Hit the 40s? Watch out for peri menopause symptoms

Hit the 40s? Watch out for peri menopause symptoms

From The Sunday Times, Sri Lanka, Sunday October 18, 2009

By Dr. Melanie Amarasooriya

It is the time in life when mothers are at their busiest. With the enormous responsibilities they hold in raising a family, working and running a home, often their health is not given enough attention. The slightly changing physiological processes are often passed off as ‘normal at 40’.

Unfortunately, this is the time that a number of physiological changes occur in women in relation to their reproductive systems. If you are around 40, you should be watchful for this is the time to detect those growing abnormalities early. Normally menopause, for many women will occur around the age of 50 years. Yet, significant individual variations will occur, meaning that it may occur at 48 years or even 53. If your mother or sisters had early menopause, the chances are that you may also experience the same.

Even though menopause usually occurs around the age of 50, the ovaries prepare for the impending ‘shut down’ a few years earlier. So from a few years before, you will start feeling the symptoms of declining oestrogen levels in your body. This transition period is called peri menopause and will last for one year from your last period.

How do you know if you are in peri-menopause?

The common symptoms are:

* Menstrual irregularities

* Irritability, mood swings and fatigue

* Sleeplessness

* Vaginal dryness

* Reduced sexual drive

* Hot flushes and night sweats- a sudden feeling of intense heat which encompasses your entire body and may be followed by day or night sweats

* Headaches

* Palpitations

* Lumpy or tender breasts

* Unexplained weight gain

* Urinary incontinence

* Vaginal dryness

Menstrual irregularities at this time could be that the menstrual flow could be heavier or lighter, the time between periods lengthen or shorten, or even become irregular. This could be due to reducing levels of oestrogen and progesterone hormone levels in your body. Some women will experience heavier flow lasting for several days with passing of blood clots.

Pic courtesy passions and soapboxes.com

If you need to change fully soaked sanitary towels every hour for a few consecutive hours, if you pass large clots, if your clothes are wet by the time you wake up or you have to change sanitary protection at night, if your daily routine is disturbed because of the menstrual periods, or if there is a recent change in the pattern you may need to seek medical advice. Menstrual flow lasting more than 7 days is also considered abnormal.

The common reasons are physiological changes that occur during peri menopause, fibroids, non cancerous polyps, and other medical causes like impaired thyroid gland function or hypothyroidism. Rarely malignant changes in the inner lining of the womb/ uterus which is called the endometrium can give rise to abnormal bleeding.

Clinically the doctor will diagnose what the more likely cause is- whether it is a gynaecological problem – that is something wrong in the reproductive system or a medical problem – a problem related to other organ systems like thyroid gland.

Fibroids or non cancerous growths in the uterus/ womb are present in one in every three women above 30. They are harmless and may be asymptomatic, or can cause heavy periods, painful periods, bleeding or spotting in between two menstrual periods. Uterine polyps, again harmless mucosal growths can also cause spotting or bleeding between two menstrual periods or after intercourse.

However one sinister cause for bleeding after intercourse is cancer of the cervix.

Therefore all women after forty who have bleeding after intercourse should take it seriously and seek medical advice, though it could be due to dryness of the vaginal wall.

If you are over 40, have a pap smear test every three years to exclude cervical cancer or predisposing conditions to cervical cancer. Cervical cancer is a common gynaecological cancer and can be cured if detected early.

Thyroid problems can also affect the menstrual cycle, though they occur with certain other symptoms not solely menstrual.

Whatever the cause, in abnormal heavy bleeding, or shorter menstrual cycles, it is wise to check the blood for haemoglobin level, as the blood loss could make you anaemic. At your first consultation with the doctor you need to tell him/her about the other medical conditions you have or other drugs you are taking as they may have a role in your current problem as well.

Then you need to be seen by a gynaecologist, if other medical problems are unlikely causes. An ultrasound scan will help in identifying uterine fibroids. If there are no fibroids or any other obvious pathology, abnormal uterine bleeding after the age of 40, needs endometrial tissue sampling. That is to collect cells from the endometrium to be examined under microscope so that the abnormalities at the cellular and tissue level can be identified.

This may be done by hysteroscopy, but in our country, the commonly performed procedure is ‘dilatation and curettage’ or ‘D and C’. This is now done as a day procedure, and usually patients can get admitted with six- hours fasting and go home a few hours after the procedure.

Depending on the histology report, the treatment will vary.

