Perimenopause symptoms are wide ranging and, for some women, can severely affect their quality of life, writes Kasmiah Mustapha
LEELA (not her real name) experienced heavy flows during menstruation when she turned 49.
At times, her clothes would be stained within seconds, forcing her to go home and change. She also had to deal with cramps, hot flashes and mood swings.
It became so bad that she sought treatment for her condition. The doctor said she was experiencing perimenopause symptoms. As her symptoms were very severe, the doctor told Leela that the best option was to remove her ovaries. With three grown-up children and no intention of having more, she decided to opt for the surgery.
Once her ovaries wre removed, she no longer experienced the symptoms. While she experienced early menopause, Leela, who is now in her 60s, did not regret the decision. The most important thing for her was that she did not have to deal with the symptoms which were affecting her quality of life.
Consultant obstetrician and gynaecologist Dr Wong Kim Lei said reaching menopause is a gradual process so some women do not realise the symptoms they are facing.
Women experience perimenopause anytime between 40 and 60 years of age. Symptoms usually last four to five years. However, perimenopause can stretch to as long as 12-15 years for some women, and as few as one to two years for others.
“Perimenopause is a time of significant change. It can be more troubling than menopause due to the symptoms being strange, unexpected and new,” said Dr Wong.
“However not all women will experience the symptoms. Some will experience varying symptoms and none will have the same symptom.”
The Malaysian Menopause Society president said the symptoms are the signs of fluctuating hormone levels. As oestrogen levels fluctuate during perimenopause, various changes in the body will invariably take place since the hormone helps regulate more than 400 different functions in women.
“What I tend to see in perimenopausal women is a condition where hormone levels are neither high or low but frequently high and low. It is this erratic behaviour that triggers the symptoms,” she said.
NOT THE SAME
Different women experience perimenopause at different times of their lives because they are born with different number of ovarian oocytes (egg cell). Smoking, severe dieting, a history of hysterectomy with conservation of ovaries, medical diseases such as autoimmune disease also contribute to earlier menopause.
“Unless women are aware of what is happening and are taking steps to prepare the body nutritionally, mentally and emotionally, many go through difficult times without understanding what is happening. As hormones control so many key features of a woman’s femininity, she will start experiencing various symptoms which can make her feel unfeminine during perimenopause,” says Dr Wong who was speaking at a workshop on Embracing Femininity organised by Nuvaceuticals aimed at raising awareness of perimenopause.
While there are 30 associated symptoms of perimenopause, the most common are tiredness, musculo-skeletal aches and pain, night sweat, vaginal discomfort and hot flashes.
The changes in hormone levels also lead to a disruption in a chain of biochemical activities. They will affect the production of mood-regulating chemicals including serotonin and endorphins in the brain. This can cause mood disturbances and depression including irritability, out-of-proportion anger, sadness and poor concentration.
MENTAL CHANGES
Clinical psychologist Dr Hariyati Shahrima Abdul Majid said perimenopause brings psychological and mental changes but some women are unaware of them. Unfortunately as we live in a conservative society, it is probably the least discussed subject and because of this many suffer in silence, not being able to understand what they are going through.
“I want women to know if they are having a tough time coping, feeling angry and more often than not living in dread, this is not due to some character flaw or psychological defect. The symptoms, struggles and difficulties attributed to perimenopause are universal and the body is going through an inevitable physical, psychological and emotional change,” said Dr Hariyati.
“It may be nature’s way of telling women to care for themselves more now. And they should find ways to manage the symptoms. Husbands also need to educate themselves about perimenopause and be more supportive.”
Perimenopause is a natural stage of a woman’s life and does not require any medical treatment. A well-balanced diet, exercise and relaxation of the mind and body are important to stay healthy and cope with these changes.
Dr Wong said: “However, in some women, the hormonal changes may occur suddenly or the hormones levels may fluctuate drastically. In these cases, the physical, mental and emotional effects of perimenopause may be strong and this can significantly disrupt their daily lives. In these cases, palliative medical therapy may sometimes be appropriate.
“Nutritional supplements rich in plants oestrogens (phytooestrogens) called isoflavones are helpful for these women. A good example is the genistein and diadzein found in soya beans. In some cases, the women are advised to seek help from healthcare professionals. Hormonal replacement or other medical therapies may sometimes be appropriate.”
REPRODUCTIVE LIFE
There are four stages of menopause:
• Premenopause: Refers to the entirety of a woman’s life from her first to her last regular menstrual period. It is best defined as a time of “normal” reproductive function in a woman.
• Perimenopause: Means “around menopause” and is a transitional stage of two to 10 years before complete cessation of the menstrual period and is usually experienced by women aged 35-50.
This stage of menopause is characterised by hormone fluctuations, which cause the typical menopause symptoms, such as hot flashes.
• Menopause: The end stage of a natural transition in a woman’s reproductive life.
Menopause is the point at which oestrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs and a woman is no longer able to get pregnant naturally.
• Postmenopause: Refers to a woman’s time of life after menopause has occurred. It is generally believed that the postmenopausal phase begins 12 months after the last menstrual period.
All four stages are characterised by different changes and symptoms. Perimenopause, the second stage of the menopause process, may be the most recognisable and famous stage of the process. While perimenopause symptoms may be difficult to endure, they are not impossible to address.
Making lifestyle changes may help ease the discomfort of symptoms and keep women healthy in the long run.
https://www.nst.com.my/news/2015/09/coping-menopause-symptoms