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I am a 49 year old woman and have started to have an irregular period and hot flashes.  Is there anything I can do or do I have to just put up with them?


Menopause – What is it?

It is the permanent end of menstruation.  It is NOT a disease but a time of transition.  It can have a huge impact on a woman and her well being.


What causes it?

Age is the leading cause of menopause.  Over the course of a woman’s life time her ovaries gradually slow down their function and end the potential for childbearing.  Other causes include surgery and other medical treatments, such as chemotherapy or radiation.  If surgery is performed to remove the uterus the woman is not necessarily in menopause because the ovaries will still function but the woman will not have a period.


When does it start?

Average age is aroundn51 years old according to the National Institute on Aging.  Women who are smokers tend to go through menopause slightly earlier.  There is no proven way to predict the onset of menopause.  Confirmation of menopause happens only after a woman has completely missed her menstrual cycle for 12 consecutive months.


What is the difference between perimenopause and menopause?

The ovaries gradually stop working and as her cycle becomes more irregular she still has the ability to become pregnant.  Despite the fact her cycles are irregular she can still ovulate and subsequently become pregnant.  Perimenopause is also not predictable in terms of time frame or how long it will last.


What to expect?

Menopause is not a one size fits all event.  It affects each woman differently.  Some women reach natural menopause without any difficulty or symptoms.  Others experience severe symptoms including night sweats, hot flashes, vaginal dryness, decreased cognition and irritability.  It is often more difficult for women forced into menopause by surgery or medical treatment.


Signs of Menopause

  • Changes in a women’s menstrual cycle is usually one of the first signs of menopause.  Her cycle may be longer or shorter, heavier or lighter, with more or less time between cycles.  When this starts the changes can be normal but it the periods become very close together or last longer than a week a doctor should be consulted to be sure there is no other cause other than perimenopause.
  • Hot flashes or flushes are common during perimenopause. A hot flash is a brief period of time that a woman feels hot to the point that she flushes on her face or neck causing temporary red blotches on her neck, chest, back and arms.  Sweating and chills often follow.  They typically last 30 seconds to 10 minutes and differ in intensity.  Hot flashes can be decreased by wearing light layers, using a fan, getting regular exercise, avoiding spicy foods and managing stress levels.  The actual cause is still unknown but most likely related to circulation.  The duration of hot flashes is also not known.  Some women have hot flashes for a short period of time but some may have them to some degree for the rest of their life.  Generally they lessen in intensity over time.  To decrease or prevent hot flashes women should avoid caffeine, tight clothing, alcohol and cigarette smoking.
  • Sleep Issues including night sweats are another sign of perimenopause. Essentially, night sweats are night hot flashes.  This can wake a woman up due to heavy sweating and make it difficult to fall back to sleep.  To decrease the frequency of night sweats a woman can use a fan, avoid heavy bedding, keep a damp cloth close by and keep pets out of your bed because they can give off heat.  A healthcare provider can be contacted also to see if the hormone imbalance that is caused by the ovaries slowly decreasing function can be evaluated and treated with replacement if appropriate to decrease night sweats and hot flashes as well.
  • Problems with sex and a low libido is another sign of menopause and can and should be addressed also. Decreased estrogen can lead to vaginal dryness which may make intercourse uncomfortable or even painful.  Water soluble lubrication can be used to decrease discomfort.  Libido can also change for the better or worse.  Many factors other than menopause can affect sex drive also including stress, medications, depression, poor sleep, and relationship issues.  If a low libido continues to be a problem consult with your physician for recommendations regarding hormonal imbalance and how that can be addressed.

Hormonal imbalance is at the root of perimenopausal signs and symptoms.  With that in mind it only makes sense to help to restore balance would help to decrease perimenopausal symptoms.  A health care provider can help you make a decision about hormone replacement therapy after discussing all the risks and benefits.


At RAPS Medical we prefer bioidentical hormone replacement therapy.  This is often combined with lifestyle changes including diet, exercise, sleep and stress management.

Bioidentical hormone replacement therapy focuses on the patient’s symptoms and recommending the lowest dose possible of a hormone to control the patient’s symptoms.  This is only after current levels are measured and truly found to be deficient and by how much.  Also, replacement is only given short term to decrease the risks of hormone replacement complications such as increased risk of heart attack, stroke, pulmonary embolism, deep vein thrombosis, and breast cancer.  Short term refers to less than 5 years.  Non hormone replacement options include Vitamin E, Vitamin B complex, soy products, and Black Cohosh.  There are many more marketed but have not been proven to be helpful.


Health Risks of Menopause

After Menopause has been established women can turn their focus from trying to control their perimenopause symptoms to decreasing risks associated with being menopausal including increased risk of heart disease and osteoporosis.  A healthy lifestyle continues to hold true into menopause including getting regular check-ups to watch and manage blood pressure, blood sugar, cholesterol, and breast health.  Diet, physical activity and stress management skills should continue to be a focus as well.


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