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Perimenopause and How to Deal With It

3 of 12 in Series: The Essentials of Women's Sexual Health

Before a woman reaches menopause, she’s in what is called perimenopause. If you feel like you aren’t the “right” age for menopause but you're still experiencing many menopausal symptoms, you're probably going through perimenopause. Luckily, treatments are available to alleviate the symptoms of perimenopause (including the infamous hot flashes).

What is perimenopause?

During perimenopause, the egg-producing follicles in a woman’s ovaries may become resistant to FSH (follicle stimulating hormone), which is what kicks off ovulation. In an attempt to get those eggs released, the body produces extra FSH, causing a spike in estrogen levels. But because the body produces no normal matching increase in progesterone, rather than a steady decline in hormones, a roller-coaster effect results, which may cause a variety of symptoms.

Perimenopause is usually about four years long, but can begin a decade or more earlier or only a few months earlier. Perimenopause may begin with very mild symptoms, but as you approach actual menopause, your symptoms may become more strongly felt.

What does this decrease in hormone production cause? The list of potential symptoms includes:

  • Irregular periods

  • Hot flashes

  • Breast tenderness

  • Fatigue

  • Vaginal dryness

  • Difficulties sleeping

  • Changes in urinary habits (increased need to urinate, possible leaking)

  • Mood swings

  • Depression

  • Changes in your desire for sex

  • Osteoporosis

These symptoms are almost identical to the list of symptoms given for menopause. Since it’s almost impossible to know when you’re entering those last 12 months, it’s natural that the overlap in time would result in an overlap in symptoms.

Treatments for perimenopausal symptoms

First, just being aware of perimenopause can bring you great relief because you’ll at least know that you’re not going crazy. Some symptoms, however, may be best treated with a doctor’s help. Here are some of the most common problems and treatments for women experiencing perimenopause.

  • Abnormal bleeding: Abnormal bleeding may cause your gynecologist to order an endometrial biopsy and/or a dilation and curettage (or D&C). An endometrial biopsy is done in your gynecologist’s office. A small tube is inserted through the cervix into the uterus, and a sample of the endometrium, the lining of the uterus, is extracted for microscopic evaluation. A D&C is an invasive scraping of the uterus done in the operating room under anesthesia. A sonogram may be used as a less invasive alternative to a D&C.

  • Hot flashes: In extreme cases, a doctor may offer hormonal replacement therapy (HRT) as a short-term solution to hot flashes. HRT, however, can cause other problems, so doctors generally avoid this option.

  • Vaginal dryness: The solution to painful intercourse caused by vaginal dryness is to use an artificial lubricant. You also can use a small dose of HRT in localized form (applied directly to your vagina) that is not thought to come with the dangers of full HRT.

    Use products that are made only for sexual lubrication. Petroleum jelly or vegetable oil can certainly do the trick when it comes to protecting your vagina from becoming sore, but your vagina has no way to flush out this oil or other product so it will remain in your vagina where it can become a breeding ground for infection. (Note that douching could push the product through your cervix into your uterus where it will cause even more problems.)

  • Changes in urinary habits: Consult your urologist. Doing Kegel exercises might help, but check with your doctor first.

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The Essentials of Women's Sexual Health

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