Navigating the Menopause Journey: From Perimenopause to Menopause

Change, Change, Change, change of life. Some women dread it, find it full of misery. While others welcome it with open arms.

The other the night the girls and I invaded a quaint little Mexican place complete with a spicy waiter who danced the salsa with Ana making us all smile. It had been a while since the whole group had been together so there were conversations all over the place. Kids, jobs, husbands. You know, the usual. Groups of two or three catching up as only women can do. One ear deep in your current conversation while the other ear dips into surrounding conversations. When all of sudden Mary's hands land firmly on the table, her eyes taking in everyone at the table.

"Let's talk about menopause!" What a way to grab the attention of her 50 plus year old comrades! There was a cacophony of voices talking all at once.

"OMG! Sex is so painful. Bob had to stop another night," grimaced Jane.

"Have you tried the silicone lubes? We are supporting someone's with the amount we buy, Tanya pronounced triumphantly.

Before Jane could answer someone shouted night sweats and hot flashes.

"I have a change of clothes at my desk. I never know when my power surges will absolutely saturate me," was Margret's nonplussed reply.

"I change my sheets in the middle of the night at least once weekly. It starts with being cold and under all of the blankets. Then one foot out to cool off. Then all covers off and then out of nowhere my sheets are saturated in sweat. It's so hard to get a good night's rest when the sheets are all tangled and wet. And I don't mean the good kind," Helen winked as she sipped her chocolate martini

Heather's slow drawl redirected the group's attention," The vaginal dryness is the worst. When it first started, I thought I was having constant yeast infections. So, I took my happy self to see my OBGYN whose answer was vaginal atrophy. " A complete look of disgust donned her face. "Atrophy happens in old women; I am not old!" She emptied the entire wine glass for emphasis.

Everyone talks about menopause. We as women don't hesitate to share the craziness of their journey with other women. I believe menopause gets a bad rap. Hold on, hold on! Don't kill me! Let me explain! What most women believe is menopause is actually perimenopause. Perimenopause is that time around menopause when the ovaries begin to slow their production of estrogen. As the body attempts to adjusts to the decreased estrogen it can experience many changes. The symptoms most women find challenging tend to occur during the perimenopausal phase of life. Perimenopause symptoms occur mid to late 40's for most women. There are some women who experience perimenopausal symptoms in their 30's.

Irregular menses. It's like your body does what it wants when it wants. Periods can become very unpredictable. Some women can experience heavier, longer periods. While others can have shorter lighter periods. I have heard stories of women donning overnight and super pads only to have to change their clothes just a couple hours later or the sheets in the middle of the night.

Hot Flashes. Some have been known to call them Power Surges. I like that one! Some women will have dainty Power Surges with light sweating. Dabbing their faces like Southern Belle. While some will have bed soaking, clothes drenching power surges. It is hard to be graceful when every pore on your body is weeping. I remember watching my mom during a power surge. We were attending my first son's kindergarten graduation when I look over at my mom to see her face crying. I don't mean tears from her eyes. Her entire face was dripping water. It was a relatively chilly Spring day but her body thought we were in the tropics with high humidity.

My personal experience was somewhere in-between. I would feel a heated wheel spinning from my chest outward. I swear the first time I thought I was having a heart attack. On a day near Christmas filled with surges I found myself standing on the deck in near zero weather still feeling over heated. Mother Menopause is no joke!

If your experiences with Power Surges are difficult to manage contact your healthcare provider. There are so many options to help us through this phase.

Mood Swings. This one had me terrified! I'm already a "little moody" I equated the mood swings of menopause with crazy. I was certain my permanent residence would be the local psych unit. Luckily, my fear was way worse than the reality. Thank goodness! I lived with the mantra, "It's not them. It's you." It helped remind me to take a beat before over responding to any situation with the full-on aggression I felt in the moment.

Every woman's experience is different. While some may experience mild changes in their mood others will experience depression symptoms that truly impact their quality of life. Regardless, of which experience is yours, know there is support to help us through. Using strategies like exercise, mediation and healthy eating can help greatly. If your situation needs a little more support, contact your healthcare provider.

When you begin to experience symptoms of perimenopause, know you are not crazy, different or alone. We, this generation of women, are lucky to have awesome women's health providers who are willing to listen and guide us through this phase. I would suggest a diary to keep track of menses, emotions and any questions you may have. The more prepared you are when you meet with your provider the better, they are able to assist you.

Sex Let's talk about sex. Perimenopausal and menopausal sex can be a different beast. As estrogen, progesterone and testosterone make their decline our perspective and responses begin to change. The once tried and true "moves" that guaranteed an orgasm now elicit barely a response. This can be confusing since the man is still attractive and you're all in with sexy time. The body's response can leave you feeling frustrated. Without estrogen it can take longer to reach arousal. The sensitive areas aren't quite as sensitive. In addition, our bodies natural lubricant decreases making our vaginal areas dry and thin. To help improve the pain that can sometimes come with intercourse there are medications, pelvic floor therapy as well as estrogen therapies. Before giving up on sex talk to your partner. Let him know what the "new body" needs and what feels good. Try new positions and invest in lubricants. There are treatment options for women experiencing distress from their lack of desire or interest in sex. As with the other symptoms talk to your healthcare provider for alternative options.

Provider's Perspective

I've had the pleasure and privilege of working with some amazing women's health providers. One of the key messages they want women to know is you are not in this alone and they are prepared and willing to help.

There are several things women's healthcare providers want you to know.

Perimenopause is the road and menopause is the destination.

Symptoms will mellow in menopause.

You are not alone. They are there to provide support and guidance. In addition to their support reach out to other women. Share your experience and be open to supporting others as they make the journey.

You are not crazy. Your body is taking a new journey. Recognize this journey is a natural process with a range of symptoms affecting each woman differently.

Mental health current and past can affect your journey through perimenopause and menopause.

Your ovaries run the show. When they are done you will know. Hormone testing can create a feeling of chaos. When you have gone one year without a period, then you are menopausal. Until then enjoy the journey.

Hormone Therapy works. Guidelines for use of hormones has changed allowing more women to benefit from their use

Weight bearing exercises can help decrease weight gain. It is important to watch portion sizes.

During your menopause journey the right provider can become your "gyno-psychologist."

Self-care. Finding what helps clear the chaos and re-center you and do it abundantly.