If there are abnormalities in the report, in the first instance the doctor may offer you medication. But if the changes are significant or pre-cancerous, he would discuss with you the possibility of a hysterectomy or surgical removal of the uterus. If there are multiple fibroids and you do not expect to preserve fertility after 40, hysterectomy is the common answer. However, unless you are close to menopause, ovaries can be conserved to produce oestrogen, a hormone that has many beneficial effects. In patients who are close to menopause, hysterectomy will accompany removal of ovaries as those will anyway give up their function shortly at menopause.

The other important point about peri menopause is that even during this time you can get pregnant, though your fertility is reducing. Therefore, if you are not expecting a baby you need to use a contraceptive method.

Menopause before the age of forty is called premature ovarian failure and is associated with a number of disease conditions like osteoporosis, as the beneficial effects of oestrogen are no longer there. So if you experience early menopause or there are signs that you are approaching menopause, seek medical advice.

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The Wisdom of Menopause


I loooove this book and highly recommend it to everyone. Dr. Northrup has several books out on women’s health. I admit I have almost all of them. I find them to be very inclusive. Always offering emotional as well as medical advice. This book tackles the perimenopausal stage and is worth a read. Here’s the blurb about it:

New York Times Best Seller for more than 15 weeks…Over 1 million copies sold in 15 languages.

In The Wisdom of Menopause, updated and revised in 2006, Dr. Northrup dispels some popular misconceptions and explains why the second half of your life is designed to provide you with more pleasure, prosperity, and fulfillment than you have ever dreamed possible! According to Dr. Northrup, “the change” is not simply a collection of physical problems or hormonal swings that need to be “fixed,” but rather a mind-body revolution that brings the greatest opportunity for growth and happiness since adolescence.

This vitally important book examines the connection between menopause and a woman’s emotional and spiritual life. It stresses how the choices a woman makes at midlife—from the quality of her relationships to the quality of her diet—either secure her health and well-being for the rest of her life, or put her future at risk. Dr. Northrup draws on her own life-changing experiences as well as on many intimate case histories to explore the transformative power of these years. Readers will learn:
• How menopause literally rewires the brain, triggering a shift of priorities from nesting and caretaking to personal growth and equality.
• How to listen for the wake-up calls inherent in women’s cyclic nature, from PMS to SAD to menopausal symptoms.
• How the body adjusts naturally to changing hormones, and how to make personalized decisions about HRT and alternatives.
• How to rebalance metabolism shifts and prevent middle-age spread.
• How to deal with the myths and realities of sexual changes and appearance issues.
• How to achieve life-long cardiovascular health, as well as what the real indicators of cardiovascular disease are.
• How to prevent long-term health problems such as hormone-related cancers and memory loss.
• How to live with passion, joy, and vibrant health before, during, and well past menopause.

I’d also recommend checking out her website http://www.drnorthrup.com/index.php

She’s quite an interesting woman and she speaks openly about her life, including her divorce and her own problems with fibroids and menopause.

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One of the most important assets we need during and following menopause is a sense of humour. Sometimes it is the only thing that gets us through a particularly “disturbing” and sometimes demoralizing view of ourselves.

 Remember the days when we complained about having to shave our legs, pits and crotches. Seems every time I turned around, I was pulling out the razor. Rapidly growing body hair was particularly annoying when I caught a few peeking out of my bathing suit. Like it wasn’t bad enough that there was barely enough material to cover my larger than life rear end!

  With menopause, we experience thinning of our luxurious manes, and in many cases, the loss of much of our bodily hair. But don’t throw away the razor yet!!!! Here comes the best part. What falls off our legs, arms and crotches, reappears on our faces!! Don’t panic. It’s not black and curly. It’s more like fine peach fuzz that covers the face – like a carpet of sorts.

So what do we do? Well, for starters, we dispose of the 10X magnifier mirrors. Years ago, we needed those unflattering, despicable things to tweeze our eyebrows, or – perish the thought – to pluck away an unsightly zit. No longer necessary girls. GET RID OF THEM.

Next, use soft light around your mirrors, and NEVER use heavy foundation or lots of powder. If it’s really bothersome, you can always rely on your esthetician for help.

Finally, and most importantly, appreciate the fact that you reached this stage of life. Appreciate the fact that you have loved ones and good friends with whom to share your stories and laugh out loud! It is a gift that gets us through a lot of the little tricks life in general, and Menopause in particular, play on us.


PS check this link out!


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USE IT OR LOSE IT- Kegel Exercises


The Kegel  (named after Dr. Arnold Kegel) is the name for the exercise used to strengthen the pubococcygeus (PC) muscles that make up the pelvic floor.   These muscles act like a hammock that supports pelvic organs: the bladder, urethra, uterus, and bowel.

