Perimenopause or the Menopausal Journey

You don’t suddenly experience symptoms out of nowhere. The process begins with perimenopause, a transitionary phase. This stage usually occurs eight to ten before you go through full menopause. It usually starts during your early 40s, but some can begin experiencing symptoms in their 30s.

So what happens in perimenopausal women?

At this point, estrogen and progesterone, the hormones that control the menstrual cycle, start to fluctuate. The ovaries produce these hormones more sporadically, leading to uneven spikes and dips. Because they directly impact menstruation, periods can become hard to predict. They may be shorter or longer, and women sometimes experience cycles where they don’t release an egg. In short, the work of the ovaries becomes unreliable and unpredictable. 

As you can imagine, hormonal shifts can wreak havoc on your body. It’s not just your reproductive system that becomes unpredictable. Perimenopausal women often go through sleepless nights, noticeable mood changes, and hot flashes that come out of nowhere. Other possible symptoms include:

• Painful intercourse
• Increased susceptibility to urinary tract infections
• Urinary incontinence
• Bone loss
• Changing cholesterol levels
• Irritability
• Depression
• Hair loss
• Fertility issues
• Changing libido

RELATED: Are You Experiencing Perimenopause Symptoms?

Menopause

Perimenopausal women will continue dealing with unpredictable hormone production until they hit menopause. Perimenopause is officially over when it’s been 12 months since the last period.

At this point, hormonal changes are less sporadic. The ovaries no longer produce an egg, and the constant fluctuation of estrogen and progesterone levels is over. Instead of jumping all over the place, these hormones and testosterone are at their lowest level yet. The body still produces the hormones, but they’re at a deficient levels.

Despite having a little more stability, the lack of hormones like estrogen still causes many problems. Many of the standard systems you see in perimenopausal women occur. For example, hot flashes and trouble sleeping often persist. But outside of those issues, you may also experience the following symptoms:

• Vaginal dryness
• Dry skin
• Night sweats
• Joint and muscle aches
• Memory lapse
• Headaches
• Racing heartbeat
• Hair loss
• Significantly reduced sex drive

Mood problems can continue to be a problem as well. Many menopausal women suffer from depression, erratic mood swings, and irritability.

Heart and Bone Problems:

Among the many organs benefiting from the ovarian hormone production, our heart and bones are the most crucial to our health. Hormonal fluctuations in perimenopause and menopause increase the risk of heart attacks 10x risks prior. Bone loss also increases dramatically due to hormonal insufficiency and bone fractures become a serious issue during the menopausal years. These conditions are the most common cause of mortality and disability in menopausal years. 

Should You Contact a Doctor?

Dr. Tahery specializes in working with nature to optimize your health during perimenopause and menopause. Dr. Tahery as a urogynecologist and female hormonal specialist has been helping women navigate the health and quality of life issues in these crucial years for the past 26 years.

RELATED: Menopause and Bio-Identical Hormones

Perimenopause and Menopause Treatment

Menopause is inevitable, and there’s no way to prevent it from occurring. However, there are many options for treating the many conditions affecting the health and quality of life. 

Hormone Therapy

Hormone therapy is a way to address what’s going on inside the body directly. During the perimenopausal stage, your testosterone, estrogen and progesterone levels are all over the place. Hormone therapy can provide more balance and increase low hormone levels before, during, and after menopause bringing health and improving quality of life.

More and more we realize the potential in safe and effective methods of hormone therapy. Studies show significant benefit in women using hormones to counter the changes brought by lack of hormones in their body. Early use of hormones has shown to be most beneficial in supporting the heart and bone health and the many other issues that come with menopause. 

Dr.Tahery specializes and is experienced in using the multiple ways of delivering hormones that are appropriate for each individual. 

Anxiety and Stress

Perimenopause and menopause is also a time of significant personal and social change. Teenage children, (do I need to say more?) work issues, relationship changes,  loss or elderly parents are some of the environmental factors many encounter. Therefore, Anxiety and stress are common symptoms many women deal with and they are crucial to be addressed. 

