symptoms, decrease in libido, mood swings, cognitive

symptoms, depression, achiness, weight gain, and skin and hair changes. The most notable

symptoms during the onset of menopause are night sweats and hot flushes. Women will

experience approximately seven episodes of hot flushes in a day or about fifty such episodes in a

week (Minkin, 2019). Under vasomotor, sleep disturbances may be attributed to flush episodes

albeit studies remain equivocal on the relationship between the two events. Under urogenital,

menopausal women complain of a dry vagina often in the form of dyspareunia. Other symptoms

under this system include incontinence, prolapse as a result of pelvic floor weakening, and

intermittent urinary tract infections. The combination of the above factors then precipitates a

decrease in libido due to factors such as painful coitus and incontinence. Due to aging issues and

exogenous stressors, menopausal women will present with all or some of the symptoms that

include depression, cognitive symptoms, and mood swings (Minkin, 2019). Disruption in sleep-

wake patterns (insomnia) worsens these symptoms. In the same study, Minkin (2019), posits

that a sizeable number of women will present with generalized musculoskeletal achiness without

an underlying cause. There is also weight gain during perimenopause, especially a noticeable
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mid-body fat accumulation. Women will also complain of dry skin and hair loss during the onset

of menopause which ameliorates with hormonal treatment(Minkin, 2019).

Other life changes that can influence women’s experience during menopause

Since perimenopause is a period of physical, psychological, and emotional changes, any

underlying condition touching on these systems worsens a woman's experience of menopause.

For instance, a woman with a history of depression will have somewhat difficult perimenopause

compared to women without a history of depression. Hormonal imbalances as well will lead to

rougher perimenopause as compared to their hormonally balanced females. The same is true for

other systems such as obesity and underlying musculoskeletal conditions such as myasthenia

gravis

Women at the highest risk of osteoporosis

Perimenopause leads to factors predisposing to osteoporosis in women especially aged 65

and above. Those with a history of fracture, Asian and White women that are 50 years and older.

Smokers show a higher risk of osteoporosis as well as women who are heavy drinkers. Women

who weigh 125 pounds and lower will normally have a lower peak bone mass and any age-

related bone mass loss predispose them more to osteoporosis. There is a familial component as

well and people with a history of bariatric surgery, hepatic conditions, rheumatoid arthritis, and

renal failure are found to be at a higher risk (Osteoporosis Risk Factors at UC San Diego Health,

n.d.).

Traditional and alternative therapies for conditions associated with menopause

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The main goal of treatment in menopause is to increase or prevent loss of bone density by

majorly restoring hormonal balance. Phytoestrogens are plants known to have estrogen-like

action in the body, which are mainly lignans and isoflavones. Chickpeas, soybeans legumes, and

lentils are some of the known isoflavones that are phytoestrogens(“Nonhormonal Management

of Menopause-Associated Vasomotor Symptoms,” 2015). Lignans include foods such as

vegetables, flaxseed, some fruits, and whole grains. Bioidentical hormones are derived from

plants and have a chemical that is similar to a woman’s natural estrogen. Although there’s

inadequate literature, black cohosh is famously used by menopausal women. However, data

shows that it poses a health risk for women who have suffered from breast cancer before as well

as hepatotoxicity. Other modalities include yoga which helps in strength thus fewer falls,

acupuncture for hot flushes, and hypnosis which helps improve sleep quality for menopausal

women leading to a better quality of life.

Appropriate health, nutrition, and exercise guidelines for middle-aged and older adults

Middle-aged and older adults are at an increased risk of depressive conditions,

myocardial infarctions, inflammatory conditions, and falls. Their health, nutrition, and exercise

plans should, therefore, be tailored toward preventing or managing these conditions. In principle,

they should take a balanced diet that includes about five fruit servings a day, different sources of

proteins, whole grains, and foods rich with calcium such as milk and its products and healthy fats

(Healthy Eating for Older Adults, n.d.). Their exercise plans should include a minimum of 30

minutes of walking every day, stretches, and swimming for those in a position (Hagey & Warren,

2008). Close health monitoring helps identify deficiency or a developing complication early, and

treatment is started early, thus their health management often involves a preventive approach.
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References

Hagey, A. R., & Warren, M. P. (2008). Role of exercise and nutrition in menopause. Clinical

Obstetrics and Gynecology, 51(3), 627–641.

Healthy Eating for Older Adults. (n.d.). Retrieved May 3, 2022, from

https://www.eatright.org/food/nutrition/dietary-guidelines-and-myplate/healthy-eating-

for-older-adults

Minkin, M. J. (2019). Menopause: Hormones, lifestyle, and optimizing aging. Obstetrics and

Gynecology Clinics, 46(3), 501–514.

Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position

statement of The North American Menopause Society. (2015). Menopause, 22(11),

1155–1174. https://doi.org/10.1097/GME.0000000000000546

Osteoporosis Risk Factors at UC San Diego Health. (n.d.). UC Health - UC San Diego.

Retrieved May 3, 2022, from

https://health.ucsd.edu/specialties/endocrinology/osteoporosis/pages/osteoporosis-risk-

factors.aspx

Perimenopause | Johns Hopkins Medicine. (n.d.). Retrieved May 3, 2022, from

https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause

Surgical Menopause—Australasian Menopause Society. (n.d.). Retrieved May 3, 2022, from

https://www.menopause.org.au/hp/information-sheets/surgical-menopause

Watts, N. B. (2018). Postmenopausal Osteoporosis: A Clinical Review. Journal of Women’s

Health, 27(9), 1093–1096. https://doi.org/10.1089/jwh.2017.6706

Woods, N. F., Mitchell, E. S., & Smith-DiJulio, K. (2009). Cortisol Levels during the

Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife
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Women’s Health Study. Menopause (New York, N.Y.), 16(4), 708–718.

https://doi.org/10.1097/gme.0b013e318198d6b2