For a few decades, the health problems faced by women in relation to reproductive apparatus they are increasingly treated, both by patients and by doctors and the media.
We talk about ailments such as dysmenorrhea, related to the pain we feel when we have the menstrual period; the irregular periods, when the menstrual cycle is shorter or longer than average; wave sexual migraine, which would affect 40% of women who have their period monthly, according to figures from the US Office on Women’s Health (OASH).
However, there is a reproductive health problem that affects an important group of women but that does not usually receive much publicity from doctors and, therefore, usually unnoticed for the women.
We refer to the perimenopausia, which is often confused with the menopausal period, which is the time that marks the end of menstrual cycles for women.
What is perimenopause?
The menopausal transition, better known as perimenopause, is the period of a woman’s reproductive life prior to menopause. In other words, it is a kind of transitional stage that marks the end of fertile life and anticipates the arrival of menopause, reported the prestigious Mayo Clinic.
Since May they indicated that this period is characterized by a irregular estrogen and progesterone production, which increases and decreases. Many of the changes that are experienced during perimenopause, and that we will see later, are due to the decrease in estrogen.
Additionally, they noted that women face perimenopause at different ages. “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your forties. But some women notice changes as soon as mid 30’s“, Indicated the clinic.
There are believed to be some risk factor’s that predispose women to perimenopause such as smoking, family history – women with a history of early menopause -, cancer treatment with chemotherapy or pelvic radiation therapy, and hysterectomy – surgery to remove the uterus.
The truth is that, once you have gone for 12 consecutive months without a menstrual period, you have officially reached menopause.
According to the Mayo Clinic, during the entire transition to menopause some subtle and even not so subtle changes occur in the body. Among them, the following stand out:
– Irregular menstrual periods: “As ovulation becomes more unpredictable, the time between one period and another could be longer or shorter. Also, the flow can be light or heavy, and you may sometimes miss your period. “
– Hot flashes and trouble sleeping: “Hot flashes are common during perimenopause. Its intensity, duration and frequency usually vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable, even without them. “
– Humor changes: “During perimenopause you may experience mood swings, irritability, or an increased risk of depression.”
– Vaginal and bladder problems: “When estrogen levels drop, vaginal tissues can lose lubrication and elasticity, making intercourse painful. Low estrogen can also make you more vulnerable to vaginal infections. The loss of tissue tone (of the tissues) can contribute to urinary incontinence ”.
– Decrease in fertility: “As ovulation becomes irregular, your ability to conceive decreases. However, as long as you have menstrual periods, it is still possible to conceive. “
– Changes in sexual function: “During perimenopause, sex drive and desire can change. However, if your sexual intimacy had been satisfactory before menopause, chances are that it will continue to be so during and after perimenopause.
– Bone loss: “With decreased estrogen levels, you start to lose bone faster than you replace it, which increases your risk of osteoporosis (a disease that causes bones to become brittle).”
– Changes in cholesterol levels: “The decrease in estrogen levels can generate unfavorable changes in blood cholesterol levels.”
When should you go to the doctor?
Considering that symptoms can be subtle and they appear gradually, many women probably do not realize that these signs are related to the same phenomenon: the rise and fall of estrogen and progesterone levels.
Other women, meanwhile, seek medical attention while a group simply do not have symptoms severe enough to require medical attention.
However, if you present problems that interfere with your life or well-being – such as hot flashes, mood swings or changes in sexual function – you should consult with your doctor.
In addition to this, the Mayo Clinic emphasizes that sometimes perimenopause causes complications that must be treated as soon as possible. An example of them is when the bleeding is very heavy, that is, you should change tampons or sanitary pads every one or two hours; when the bleeding lasts more than seven days; when there is bleeding between periods; or when you have periods with less than 21 days of differences.
All of these signs may mean that there is a problem with your reproductive system requiring diagnosis and treatment.