Dr. Tahery will work with you to find the proper treatment through mind and body care. 

Lifestyle Changes

Dr. Tahery understands that each woman experiences perimenopause and menopause differently. Depending on the needs of your body, we recommend lifestyle changes to improve your health. 

One of the most common complaints in perimenopause and menopause is weight gain and reduced metabolism. Exercise and menopausal diet is one of the core principle of perimenopause and menopausal health. 

Dr. Tahery works with expert dieticians and therapists when needed to optimize health and well-being. 

Whether you’re struggling with the impact of early perimenopause or deep in a change of life, don’t hesitate to contact the offices of Dr. Michael Tahery. As an expert Urogynecologist and female hormone specialist with many years of experience in Los Angeles, Dr. Tahery has the expertise to help you through this transition. Reach out today to schedule your appointment.

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Not to be confused with premenopause, perimenopause affects all women differently. Some will notice changes in their 30s. However, others may go through this stage for only a few months before reaching menopause.

Either way, the body’s production of estrogen rises and falls unevenly. As a result, women experience a wide range of perimenopause symptoms. Fortunately, treatment options are available to ease the transition. Here are some of the most common symptoms women can experience:

Irregular Periods

Erratic periods are standard during perimenopause. Ovulation becomes more unpredictable, leading to changes in the flow and length of periods. The space between periods can vary as well.

The changes can be so significant that some women assume they have entered menopause. Despite the drop in fertility, it’s still possible to get pregnant during perimenopause. It’s only when a period doesn’t occur for 12 months that doctors typically diagnose full menopause.

A specialist may recommend treatment options if symptoms begin to interfere with daily life. These may include hormone therapy, lifestyle changes, and more.

RELATED: 4 Common Reasons You Might Be Experiencing Irregular Periods

Hot Flashes

Hot flashes are an infamous sign of menopause. However, these bouts of sudden body heat can occur during perimenopause, too. They’re one of the most common symptoms, affecting more than two-thirds of women heading into menopause.

Characterized by an intense wave of heat over the face, neck, and chest, hot flashes can result in profuse sweating and sleeping issues. The frequency and severity of hot flashes vary based on the hormonal changes within.

Luckily, a specialist can help manage hot flashes with hormone treatments like birth control, patches, gels, and more.

Mood Swings

Not all perimenopause symptoms are physical. In many cases, the transitional period causes noticeable emotional instability. Sometimes called “Perimenopause Rage,” these mood swings differ from standard anger or frustration.

Some women describe it as a sudden shift to intense irritation, resentment, or a lack of patience.

Mood swings occur for a variety of reasons. They could be a product of sleep disruption from hot flashes or outside factors. Internally, there’s a chemical reason for the emotional shift.

Estrogen impacts the release of serotonin, the body’s mood regulator hormone. With erratic estrogen production, serotonin levels become unstable. With time lost symptoms improve as the body adjusts to a low hormonal environment.

RELATED: Menopause and Brain Fog

Weight Gain

Weight fluctuations are prevalent in perimenopausal women. Studies suggest that lower estrogen levels change how the body stores fat. Throughout the reproductive stage, women store fat in the hips and thighs. It’s subcutaneous fat, which is usually harmless and doesn’t increase one’s risk of disease.

However, during perimenopause, the dip in estrogen causes the body to store fat in the belly area. It takes the form of visceral fat. Unfortunately, visceral fat comes with higher risks of heart disease, insulin resistance, and a range of health problems.

Of all the perimenopause symptoms, this is one that many women overlook. A crucial part of treatment is to adopt a healthier lifestyle to combat weight gain.

RELATED: Weight management in Los Angeles

Vaginal Dryness

The vaginal tissue can suffer significantly during perimenopause. Estrogen is a vital hormone that governs vaginal elasticity and natural lubrication. When this hormone’s presence in the body decreases, dryness occurs, and vaginal tissue thins. 

