1. Chapter 20:
Perimenopause and
Menopause
Catherine Lemelin
HE 210-OL

2. What is the difference between
Perimenopause and Menopause?
Perimenopause
Menopause
The ovaries function
erratically and hormonal
fluctuations may bring a
range on changes.
 Can be a one-to-ten year
stretch.
 Changes include: Hot
flashes, night sweats,
trouble sleeping, and
heavy menstrual bleeding.
 Each woman is affected to
the transition differently.



Ovaries settle down and
the reproductive
hormones have declined
to low, steady levels.
Marked by the final
menstrual period (final
after one year with no
periods).

4. Midlife Perimenopause
Brings the end of
the childbearing
years.
 Involves emotional,
social, and physical
changes.
 Everything from a
new sort of
loneliness to a
profound sense of
new freedom may
emerge.


5. The menopause transition may fill our
minds with all sorts of questions:
What do I want to do?
What am I not able to do?
What can I control?
How do I want to live?

6. Have I reached
Perimenopause?



Transition can begin
from late 30’s to 60
and can last from 1-10
years
Smokers tend to reach
menopause earlier
than nonsmokers
Women typically begin
the transition at the
same age as their
mothers

7. According to Endocrinologist, Jerilynn Prior, if
you apply to any three of the list below, you
can assume you have begun perimenopause:
1.
2.
3.
4.
5.
6.
7.
8.
9.
New-onset heavy and/or longer flow
Shorter menstrual cycles (less than 25 days)
Newly sore, swollen, or lumpy breasts
New midsleep wakening
Increased cramps
Onset of night sweats (esp. around menstrual
flow)
New or markedly increased migraine headaches
New or increased premenstrual mood swings
Weight gain without changes in exercise or
eating

8. Non-medical self help
approaches to alleviate
discomforts
Meditation
 Yoga
 Relaxation
 Regular exercise
 Healthful food
 Enough sleep
 Support from
family and friends


9. Perimenopausal Signs

Premenstrual Syndrome (PMS)
◦ Swollen/tender breasts, bloating, anxiety, etc

Menstrual Cycle Changes
◦ Shorter cycles, skipped periods

Abnormally Heavy Bleeding
◦ 25% of women in perimenopause experience
heavy bleeding

10. Facts about Perimenopause



Contrary to popular
belief, you can still
become pregnant
during
perimenopause.
20-30% of women
never experience hot
flashes during
perimenopause.
Sleep disturbances
are common in both
perimenopause and
postmenopause.

11. Ways to Eliminate Sleep
Disturbances




Cut out caffeinated
beverages
Avoid smoking
Avoid or limit
alcohol
consumption
Go to bed at
approximately the
same time each
night



Exercise regularly
Before bed, take a
bath, listen to music
or read
Filter out noise and
light

12. 

Vaginal Changes
Vaginal dryness is a
common change in early
perimenopause
Estrogen and
progesterone levels
decline and the vaginal
walls frequently become
thinner, drier, less
flexible, and more prone
to tears and cracks
Urinary Changes




Finding the need to
urinate more often
Urge incontinence
(sudden strong urge to
urinate followed by
involuntary flow)
Urinary incontinence
Incontinence can be
successfully managed,
treated, and sometimes
cured (i.e. kegal
exercises, bladder
training, medications,
vaginal estrogen)

13. Tips to Relieve Vaginal Dryness
and Sexual Discomfort
Lubricants and
vaginal
moisturizers
 Regular sexual
activity
 Wait until fully
aroused before
penetration
 Drink more fluids

Graduated dilators
 Low-dose local
vaginal estrogens
 Hormone therapy


14. Postmenopause



The ratio of body fat to muscle mass
increases as we grow older, so it is very
important to exercise to maintain muscle
mass.
Weight gain is common due to a
combination of slower metabolism,
decreased activity, and increased caloric
intake.
Eating well can help prevent/manage
chronic diseases and enhance sexuality.

15. Bone Loss and Osteoporosis




Osteoporosis is a condition of significantly
low bone density.
As we get older, we start to lose bone
faster than we replace it.
Prevention includes: yoga, jogging,
strengthening with weights, avoiding
harmful habits, eating healthy, etc.
Vitamins that limit bone loss and reduce
fractures are Calcium, Vitamin D, and
Magnesium.

16. Care and Treatment for
Perimenopauseal Discomforts
Alternative therapies such as herbs or
botanicals
 Western medicine of drugs or surgery
 Establishing a relationship with a
healthcare practitioner or clinician whose
philosophy is similar to yours and is
open-minded
 Possessing insurance and access to
health care
 Nonhormonal medications such as
bisphosphonates, anti-depressants, or
sleeping pills


17. Hormone Therapy



Hormone Therapy is the process which
women receive treatments and
medications to help the body replace
hormones that are no longer produced
after menopause
Pros: Relieves discomfort of menopause
(hot flashes, night sweats, vaginal
dryness)
Cons: Causes health risks (breast cancer,
stroke, blood clots)

18. Debate over Hormone Therapy
There is a current debate regarding the
use of hormone therapy. Some feel that
because perimenopause and menopause
are not diseases, then treatments should
not be pushed on women. Although HT
may provide negative effects, others who
suffer during this time are happy to know
that there are treatment options and are
willing to take the risks.

19. Various Hormones







Progestogens
Medroxyprogesterone
Acetate (Provera)
Progestin-Releasing
IUD (Mirena)
Bioidentical
Micronized
Progesterone
PremPro
Estrogen/Progestin
Patches
Estrogens
◦ Estradiol, Estriol, and
Estrone

20. Discussion Question
What are your thoughts on the
debate over hormone therapy?

21. “ Intellectually, I know some of my physical
and mental capacities will diminish as I
age, but I want to deal with this with a
sense of self-acceptance [and] not lower
expectations. I hope my generation of
feminist boomers will not deny the limits of
aging and not give in to internalized ageist
attitudes towards others and ourselves as
we age” (546)

22. Resource

The Boston Women’s Health Book
Collective.“Chapter 20: Perimenopause and
Menopause” (pages 505-546). 2011. Our Bodies,
Ourselves. New York, NY: Simon & Schuster.