Menopause transition: What's normal?

Did you know the menopausal transition known as perimenopause begins four years before a woman’s final menstrual cycle? It’s true. Hormone production from the ovaries often starts to change when a woman is in her 40s, and thus the time between periods begins to shorten. Some women have menopausal symptoms clustered around the time of menses. Others do not. It’s important to know that perimenopausal symptoms are common and usually diminish with time.

Approximately 80 percent of women experience symptoms such as hot flashes, sleep disturbances, mood changes and vaginal dryness during perimenopause. Other symptoms include:

• Headache
• Vertigo (dizziness)
• Itchy skin
• Restless leg symptoms
• Heart palpitations
• Difficulty concentrating
• Breast tenderness
• Constipation
• Bloating
• Muscle and joint aches

Mood changes can include tearfulness, irritability, anxiety and even panic attacks. These symptoms can last four to five years on average from the first hot flash. About 10 percent of women will continue to have symptoms into their 70s. Often, symptoms are most severe when a woman is still having periods, which can be heavier or lighter during this time. Eventually, she will skip periods for a few months until they stop altogether. A woman is considered postmenopausal if she has not had a period in more than a year. On average, this occurs around 51 years of age.

Although most women have menopausal symptoms, only 20-30 percent seeks medical attention for treatment. If symptoms are significantly impacting quality of life, such as relations at work or home, medication may help. Unfortunately, well-designed trials do not support use of many over-the-counter supplements. However, there are some studies that show yoga and exercise can help some women.

Some medications used for depression may help with menopause symptoms. Hormone therapy is another option that can be considered, although there are health risks, including blood clots, breast cancer, gall bladder disease and stroke.

The bottom line is that perimenopausal symptoms are common; they’re typically mild for most women and usually diminish over the course of several years. However, if these symptoms are affecting your quality of life, see your health care provider to discuss your options.

Kathryn Gruenwald, M.D., is an obstetrician-gynecologist in Cannon Falls, Minnesota.