The dehydration is not just limited to the vaginal tissue. Many women experience it on the face and other parts of the body as well. However, vaginal dryness can affect sexual health and comfort. Furthermore, a lack of moisture and resilience may make women more vulnerable to vaginal and bladder infections. 

Vaginal dryness is one of those perimenopause symptoms that many women don’t bring up to their specialist. But, there are plenty of treatment options to stave off the effects of hormonal changes.

If you notice any of these perimenopause symptoms, go to a specialist like Dr. Tahery for professional care. Dr. Michael Tahery is a urogynecologist who specializes in both women’s health and urology. He’s spent the last two decades helping women in the Los Angeles area manage this life change. Call us today to schedule an appointment.

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Researchers hypothesis that during premenstrual, postpartum, and perimenopausal transition women are particularly sensitive to changes in their bodies hormonal environment . Each of these stages are characterized by large fluctuations in ovarian hormone production that cause similar depressive effects. 45-68% of perimenopausal women have been found to have elevated depressive syndrome.

Women at high risk for PMDD are those with history of antidepressant use, premenstrual depressive symptoms(PMS), anxiety, and social issues such as social isolation and major stressful life events. Added pressure of caring for young children, aging parents, and at the same time managing a career without support increases the risk for PMDD.

The challenge in diagnosing PMDD is separating perimenopausal and psychiatric symptoms. It is also important to recognize physical, social, emotional, and financial stresses creating added pressure on a woman’s condition. Having a low threshold and educating women during perimenopausal transition to recognize and report to a physician the depressive symptoms is crucial in early diagnosis.

The principal components of treatment are aggressive, early treatment, and close follow up.
In my practice treatment begins with educating women during perimenopausal transition to recognize the life stresses and learn to cope with them appropriately and recognize the depressive symptoms. I use exercise, bio-identical hormones, and diet as the first line of therapy in PMDD. Even though life changing this condition can be treated and managed effectively in the majority of cases in this fashion. Close evaluation and follow up may indicate further treatment with anti-anxiety medication and psychotherapy.

If you recognize these symptoms in yourself or any of the women around you at any stage of life, we are here to help.

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These are the most common questions I am asked from women transitioning through perimenopause or in menopause. Women concerned about changes they see in themselves, friends, or family seek ways to either make it easier or prevent unwanted changes associated with reduced hormones.

Changes that are most reported are hot flushes, fatigue, insomnia, vaginal dryness, mood changes, mental fogginess, decreased libido, and weight gain in the mid abdomen. Long term, hair loss, loss of skin elasticity, decreased muscle tone, and reduced metabolism also occurs.

Reduced hormones during perimenopause and menopause increase the risk of heart attack by 10 fold, causes gradual weakness in the bones or osteoporosis, and worsen vaginal prolapse and urinary control problems.

The controversies surrounding the safety of hormone therapy that has raged for the past 30 years now is settled by several major studies. These studies show hormone therapy as a significant part of women’s health in perimenopause and menopause.

RELATED: Menopause Care in Los Angeles

Studies also show that starting hormones in perimenopause or very quickly after menopause has the least risk and the greatest benefit. These benefits last as long as the hormones are used. We have also found that hormone customization is the best way to approach hormone replacement. We are all different and are affected differently as we go through the change of life. Evaluating a woman’s symptoms and testing guide the type of hormones her body needs and close follow up allows for adjusting the dosage for complete resolution of symptoms.

In my practice we use bioidentical hormones. These hormones are sourced from soy and yam and compounded to resemble the hormones naturally produced by a woman’s body. I feel that this similarity in hormone structure to natural hormones allow better acceptability and efficacy and minimize side effects. Also using creams to deliver the hormones through the skin has shown to eliminate the risk of deep venous blood clots, stroke, and heart attacks, a major concern with other delivery methods. The goal of hormone replacement is to maximize benefit and minimize risk.

