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Low Sex Drive, Moods, Weight, Insomnia: It Might Be Perimenopause & Sooner Than You Think


Menopause---it's way more than a hot flash, and it might happen sooner than you think!


The average age of menopause in the US is approximately the age of 51, but perimenopause for many starts in their 40's. For some, it may start even earlier. Decreasing levels of hormones can disturb your mood, vaginal health, urinary health, bone strength, weight, food cravings, desire for sex (libido) and much, much more.


This is part one of series on perimenopause and menopause. Read on to learn why you feel the way you do, what you can expect, and what you can do about it from an integrative medicine perspective. We will provide you natural and also prescription options for your transition and hopefully shed some light on this poorly addressed topic in medicine.


The transition from perimenopause into menopause may take several years or come much sooner.


For many, it’s smooth sailing, but for some, it can feel like a shipwreck at every turn. It is often hard to navigate, especially in the beginning. You may hear hormone replacement therapy is harmful, yet another doctor says it is safe. Your mom might tell you horror stories of "hormones." Your friend might tell you hormones are the best thing since sliced bread, even brought back her sex life and saved her marriage.


First of all....What is perimenopause?


The gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called perimenopause (literally meaning “around menopause”). It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some people, these symptoms are troublesome enough to need medical intervention.


Low levels of estrogen and progesterone will eventually stop your monthly menstrual cycle.


And What is menopause ?


Menopause is a natural decline in reproductive hormones typically starting when a person reaches their 40s or 50s. Menopause is signaled by 12 months since last menstruation.


Although the diagnosis can be made by the patient’s history, laboratory testing may be performed to confirm the diagnosis of menopause. Elevated follicle stimulating hormone (FSH) and low estrogen (estradiol) are consistent with menopause. Hormonal therapy, such as birth control pills, may skew & invalidate the FSH and estradiol tests, so it is preferable to check levels without any other hormones on board.



Can menopause happen before 40?


Menopause, whether natural or induced, is called "premature menopause " when it happens at age 40 or younger. This occurs in about 1% of people in the United States. Premature menopause that is not induced can be genetic, metabolic, autoimmune, or the result of other poorly understood conditions. Premature menopause should be evaluated thoroughly.



Surgical Menopause (caused by a medical treatment such as a hysterectomy)

Induced menopause is menopause caused by a medical treatment such as full hysterectomy (removal of both ovaries), and in some cases, even with partial hysterectomy (preservation of one or both ovaries). Certain drug and radiation therapies can damage the ovaries and cause menopause. The most common cause of surgical menopause is the surgical removal of both ovaries.


If you have a total or radical hysterectomy that removes your ovaries, you'll experience menopause immediately after your operation, regardless of your age. This is known as a surgical menopause.


If a hysterectomy leaves 1 or both of your ovaries intact, there's a chance that you'll experience menopause within 5 years of having the operation.


If a hysterectomy is performed in which the uterus is removed but the ovaries are not, the body will still produce hormones, but at a lower level. Removal of the uterus without the ovaries causes less dramatic changes in hormone levels than a full hysterectomy does, but a partial hysterectomy can still cause a hormonal imbalance.

Those who experience induced menopause do not have the typical perimenopause—the gradual transition leading up to their final menstrual period when hormones wax and wane.

Surgical menopause (removal of ovaries) occurs abruptly, on the day of surgery. Abrupt loss of ovarian hormones often causes drastic symptoms compared to natural menopause.

Induced menopause at a much earlier age than natural menopause (typically, age 51) may result in increased risk for some diseases due to the loss of protection from estrogen and other ovarian hormones---the protective effect of estrogen on bone health is lost, resulting in increased risk for osteoporosis and fracture.

Those with induced menopause may need care for menopause-related symptoms such as hot flashes and vaginal dryness more often than those who reach menopause naturally; they may need treatment longer and at higher doses to control the symptoms and to lower the risk of diseases later in life.


Menopause symptoms related to induced menopause can be similar to those from natural menopause, including hot flashes, sleep disturbances, and vaginal dryness.


How Do I know if I am going into natural menopause?


There is no simple test to tell you that your menopausal transition begins or end. After your periods have stopped completely for a year, you are considered to be postmenopausal. Before that point, your periods will likely become highly irregular. Menopausal symptoms usually do not stop after a person reaches this point but, for many, they will slowly subside as estrogen stays consistently at a low level. Often we will check follicle stimulating hormone (FSH), progesterone, and estrogen when assessing for possible perimenopausal symptoms. Sometimes we will also check testosterone.


Many women experience symptoms such as hot flashes, mood swings, sleep difficulties, low libido, weight gain, increased urinary problems, painful sex and vaginal dryness during perimenopause and menopause.

How do my hormones play a role?


Perimenopause and menopause are defined as natural decline in hormones. The primary hormones that decrease are estrogen and progesterone. Testosterone also typically decreases. At different times in your life, you may have any of three forms of estrogen circulating in your blood. Estradiol is naturally present in perimenopause, estrone is dominant in menopause and estriol is the weakest of all three.


Testosterone is often thought of as 'the male hormone', but it is also an important sex hormone in women and it too declines with age (an