The problem that nobody talks about
Although it is a reproductive health problem that affects many women, the truth is that the concept of perimenopause is not very widespread in society.
This was pointed out Arianna Sholes-Douglas, an obstetrician-gynecologist and comprehensive health physician interviewed by The Huffington Post, who recalls that her perimenopausal period began while performing a cesarean section.
“My mind went completely blank. He did not remember what to do. I was very scared and did not know who to talk to or what to do, “he said about the fact that marked a before and after with respect to this condition.
Although at first she thought she was suffering from an early symptom of Alzheimer’s, she soon discovered that her problems had a hormonal origin that even she, a specialist in women’s health, could not detect.
“They have not educated us. Neither the patients nor the doctors. Women have not been able to rely on a reliable source of information and almost all of them are caught off guard by this transition. In people’s minds, menopause is a problem for older women that appears when they stop having periods, “explained Sholes-Douglas, who after her experience decided to write the book” The Myth of Menopause. “
Angie McKaig, a Canadian banker, also suffered with perimenopausal symptoms without knowing what she was dealing with. It all started after her mother passed away in 2018. At that time she had irregular periods, hot flashes, insomnia and excessive hair loss, in addition to memory problems that she described “As if someone had taken my brain and shook it” until leaving it blank, as he told The New York Times.
At the time, like Sholes-Douglas, she thought she might have premature Alzheimer’s or that her changes were a physical response to her grief, until her therapist told her that her symptoms were characteristic of perimenopause.
“I realized how little the subject is addressed, and the little information they provide us. So I’ve tried to normalize it, ”McKaig said.
In the words of Purple nightingale, professor of obstetrics and gynecology at New York University Grossman School of Medicine, who has been treating perimenopausal women for 50 years, “We hear the same thing: ‘Nobody warned me, my mother never told me’And the same thing happened to me many years ago with my mother ”.
Despite all the “secrecy” surrounding this problem, the truth is that the future provides hope.
The future of perimenopause
According to Stephanie Faubion, medical director of the North American Menopause Society, medicine is currently going through what she calls the “menopause management vacuum.” This means that there is no single medical specialty that can be considered the “owner” of treatment for menopausal and perimenopausal women, as symptoms affect many different systems and parts of the body.
In addition to the above, the medical world faces the problem that less than 7% of residents feel “sufficiently prepared” to treat women experiencing menopause, according to a 2017 survey posted on the Mayo Clinic website.
Despite this, there are “spokespersons” like Angie McKaig herself who tries to spread everything related to perimenopause at the micro level. At the same time, with increasing frequency we see health services companies, beauty companies and writers who seek to make this reality visible but at a macro level.
Examples of these are the telemedicine providers Elektra Health and Gennev, which are entering the perimenopause market; Stacy London, hairstylist and TV star who founded a skin care company called The State of Menopause; and celebrities like Gwyneth Paltrow Y Michelle Obama, who have spoken openly about their perimenopausal symptoms.
“When you think about everything a woman’s body has to do throughout her life, going from being ready to give birth to giving birth, and then having the entire reproductive system shut down at menopause, right? ? The changes, highs and lows, and hormonal changes, there is power in that. But they taught us to be ashamed of it (our body) and not even seek to understand or explore it for our own edification, much less to help the next generation, ”the former US First Lady said in 2020 in a podcast of Spotify, reported by Harper’s Bazaar magazine.
Precisely talking about perimenopause and its diverse symptoms seems to be the key.
Lucy Hutner, a reproductive psychiatrist in New York, told The New York Times that “I actually think it’s extremely vital change the conversation. Because a lot of what you hear about perimenopause is discriminatory towards women and the elderly ”. He added that many of his patients who are experiencing these changes feel very empowered, increasingly resilient and following their “internal compass.”
Anyway, the universal advice is the following: listen to your body, connect with the signals that it sends you and, if you think something is “different”, do not hesitate to seek medical help to treat the symptoms of perimenopause.