RELATED: Are you experiencing perimenopause symptoms?

Most women are good candidates for hormone replacement therapy with promise of better health and quality of life. If you are on hormone therapy and looking for better results, or thinking about starting, we are happy to see you. Please call us with questions or make an appointment for a consultation.

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‘Menopause-related cognitive impairment happens to women in their 40s and 50s, women in the prime of life who suddenly have the rug pulled out from under them,’ an expert says.

By Jane E. Brody (article from The New York Times)

Dec. 17, 2018

Dr. Gayatri Devi’s patient, a 55-year-old former headmistress, had good reason to be distraught. The woman had a yearlong history of progressive memory loss and behavioral problems and was referred to Dr. Devi, a neurologist, with a possible diagnosis of frontotemporal dementia.

As Dr. Devi recounted in the journal Obstetrics & Gynecology, the woman’s once prodigious memory had seriously deteriorated and she’d become increasingly irritable. She had difficulty organizing tasks, keeping track of belongings, setting goals, making plans and seeing them through. Yet the results of medical and neurological tests and brain scans were normal.

Noting that the woman had gone through menopause a year earlier, Dr. Devi traced her symptoms to the decline in estrogen stimulation of the brain that occurs in all women at menopause with varying effects. Some are more sensitive to falling estrogen levels than others.

With a likely diagnosis of menopause-related cognitive impairment, the doctor prescribed hormone-replacement therapy. Within 15 months, the woman’s behavioral symptoms had disappeared and her learning ability and memory were back to normal. She was able to complete a demanding graduate program and assume a new leadership position in education.

This woman’s case was admittedly extreme, but Dr. Devi told me that “60 percent of women go through menopause-related cognitive impairment” that, when serious enough to be brought to medical attention, is too often misdiagnosed as “mild cognitive impairment,” a precursor to dementia.

Menopause-related cognitive symptoms are very similar to “chemo brain,” a common complaint among women treated for breast cancer and in some men treated for prostate cancer. Treatment of both diseases often results in an abrupt drop in estrogen levels. People with so-called brain fog following cancer treatment “have trouble with short-term memory, multitasking, coming up with words and putting cogent thoughts together,” said Dr. Devi, an attending neurologist at Lenox Hill Hospital in New York and clinical professor of neurology at SUNY Downstate Medical Center in Brooklyn.

“Menopause-related cognitive impairment happens to women in their 40s and 50s, women in the prime of life who suddenly have the rug pulled out from under them,” she said. Yet, she believes, the correct diagnosis is missed more often than not.

“Women with menopause-related cognitive impairment are afraid they’re developing some form of dementia, but if they go to a memory disorder specialist, they may not get the right diagnosis,” Dr. Devi said in an interview. Internists may check for thyroid disease, a vitamin deficiency or infection, but rarely connect the woman’s menstrual history to her cognitive symptoms, she said.

Dr. Devi chose to publish her report in the obstetric journal because many women in midlife use their gynecologist as their primary care physician “and I want them to know this condition exists and often responds to short-term treatment with estrogen to tide the brain over.”

In an accompanying editorial, Pauline M. Maki, a professor of psychiatry and psychology at the University of Illinois at Chicago, noted that “not only do women more frequently report cognitive difficulties as they transition from premenopause to perimenopause to postmenopause, but they also perform more poorly on standardized neuropsychological tests, particularly tests of verbal memory, aspects of executive function, and processing speed.”

Women often describe these deficits as “brain fog,” and they and their doctors may blame the sleep deprivation associated with hot flashes and night sweats, which are definitely “taxing to the brain,” Dr. Maki said. But while these common menopausal symptoms can add to the severity of memory problems, they are not the primary cause of cognitive issues in these women, she said.

A six-year study of 1,903 women who were at midlife found that menopause-related symptoms like depression, anxiety, sleep disturbance and hot flashes did not account for declines in memory, learning and how fast the brain processes information during the menopause transition.

