By Sue Sveum
While the subject of menopause and perimenopause is sure to pop up among friends, it’s discussed far less often in the doctor’s office. SSM Health nurse practitioner Sarah Block, APNP–CNP, would like to change that. With help from two patients who’ve experienced those changes, they let readers know what they may not know — but should.
Most women have a general idea of what menopause is (marked by 12 consecutive months without a period), but perimenopause? Not so much. Here’s the rundown.
“Perimenopause is the time leading up to the menopause transition,” explains Block. “Symptoms typically start in [a woman’s] mid-40s, but it can vary widely — and can start as early as 35.”
Block explains that perimenopause symptoms can also be tricky to pinpoint if a woman is on birth control or has had a hysterectomy. “This distinction is hard to make,” adds Block. “However, symptoms can be very telling.”
Caused by decreasing estrogen, progesterone and testosterone, early perimenopause signs include changes to the menstrual cycle, hot flashes, night sweats, and mood changes. Symptoms can occur from head to toe — including cognitive changes, mood shifts and achy joints.
More specifically, women may experience weight gain, mood changes, fatigue, loss of motivation and decreased sex drive.
“Education on what to expect and how to manage these symptoms is paramount,” Block says. “Some women experience life-altering symptoms.”
One such side effect not often discussed is the emotional aspect of these life changes. After her fourth child was born when she was 38, Tessa Karls expected to bounce right back. But that didn’t happen.
“The exhaustion didn’t pass. My energy tanked. My libido disappeared. And the mood swings? Let’s just say I didn’t even recognize myself some days,” explains Karls.
“I’ve always been the calm, patient one — steady, even when life is chaotic. But suddenly, everything felt off.”
Months blurred into years, and she couldn’t tell where the postpartum period ended, and perimenopause began.
“No one talks about this messy middle ground where you’re raising little ones while your body quietly shifts into a new phase,” she says.
“The hardest part [was] feeling like I wasn’t in control of my own emotions. That’s what finally pushed me to get help. I needed answers. I needed to feel like me again.”
For Lisa Peterson, it began with night sweats. “I’d read about menopause and the symptoms, but it took a while to figure out that I was actually having those symptoms!” she says. “It kind of creeps up on you.”
Because she had irregular periods, she didn’t notice the duration between them. She also started having night sweats every evening (which led to sleep disruption), daytime hot flashes, joint pain and fatigue.
“I felt a bit irrational at times,” she recalls. “I started not liking the person I felt I was becoming.”
“These feelings aren’t uncommon,” Block says. “Starting in perimenopause, we often see mood changes including symptoms of anxiety, depression, irritability and even attention-deficit/hyperactivity disorder (ADHD) that may affect quality of life.”
And the emotions are only compounded by accompanying physical changes: midsection weight gain; loss of skin elasticity leading to sagging skin, wrinkles and cellulite; and dry skin, hair and nails. Women may even experience hair loss, which can be especially distressing.
According to Block, treatments vary based on symptoms. Non-hormonal options for hot flashes and night sweats include “adopting a healthy lifestyle by following the Mediterranean diet, exercising and stress reduction as the first-line treatment,” she says, adding, “but hormone therapy (HT) is the most effective.”
Karls initially chalked her symptoms up to getting older. “I thought, ‘Maybe this is just what happens now,’” she says, “until I realized it doesn’t have to be that way.”
She adds that reaching out for help changed everything.
“I made some changes to my diet and started using an estrogen patch,” she says. “That decision made a world of difference. My symptoms began to improve, and more importantly, I started to feel like myself again.”
Peterson also found relief with hormone therapy.
“Once I learned more about HT, I felt really positive and excited to try it,” she says. “I felt pretty much back to ‘normal’ in about two to three weeks. My symptoms went away completely — with no side effects at all. It’s been life changing.”
“Many women come in with ideas of treatments based on social media, suggestions from friends and internet searches,” says Block. “We work with patients individually to find the best treatment that fits their goals — there’s not a ‘one-size-fits-all’ approach.”
The first step is to speak up if you’re experiencing any symptoms or changes related to perimenopause or menopause. You don’t have to endure it alone. “There’s no benefit to ‘powering through,’” says Peterson. “We should be able to enjoy this stage of our lives as much as any other stage.”
Karls agrees, adding, “So many of us are walking through different versions of the same struggles — exhaustion, hormonal shifts, identity changes — and yet, we often feel like we’re doing it alone. But we’re not.”
Why I Focus on Perimenopause and Menopause
A labor and delivery nurse before getting her doctorate, nurse practitioner Sarah Block, APNP-CNP, knew she wanted to focus on women’s health. During her studies, a professor she had was associated with the Menopause Society, a resource for health care professionals and the public that provides accurate information about menopause and midlife women’s health. This professor inspired Block to pursue additional training in the area of menopause.
“The lack of attention and research in women’s health motivated me to focus on this field,” says Block. “And the general disregard of menopause by the medical community really sparked my enthusiasm.”
Being a woman currently going through perimenopause herself has changed her perspective and enhanced her relatability.
“I love caring for women,” says Block. “Especially treating perimenopause and menopause due to the dramatic improvements in health and happiness that can occur.”
Ask Your Provider: No Embarrassment Allowed
Has your health care provider ever initiated the topic of perimenopause or menopause with you? If not, and you have questions or concerns, just ask!
“Patients should feel comfortable talking with their provider,” says Block. “Our goal is that you’re healthy and happy, no judgment.”
Many questions — such as when perimenopause will start or how long symptoms will last — don’t have a universal answer, since each person’s experience is different.
Before an appointment, prepare:
- A list of symptoms
- Age your female family members went through menopause
- Your health history
- Any concerns
“Then we’ll devise a treatment plan right for you,” explains Block. “You don’t need to power through alone.”
Is Hormone Therapy Right for You?
Good news: Updated research shows hormone therapy (HT) is a safe and effective option for most women. According to Sarah Block, APNP-CNP, it has many benefits — in particular, a better quality of life.
Here are the basics:
- HT replaces hormones that the ovaries no longer produce.
- It has a lower dose of hormones than birth control pills.
- Estrogen is administered via a skin patch, oral tablet or vaginally.
- Nightly progesterone capsules are also needed unless you’ve had a hysterectomy.
- Hormone doses are individualized for the very best results.
- Side effects may include breast tenderness, bloating and initial spotting, which typically dissipate with time.
- Women with active breast cancer, deep vein thrombosis (DVT) or unexplained irregular uterine bleeding are not eligible for HT.
Block’s advice? “If your symptoms affect your daily life, consult a provider who specializes in treating menopause to discuss HT.”
