Is hormone replacement therapy right for you?

What is perimenopause?
Perimenopause is the time leading up to menopause when you start to notice menopause-related changes--plus the year after menopause. Perimenopause is what some people call "being in menopause" or "going through menopause." But menopause itself is only one day--the day you haven't had a period for 12 months in a row. During perimenopause, your ovaries start to shut down, making less of certain hormones (estrogen and progesterone), and you begin to lose the ability to become pregnant. This change is a natural part of aging that signals the ending of your reproductive years.

When does perimenopause start?
Women normally go through perimenopause between ages 45 and 55, but some women start perimenopause earlier, even in their 30s. When perimenopause starts, and how long it lasts varies from woman to women. You will likely notice menopause-related symptoms, such as changes in periods.

What are some of the signs and symptoms?
Menopause affects every woman differently. Your only symptom may be your period stopping. You may have other symptoms, too. Many symptoms at this time of life are because of just getting older. But some are due to approaching menopause. Menopause-related symptoms you might have during perimenopause include:

  • Changes in pattern of periods (can be shorter or longer, lighter or heavier, more or less time between periods)
  • Hot flashes (sudden rush of heat in upper body)
  • Night sweats (hot flashes that happen while you sleep), often followed by a chill
  • Trouble sleeping through the night (with or without night sweats)
  • Vaginal dryness
  • Mood changes, feeling crabby (probably because of lack of sleep)
  • Trouble focusing, feeling mixed-up or confused
  • Hair loss or thinning on your head, more hair growth on your face When you visit your doctor, take along a diary about what's happening with your period. For a few months before your visit, record when your period starts and stops each day, and indicate whether it is light of heavy. Also note any other symptoms you have.

    Is there any treatment for perimenopause? What can I do?
    Some women take oral contraceptives (birth control pills, or "the pill") to ease perimenopausal symptoms--even if they don't need them for birth control. These hormone treatments of combined estrogen and progestin can help keep your periods regular plus ease all the symptoms listed above. Talk with your doctor to see if this option is for you. If you are over 35, you should not take birth control pills if you smoke or have a history of blood clots. You need a prescription to get oral contraceptives. After a woman reaches menopause, if she still needs treatment for menopause symptoms, she should switch from birth control pills to menopause hormone therapy (HT). HT contains much lower doses of hormones, and thus has less risk for bad side effects.

    Making some changes in your life can also help ease your symptoms and keep you healthy.

  • Eat Healthy. A healthy diet is more important now than before because your risks of osteoporosis (extreme bone loss) and heart disease go up at this stage of life. Eat lots of whole-grain foods, vegetables, and fruits. Add calcium-rich foods (milk, cheese, yogurt) or take a calcium supplement to obtain your recommended daily intake. Get adequate vitamin D from sunshine or a supplement. Avoid alcohol or caffeine, which also can trigger hot flashes in some women.

  • Get Moving. Regular exercise helps keep your weight down, helps you sleep better, makes your bones stronger, and boosts your mood. Try to get at least 30 minutes of exercise most days of the week, but let your doctor recommend what's best for you.

  • Find healthy ways to cope with stress. Try meditation or yoga--both can help you relax, as well as handle your symptoms more easily. Our Stress and Your Health FAQ can be a good resource as well.

    Can I get pregnant while in perimenopause?
    Yes, you can get pregnant until you've gone 12 months in a row without a period. Talk to your doctor about your birth control options. Keep in mind that birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure also to use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don't provide complete protection against STDs and HIV--the only sure protection is abstinence (not having sex of any kind). But making sure to always use--and correctly use--latex condoms and other barrier methods can help protect you from STDs.

    Source: Womens Health, www.womenshealth.gov/faq/stress-your-health.cfm

    More Resources:

    >> Dr. Alan Altman
    Website: www.alanaltmanmd.com

    >> National Institute on Aging
    Website: www.nih.gov/nia

    >> Food and Drug Administration (FDA)
    Website: www.fda.gov/womens/menopause

    >> The North American Menopause Society (NAMS)
    Website: www.menopause.org

    >> The National Women's Health Resource Center
    Website: www.healthywomen.org

    >> Power Surge
    (Online community for women featuring articles and chat on perimenopause and menopause)
    Website: www.power-surge.com

    >> Pink Sunrise, The Hot Flash Site
    (Online articles and commentary focused on women's health)
    Website: www.pinksunrise.com

    Article: WHI admits HRT prevents heart disease

    About Alan M. Altman, MD:
    He is Assistant Clinical Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. He is a practicing gynecologist who specializes in peri and post-menopausal care, problems with hormone replacement therapy and issues of mid-life sexuality. He his well known for his ability to sift through even the most complex problems in these areas and help guide women to the best kind of treatment if treatment is necessary. Over the past eighteen years he has been quoted in a variety of publications including Time Magazine, Newsweek, U.S. News and World Report, the Boston Globe, Boston Herald, Glamour and Self-magazine. He has appeared on such shows as Good Morning America, People are Talking, Getting Healthy and Doctor On Call. He has participated in numerous radio programs. Dedicated to the education of women of all ages, he co-produced three highly acclaimed video productions on the subjects of menopause, fertility and adolescence. Dr. Altman lectures to hundreds of health care professionals each week teaching them better ways of understanding, diagnosing and treating women with complicated peri and post-menopausal problems. Through direct speaking engagements as well as audio conferences, Dr. Altman has helped instruct in one way or another up to fifty percent of the nation's obstetricians/gynecologists. He is now beginning to reach the primary care physicians who may very well turn out to be the future providers of women's health care. Whether he is teaching students at Harvard Medical School, giving grand rounds, instructing resident physicians or leading a seminar for couples at Canyon Ranch, his popular talks on such topics as perimenopause, menopause, sexuality and the state-of-the-art developments in hormone replacement therapy are well received by both the professional and the lay person.

    In the last decade he has become a sought after speaker with a growing national reputation for introducing humor and candor into hard-to-discuss topics. He is about to become the national spokesperson for LEAP (Life's Hormones: Estrogen, Androgen and Progesterone) a national education program of the National Women's Health Resource Center.

    Dr. Altman received his B.A. in Biology at the University of Pennsylvania. He was graduated with honors from the New York University School of Medicine in 1975. He later completed his internship and residency at the Boston Lying-In and Free Hospital for Women, which then became the Brigham and Women's Hospital. He maintains his private practice in Brookline, Massachusetts.

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