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If you're Japanese and living in Japan, you probably have no symptoms of perimenopause. Hot flashes are not even part of the vocabulary and menopause appears to be basically no biggie. In the United States, however, we're trying to figure out exactly why we are experiencing perimenopausal symptoms.
Some researchers believe it may have more to do with diet than climate. Japanese women eat less animal protein than Western women, consume less fat and eat several servings of soy each day. These foods are rich in compounds called phytoestrogens, which may "fake your body out" by acting biologically like female hormones.
Italian researchers who studied 51 menopausal women found that those who took daily supplements of 60 grams of soy protein had 45 percent fewer hot flashes. But here's the rub: About half complained of constipation or other gastroinestinal problems. However, other studies have shown soy to have little or no benefit in treating menopausal symptoms.
Researchers continue to study the relationship between a soy-rich diet and female hormones. Although each woman experiences perimenopause (the period leading up to menopause) and menopause differently, you may experience one, some, all, or none of the following:
Hot flashes, night sweats and insomnia
Probably everyone has heard of hot flashes, which herald the approach of menopause for more than 60 percent of women. As estrogen levels begin to go up and down, the body's internal thermostat, the hypothalamus, gets a bit jumpy as well, sending heat surges through the body. Your face and neck may become flushed, and red blotches may appear on your chest, back and arms.
Heavy sweating is often followed by cold shivering as your body tries to swing its temperature back the other way. A hot flash can last only a few moments or as much as 30 minutes. Eighty percent of all women with hot flashes report that they have them for two years or less, but women report having them for more than five years. In one study conducted by researchers at the University of Pennsylvania, results showed African-American women are twice as likely to develop hot flashes as white women.
If you happen to be trying to sleep, your hot flash becomes a night sweat. Need we say more about why you might have trouble sleeping?
But take heart. As uncomfortable as hot flashes may be, your mental health will be the better for it, according to researchers at the University of Pittsburgh. They found menopausal women who were not taking hormones were more likely to suffer hot flashes but had better mental health than menstruating women in the same age group. In short, they were going by the "grin and bear it" philosophy.
For those who find hot flashes nothing to smile about, some women report waking up 10 or more times a night. Hormone therapy has proven effective, but it's not for everyone.
Some women say vitamin E helps, but this has not been scientifically proven. Eating a soy-rich diet might also help. For additional relief, The National Institute on Aging offers the following tips for cooling down:
- Dress in layers so that you can remove them at the first sign of a flash
- Drink a glass of cold water or juice at the onset of a flash
- At night, keep a thermos of ice water or an ice pack by your bed
- Use cotton sheets, lingerie and clothing to let your skin "breathe"
Changes in menstrual cycle
Though you may still be fertile, more than three-quarters of all perimenopausal women experience changes in their menstrual cycle. Your body has fewer eggs now, but the pituitary gland keeps releasing the hormones needed to stimulate ovulation. Ovulation may or may not occur, which can cause your period to go a bit wacky. Cycles may become longer or shorter. You may miss a period, or get more than one period in one month. Your bleeding may be heavier or lighter.
Over time, as your body loses its supply of eggs, both estrogen and progesterone levels decrease dramatically and you stop having your period. You are now easing into menopause.
Mood swings and forgetfulness
Again, mood swings are not a given, as researchers report that many women report feeling much better during this stage in their lives. Others believe that changes in hormone levels may interfere with the production of the body's mood regulator, serotonin. This can cause some women to feel anxious or weepy.
Still other researchers, such as those at the New England Research Institute, have found that menopausal women were no more depressed than the general population. The exception is women who undergo surgical menopause. Their depression rate is reportedly double that of women who have a natural menopause.
Researchers at the New England Research Institute found that depression and anxiety were not a result of menopause at all for the women they studied. They got the blues from some of the big life changes many women experience during these years: children leaving the home or divorce. While causing distress in some women, others find those same life events to be enormously liberating. It's a very individual thing.
Some menopausal women have problems remembering things or report losing their train of thought more frequently. Such lapses may be due to everyday stresses, but some medical studies have linked low estrogen levels to memory loss. Regardless, report to your doctor if you are troubled by persistent or unusual memory lapses because other medical conditions can have similar symptoms.
Vaginal dryness and less interest in sex
With dropping estrogen levels, the vagina becomes drier and its walls are thinner. Intercourse may become uncomfortable or even painful. Many experts advise that the use of vaginal lubricants will solve the problem, and sometimes it does. But for women who have lost interest in sex, lubricants won't put the zip back into lovemaking.
A decreased libido may have several causes. Some women may equate menopause with a loss of sexuality. They may not feel sexy anymore. For others, the opposite is true. They find the relief from fear of pregnancy to be liberating.
But if you're finding that the prospect of a nice hot bath seems far more appealing than a romantic interlude, you're not alone. Researchers from the Yale University School of Medicine in New Haven, Conn., report that as many as 60 percent of menopausal women experience a significant decline in sexual function.
If you're one of these women, consider talking to your health care provider about it.
Headaches
Some women report problems with migraine headaches during perimenopause, and researchers generally believe hormones are, once again, the culprits. One researcher at Mount Sinai Hospital in New York reports a dramatic reduction in the frequency and duration of migraine in patients treated with a combination of vitamin D and calcium. Although the study size was too small to generate conclusive findings, most of us could use more calcium anyway; so this combination of supplements may be worth a try. Talk with your doctor about an appropriate dosage for you. Just don't overdo. Too much calcium may put you at risk for problems, such as kidney stones.
Urinary problems
Estrogen plays a key role in maintaining the function of a woman's vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder). After menopause, all of these organs may weaken or shrink. When these changes occur in the bladder and urethra, they can lead to the involuntary leakage of urine, infection, or painful urination.
Before you even consider resigning yourself to these types of urinary symptoms, talk to your health care provider. Many new options are available to alleviate incontinence. Kegel exercises, which women generally practice during pregnancy, can be helpful now, too.
If you are experiencing vaginal dryness, you may also be experiencing frequent urinary tract infections (UTIs), particularly following intercourse. Here are some tips for reducing UTIs that can be helpful at any age:
- Urinate both before and immediately following intercourse to rid your urinary tract of excess bacteria.
- Avoid using sexual positions, which place excess pressure on the bladder.
- Drink unsweetened cranberry juice, available at health food stores. Though bitter, it contains a natural substance that is believed to help cleanse the bladder. Sugars found in sweetened cranberry juice tend to neutralize this healing effect.
- After going to the bathroom, always wipe from front to back to avoid spreading bacteria to the sensitive urethral area.
This article was reviewed and updated June 2007.
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