Dr. Ash Sujit G
Perimenopause denotes the transitional phase preceding menopause, characterized by alterations in the menstrual cycle alongside various physical and emotional symptoms. This period may extend from 2 to 10 years. Throughout perimenopause, ovulation becomes less frequent, estrogen and other hormone levels decrease, fertility diminishes, and menstrual cycles often become shorter and irregular.
Perimenopausal women commonly encounter difficulties in accessing quality healthcare services and supportive communities. Unfortunately, awareness and access to menopause-related information and services remain substantial challenges across many countries. Sexual well-being for menopausal women is frequently neglected, leading to untreated gynecological issues such as vaginal dryness and discomfort during intercourse. Additionally, older women may underestimate their susceptibility to sexually transmitted infections, including HIV, or may not receive adequate counseling from healthcare providers regarding safe sex practices or testing.
Hormonal fluctuations during perimenopause give rise to various symptoms, including mood swings, hot flashes, and sleep disturbances. Fluctuating estrogen levels contribute to symptoms like hot flashes and night sweats. Other manifestations encompass mood swings, insomnia, joint pain, and vaginal dryness. Each womans experience is unique, with hot flashes affecting 35-50% of perimenopausal women and persisting for years beyond menopause in 10% of cases. Reduced progesterone levels may lead to uterine bleeding issues, while sleep disturbances affect 40% of perimenopausal women, possibly linked to night sweats. Mood symptoms affect 10-25%, with factors such as stress and health history playing significant roles.
Distinguishing between symptoms of perimenopause and other conditions can pose challenges for patients. Therefore, combining symptoms, medical history, age, and physical examination can provide valuable insights. Blood tests may assist in measuring hormone levels for early diagnosis and management of risks and issues associated with menopause, including non-communicable diseases (NCDs), cancer, and osteoporosis.
Treatment for perimenopause should only be considered if symptoms are bothersome. Options include hormone therapy using estrogen or estrogen and progestin to balance hormone levels, antidepressants to stabilize moods, and lifestyle adjustments such as adopting a healthy diet rich in fruits, vegetables, and whole grains and consuming 1000-1200 mg of calcium daily, among other recommendations.
Maintaining cool air temperatures and avoiding hot beverages and spicy foods are recommended to minimize potential triggers of hot flashes. Estrogen is the most effective treatment for severe hot flashes and night sweats, with low-dose estrogen pills or patches often proving effective. Cognitive behavioral therapy and mind-body techniques may also provide relief.
Oral contraceptives offer various benefits during perimenopause, including ovulation suppression, regulation of menstrual flow, and protection against endometrial and ovarian cancers. They also alleviate hot flashes, reduce vaginal dryness, and prevent bone loss.
For women experiencing severe hot flashes who are not suitable candidates for hormone therapy, alternative medications such as Effexor, Prozac, Neurontin, or clonidine may be considered. Relief for vaginal dryness can be achieved with low-dose vaginal estrogen or non-hormonal options such as Replens moisturizers and lubricants like K-Y Jelly and Astroglide, enhancing comfort during intercourse.
Dr. Ash Sujit G, is Senior Consultant, Gynecology & Obstetrics, PD Hinduja Hospital, Mumbai