Why should women do Kegel exercises?

Factors such as pregnancy, childbirth, pelvic surgery (such as a cesarean section), being overweight, and the normal effects of aging can result in weakening of the PC muscles.  When these pelvic floor muscles weaken, the pelvic organs can descend and bulge into the vagina, a condition referred to as pelvic organ prolapse.  This condition can be associated with significant pelvic pressure and discomfort, and can contribute to leakage of urine or feces.  The PC muscles are like any other muscles in the body—If they do not get a regular “work out” they become weak and eventually atrophy.  Vaginal atrophy is a common problem for menopausal women.  So, this really is a “use it or lose it” phenomenon!  Doing Kegel exercises regularly can help reduce the risk of urinary/bowel leakage and incontinence.  Kegel exercises can also aid in the prevention and treatment of pelvic organ prolapse.   These exercises are commonly recommended for pregnant women to strengthen the pelvic floor in preparation for the later stages of pregnancy and vaginal childbirth.  Additionally, maintaining strong pelvic floor muscles through Kegel exercises can increase sexual satisfaction and orgasmic capacity. 

How do I do Kegel exercises?

The first step is finding and isolating the PC muscles.  One of the simplest ways to do this is to sit on the toilet and begin to urinate.  Try to stop the flow of urine midstream.  The muscles you contract in order to stop the flow of urine are the pelvic floor muscles.  Repeat this action several times until you become familiar with the sensation of contracting and relaxing these PC muscles.    Another technique is to insert a finger inside your vagina and try to squeeze the surrounding muscles.  If you are doing this correctly, you will be able to feel your vagina tighten when you squeeze and release as you relax.    Once you have identified the PC muscles, you are ready to start your Kegel workout:

·      Empty your bladder and get into a comfortable position (sitting or lying down)

·      Contract your pelvic floor muscles

·      Hold the contraction for four seconds and then relax for four seconds

·      Repeat 10 times, three times per day

·      Work up to contracting and relaxing for 10 seconds at a time, three times per day

No special “attire” required

The beauty of Kegel exercises is that they can be done anywhere at any time.  You don’t need to belong to a gym or own any fancy outfits in order to do them, and you won’t even break a sweat!   Only you and your vagina will know you’re exercising!


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When the Well Runs Dry

Last night , during one of my many periods of interrupted sleep, I turned on the television to distract me from the onslaught of “things” that race through my mind in the stillness of night. The first thing I saw was the all too familiar ad for Cialis. Picture this – a middle-aged man and woman in twin bathtubs, staring dreamily at the horizon, as the announcer expounds on the wonder drug for erectile dysfunction. Never once did I hear him say anything about the libido of the woman in the picture, but then again, this WAS an ad for men.

There ISN’T an ad like that for women, because up until recently, we women, in and past menopause had kept our sex drive, or lack of it, under wraps. Now that our partners can get it up and keep it up for hours at a time, we have an issue to discuss!
As many of you may or may not know, depending on your age, hair and skin are not the only things to dry up as we age. Oh yes ladies ( and gentlemen ), THAT too. Since vaginal dryness is not a subject that comes up much at the bridge table, on the golf course, or at cocktail parties, many of us suffer in silence, feeling betrayed by our bodies. This is supposed to be OUR time, with the kids out of the house, financial pressure substantially less than it was when we had young families, and more time to spend enjoying one another. Then along comes Menopause, and accompanying it, vaginal dryness, and the thin dry walls of our urinary tract. Ever wonder why you have recurrent urinary tract infections after Menopause? Wonder no more my friends. Vaginal dryness is one of the culprits. It makes perfect sense that loss of estrogen, coupled with vaginal dryness would take a lot of the credit for our feeling less than sexy, when our partners are “rarin to go”. WONDERFUL!

I’ll bet the researchers who discovered the wonder drugs for our guys were men. Did they forget it takes two to tango? Personally, I am against taking drugs when there is an alternative, or unless they are absolutely necessary to control protracted pain, or sustain life. So I am not advocating a “little blue pill” for us gals. My beef is that women in general, do not get the attention they need. There is very little public awareness about “female” problems, before, during or after Menopause. So lets go back to my first paragraph and the idyllic scene of the happy couple in the matching bathtubs. I would like to know that women my age get equal time and attention; that our needs are recognized, and TALKED ABOUT. What good is an old guy with a THREE HOUR erection, if his better half, sitting in the bathtub beside him is happy just to enjoy the sunset, read a good book, and go to sleep?

Any comments?


The woman is in the picture ... but not really!

The woman is in the picture ... but not really!

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