A guide to perimenopause and menopause: Symptoms, treatments and more

What is menopause?

"Menopause is a natural biological process in a woman's life," explains Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health. "It's a time when a woman's ovaries stop releasing eggs and she stops menstruating, marking the end of her reproductive years. Women officially reach menopause when they haven't had a menstrual period for 12 consecutive months."

The word "menopause" comes from the Greek words men, which means "monthly", and pausis, which means "pause". Most women experience menopause naturally, between the age of 45 and 55, with the average age being 51.

Certain surgeries can also cause menopause. Two examples are a hysterectomy (an operation in which the surgeon removes the uterus) and an oophorectomy (an operation in which the surgeon removes the ovaries). Cancer treatments, like chemotherapy, may also cause menopause. This happens when the treatments cause the ovaries to temporarily stop producing eggs.

What is perimenopause?

Perimenopause is the time leading up to menopause. As a woman, you can be in perimenopause for six to ten years before your period stops completely.

"During perimenopause, a woman's body produces lower levels of the female hormones, oestrogen and progesterone. Even though her fertility declines and her periods may become irregular during perimenopause, she can still fall pregnant," explains Dr Nematswerani.

"Women may experience physical and emotional symptoms linked to the fluctuations in hormone levels during perimenopause. These symptoms may be persistent, or they may happen on and off over several months or even years."

How do you know if you are in perimenopause or menopause?

According to Dr Nematswerani, "The symptoms associated with perimenopause can start years before a woman's periods stop (menopause). These symptoms are caused by the changes in the level of important hormones related to female reproductive health. The degree to which women experience the symptoms of perimenopause and menopause varies".

Signs and symptoms of perimenopause and menopause may include:

• Vasomotor symptoms, like hot flushes, night sweats and heart palpitations
  ("Vasomotor" means that the symptoms are related to how the blood vessels are working in your body.)
• Irregular periods (during perimenopause)
• Sleep problems
• Mood swings
• Irritability
• Anxiety
• Depression
• Poor memory and brain fog
• Fatigue

How do you manage hot flushes?

Apply these tips to make hot flushes more bearable:

• Layer your clothes so that you can remove layers when you are feeling warm.
• Avoid food and drinks that can cause the hot flushes to start (for example, chocolate, coffee and sometimes tea).
• Drink a glass of cold water when you feel a hot flush starting. This sometimes helps.
• Lower (and manage) your stress levels. (Stress hormones, like cortisol, can make your body temperature go up.)
• Make sure that your sheets, sleepwear and clothes are made from breathable fabrics, like cotton. This will help you to stay cooler during hot flushes.

What long-term health conditions can menopause cause?

Some women develop long-term health conditions once they've reached menopause. This is because their oestrogen and progesterone levels have changed, and this has a whole-body effect.

Long-term health conditions can include:

• Cardiovascular problems:Your risk of developing cardiovascular conditions, like strokes, heart attacks and blood clots, may increase.
• Fat redistribution:You may gain weight or experience a build up of fat around the waist.
• Problems with the bones and teeth: Problems with the bones and teeth can include osteopenia (loss of bone density), osteoporosis (weak and brittle bones), tooth loss and receding gums.
• Problems with the skin and hair:These can include dry skin, wrinkles, thinning hair and facial hair.
• Urogenital concerns:These can include vaginal dryness, pain during sex, a low libido, urinary tract infections, the need to urinate more often and feeling that you need to urinate urgently.

What treatment options are available for perimenopause or menopause symptoms?

"Menopause and perimenopause symptoms can have a big impact on a woman's life and affect her physical, emotional, mental and social wellbeing," says Dr Nematswerani. "I really want to encourage women to speak out. Where they are experiencing symptoms that are disrupting important areas of their lives, they should feel empowered to speak to their doctor or gynaecologist about treatments to alleviate the symptoms. There are hormonal and non-hormonal treatment options, as well as certain lifestyle changes, that help with symptoms."

"Hormone therapy, previously known as 'hormone replacement therapy', is a safe and effective treatment for hot flushes, night sweats and other symptoms of menopause. Hormone therapy consists of oestrogen and progesterone, which can be given to those women who need it (a doctor will assess that) in the form of daily oral tablets, skin patches, skin creams, vaginal creams or tablets, or intrauterine devices. The type of hormone therapy given to a woman will depend on whether she has had a hysterectomy (removal of the uterus) or not."

"In cases where a woman can't use hormone therapy, a doctor may prescribe other medicine to help with her symptoms."

"It's important to note that treatment for the symptoms of perimenopause and menopause is personalised. There is not a one-size-fits-all approach. A healthcare provider will treat each patient according to their specific symptoms, needs and health history."

- If you are a Discovery Health Medical Scheme member, we cover the medical and surgical management of your perimenopause and menopause as a Prescribed Minimum Benefit. This includes cover for hormone therapy.

"If a woman is struggling with the emotional and mental health symptoms related to menopause, it is important for her to discuss this with her doctor. She may need psychotherapy or prescription medicine to manage her condition. Her treating doctor will advise her on the appropriate treatment for her."

Does a healthy lifestyle ease symptoms?

" Women are encouraged to lead as healthy a lifestyle as possible to support their transition to menopause. Not only will this help with symptoms, but it will also help them to avoid or minimise potential long-term complications of menopause, such as osteoporosis and cardiovascular diseases," says Dr Nematswerani.

If you are in perimenopause or menopause, we encourage you to:

• Get vitamin D by exposing yourself to sunlight daily, eating foods that are rich in vitamin D or taking vitamin D supplements
• Take calcium supplements
• Follow a balanced exercise programme, which includes cardio and weight resistance training
• Enjoy a healthy, balanced diet.

"In fact, the effects of healthy eating and exercise are cumulative. The earlier in your life you start with healthy lifestyle behaviours, the better the overall, long-term health benefits are," notes Dr Nematswerani.

What screening tests are important for women?

"Going for regular Health Check screenings is important throughout your life. Screening helps to give you an idea of your baseline health and detect diseases early on, when they are easier to treat. As a woman gets older, there are additional screening checks that she should go for, in addition to the standard annual Health Check."

Important screening tests for women include:

• Cervical cancer screening every 3 to 5 years, from age 25
• Mammograms every 2 years, starting from age 40
• Colorectal cancer screening, from age 45
• Annual Health Checks (to check blood pressure, body mass index, cholesterol and glucose)
• Dental check-ups every 6 months.

- As a Discovery Health Medical Scheme member, you can access some of the above screenings through your screening and prevention benefits.

What should you do if you're struggling?

"Perimenopause and menopause are just one of the seasons in a woman's life. And while the changes her body will go through are completely natural, there is no shame in reaching out for help if the symptoms become too uncomfortable or unbearable," concludes Dr Nematswerani.

If this is you, please reach out to your doctor or gynaecologist. You don't have to navigate these seasons alone.

Related articles

Screening tests every woman needs
Menopause and its effects on women's health
Take a hands-on approach to breast health

References

https://www.menopause.co.za/
https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
https://my.clevelandclinic.org/health/diseases/21841-menopause