Menopause, Part 2

​Menopause: a time of change; a point in a woman’s life that most have heard about and will eventually
experience. The time leading up to this point, however, is less known and not well understood by many
women. This transitional period is PERIMENOPAUSE and can last for a few months to several years. It is
during this phase that women begin to experience the full weight of reduced ovarian function, resulting
in hot flashes/night sweats, decreased sex drive, sleep disturbances, and mood changes as well as many
other bothersome symptoms. Let’s try to understand the “WHYs” of these symptoms.
Hot flashes and night sweats (hot flashes during sleep) are, perhaps, the most widely recognized
symptoms of perimenopause. Clinically known as vasomotor symptoms, hot flashes are experienced as a
sudden, intense feeling of heat, mostly in the upper body. These are the result of disturbances of
temperature regulation in the brain. Even though the episodes are brief, typically lasting only a few
minutes, they may be debilitating for some, often accompanied by intense sweating, chills, and rapid
heart rate.
The brain contains a wide distribution of estrogen receptors, including areas involving mood regulation.
Though not completely understood big swings in estrogen levels, like those that occur in the
perimenopausal phase, result in mood symptoms (irritability, anger, lability), “brain fog,” sleep changes,
and decreased libido. Lifestyle behaviors (nutrition, exercise, nicotine use), stressful life circumstances,
and the severity of perimenopausal symptoms also play a role in mood changes.
Decreasing amounts of estrogen also result in unwelcomed vaginal and urinary changes, such as vaginal
dryness and burning, pain with sex, pain with urination, and leaking of urine. As levels of estrogen drop
the tissue of the vagina becomes less pliable and less estrogen-produced lubricant is available, creating a
drier, tighter vagina and urethra. This makes sex less comfortable and, if pain is associated with sex, less
desirable. Peeing can become painful, more frequent, and less controlled as the moisture and stretch
are lost.
One begins to see the overlapping of brain and body changes which magnify the personal experiences of
the perimenopausal transition. But there is hope! Next time: To Treat of Not to Treat- What are the
Options? Until then, BE WELL! BE KIND! SEEK JOY!