Understanding Perimenopause and menopause Symptoms, Diagnosis, and Treatment Options
As we age, the body produces lower levels of key sex hormones like progesterone, estrogen, and testosterone. This decline can lead to significant changes in both the mind and body. Menopause, which typically occurs around age 51, is marked by 12 consecutive months without a period. However, there’s an important phase leading up to menopause known as perimenopause. During perimenopause, you may experience a range of unusual symptoms, and your perimenopause symptoms could begin as early as 10 years prior to your actual menopause.
The symptoms of perimenopause are often vague and can be difficult to pinpoint, making it hard to recognize when this phase is ending. For many women, perimenopause symptoms can be more intense than those of menopause itself. It’s essential to pay attention to these early signs and manage them effectively, so you can step off the hormonal roller coaster before menopause fully arrives.
Most women with perimenopause may experience the following symptoms, but not limited to: anxiety, irritability, skin and hair changes, difficulty sleeping, discomfort during sex, hot flushes, increases in facial hair, night sweats, weight gain, etc.
How can we diagnose perimenopause?
Many labs may help to understand your perimenopause. Those labs include estradiol, progesterone, Testosterone, DHEA (If doing Saliva DHEA-S), progesterone to estradiol ratio, baseline CMP (rule out liver and renal issues), baseline CBC (will show anemia if menorrhagia is severe, normal period should not cause anemia), lipids (at least a baseline at age 25 and every 5 years if no other risk factors), baseline TSH, FT3, FT4 (thyroid imbalance can cause menstrual irregularity)
Treatment Options
Oral:
Hormone replacement like estradiol and progesterone can effectively alleviate symptoms. Also, some herbal and natural supplements are available. It may take longer to see/feel symptom relief.
Creams:
Topical creams with estradiol, progesterone, and testosterone deliver targeted, localized relief. Skin absorbs better and faster than our gut!
Pellets:
Implantable hormone pellets provide a steady release of hormones, offering long-lasting symptom management. Only placed by trained providers, and dose adjustment can be difficult once it is implanted under your skin.
Oral hormones may be covered by insurance with a co-pay, while creams and pellets are typically not covered.
Risks Associated with HRT
In the largest clinical trial to date, hormone replacement therapy using an estrogen-progestin pill (Prempro) was linked to an increased risk of several serious conditions, including:
Age: Women who start hormone therapy at age 60 or older, or more than 10 years after the onset of menopause, have a higher risk for these conditions. However, starting hormone therapy before age 60 or within 10 years of menopause seems to offer benefits that may outweigh the risks.
All of these risks should be carefully considered by both you and your provider when deciding whether hormone therapy is an appropriate option.
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