“The most helpful thing we can do is to normalize these experiences for women who are transitioning through the menopause and let them know that women’s brains are sensitive to fluctuating levels of estrogen, both in terms of cognitive ability and mood,” Dr. Maki said.

In fact, symptoms similar to those in menopausal women affect many women premenstrually, when there is a short-lived drop in circulating estrogen. But unlike a normal menstrual cycle, the transition through menopause is gradual and typically takes months and sometimes years, making it harder to recognize its link to cognitive problems. Estrogen levels usually start to decline around age 45, but a woman may not become postmenopausal until age 50 or later, when menstrual bleeding stops for at least a year and very little estrogen is released by her ovaries.

The other critically important fact that all women transitioning through menopause should know is that the brain and mood effects are temporary, said Dr. Gail A. Greendale, a specialist in geriatrics and women’s health at the David Geffen School of Medicine and the University of California, Los Angeles. The postmenopausal brain, it seems, adjusts to having little or no estrogen on board.

In a study Dr. Greendale directed that followed 2,362 women for four years, declines in memory and learning ability that characterized their transition through menopause rebounded postmenopausally, “suggesting that menopause transition-related cognitive difficulties may be time-limited,” she and colleagues concluded.

“The brain fog when women’s brains seem not to be hitting on all eight cylinders is temporary,” Dr. Greendale said in an interview. “During the menopause transition, a woman’s brain may feel a little off, a little muddy, but when the transition passes, the clouds clear and the fog lifts. Sometimes all a woman needs to know is that this too shall pass.”

However, for women unwilling or unable to ride out the transition, Dr. Maki said treatment options, in addition to hormone replacement, include following a Mediterranean diet, brisk walking and minimizing alcohol consumption. Those who can safely take estrogen should know that participants in the Women’s Health Initiative, a large government study of postmenopausal women, who were randomized to take hormone replacements starting in their 50s had a lower mortality rate and were less likely to die of Alzheimer’s disease during an 18-year follow-up.

In 2015, the North American Menopause Society reviewed nonhormonal treatments for hot flashes, several of which may also relieve cognitive symptoms. One is a low dose of the antidepressant paroxetine (Paxil). Another is gabapentin, an anticonvulsant and pain reliever that hooks onto estrogen receptors in the brain.

The critical message, Dr. Maki said, is that menopause-related cognitive issues “need not compromise a woman’s quality of life,” though women may have to be proactive for the condition to be properly diagnosed and treated.

Jane Brody is the Personal Health columnist, a position she has held since 1976. She has written more than a dozen books including the best sellers “Jane Brody’s Nutrition Book” and “Jane Brody’s Good Food Book.”

A version of this article appears in print on Dec. 17, 2018, on Page D5 of the New York edition with the headline: The Brain Fog of Menopause Can Burn Off. Order Reprints

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The changes in a woman’s body that eventually result in the symptoms mentioned above start long before the actual symptoms present themselves, which is why physicians should be watchful during yearly exams for any early signs. Also, women going through these hormonal changes should be aware of changes in their body and report any symptoms to their physicians.

There are several treatment options and each needs to be personalized based on the current level of discomfort and need. However, prevention is always the best policy.

Early hormonal replacement can prevent these changes from occurring. In our office, we prefer natural hormone therapy as it offers minimal adverse effects and maximal benefits to the affected area. We synthesize the hormones naturally and therefore have control over the dosage and ensure that the chemical structure is similar to the ones naturally produced in a woman’s body.

Non-hormonal options are also available for few patients that do not qualify for hormone therapy. This type of medication increases lubrication and reduce symptoms associated with menopause during use.

Evaluation of the bladder can help your doctor determine the exact nature of the urinary problem that may have gotten worse after menopause. Many options are then available to address these issues before they turn into major problems.

Kegel exercise, modification of diet and fluid intake and weight loss help strengthen the pelvic muscles and improve the function of the genital and urinary organs, keeping you healthy and improve the quality of life during this next stage of life.

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