perimenopause_womanI just spent a long weekend with some college friends. We are all in perimenopause, which is as big of a mind shift as it is a physical transformation.

From the very beginning — in junior high and high school – the emphasis on how our bodies change was all about fertility. Our teachers and other educators made sure we understood how our bodies were maturing and evolving, and also how important birth control was. As we headed into college, we were inundated with information about contraception. All our focus was on preventing pregnancy.

And then, it was time to start a family, so we stopped using birth control. For some, pregnancy came quickly and easily.  For others, the information journey extended from the Internet to doctors and fertility clinics. Once pregnant, the education focus shifted again, and we were inundated with information on approaches from Lamaze to Bradley, and other childbirth techniques… soon followed by parenting classes.

But then… a drop off in information. The next life phase is perimenopause, and then menopause, and for many reasons – including that our culture glamorizes youth, but often ignores aging – there is a lack of education and understanding about these next phases of life.

It’s just as important to be informed about how your body will change, so here are some key facts:

Changing Menstrual Cycles: You are still cycling, and it may seem like it almost never stops; it is common to have shorter periods, more frequently. A menstrual cycle that is anywhere from 21 to 35 days is normal. Shorter cycles may mean early ovulation – it can be as early as cycle day seven, which may even be the last day of your period. Alternatively, you may be ovulating on time, but making less progesterone after ovulation, so your next period may come sooner than expected.

Considerations: Bleeding more frequently than 21 days from first day to first day of your period usually suggests no ovulation and estrogen withdrawal bleeding. This may puts you at increased risk of too much uterine tissue and abnormalities of the uterus including polyps and possibly precancerous and cancerous spots in the uterus. Be sure to let your doctor know if you experience frequent bleeding.

Contraception: During perimenopause, birth control is still essential. Over 53% of these pregnancies are lost as miscarriages, and if you conceive at the age of 45, there’s a 1-in-21 chance that the baby will have chromosomal abnormalities, such as Down’s Syndrome.  And those statistics continue to plummet as you age; at 48 years old, it’s 1-in-10. The bottom line is that you should continue to use contraception until menopause is over (no menses for one year).

So what contraception can you use?
1) The pill: Contraceptive pills can be taken if there are no contraindications. (Keep in mind that 5% of women on the pill have elevations in blood pressure while taking it; so keep an eye on your blood pressure.). The pill has many benefits during perimenopause:

  • It can control your cycle, stretching it to 28 days.
  • It can lessen the bleeding (which may help if you have developed anemia by bleeding frequently).
  • If you’d prefer to skip menses, certain birth control pills do that, too.
  • If you are experiencing hot flashes or night sweats, the pill should improve that as well.

For some, the regulated cycles that the pill provides also helps tame mood changes (PMS). Keep in mind, however, that for others the pill is associated with chronic PMS-like symptoms or mood disorders, so just like at any other phase of life, the pill may not be for you.

2) Intrauterine Device (IUD): The IUD is another great method of hormonal birth control. It won’t treat hot flashes or night sweats but the IUD will protect that uterus from extra bleeding. In fact, about 50% or more of women who have an implanted IUD don’t have periods, as there is no tissue developing in the uterus to bleed every month. Here are the top IUD options:

  • The Mirena IUD: This IUD should not exacerbate mood swings or negatively affects sex drive – you will still ovulate monthly. And it is even more effective than the pill – it’s 99.9% accurate! It also can help you through menopause, as it will protect the uterus from any estrogen that you may take to combat menopause symptoms.
  • The ParaGard IUD: This IUD is also very effective – 99% — and your periods will come monthly, but they may be heavier than if you used the Mirena IUD, and may also last a day or two longer and be associated with more cramps. If you are already having extra bleeding or irregular cycles, this may not be the best option for you as it may make it worse.

Fibroids & Polyps: If you notice that your bleeding frequency is more than expected, or if the cycle is regular but the flow is particularly heavy, you should speak to your doctor to see if your cycles are indeed ovulatory, or if there is a polyp or fibroid in the uterus that is causing the excess bleeding. Your physician can do an ultrasound to check the uterus, or a water ultrasound to better see the lining of the endometrial cavity (uterine lining). If there are growths, most can easily be removed in a simple, one-day outpatient surgical procedure.

It is very important to remember that too much bleeding during perimenopause may not be normal and should be discussed with your doctor.

Vaginal dryness: This is a common complaint – and I always say for vaginal dryness, a little bit of local estrogen cream can go a long way.  Another option is estrogen tablets, which are placed in the vagina twice a week and work really well.  Finally, using a lubricant during sexual relations is a great way to combat dryness.

Next time we’ll address what to do and discuss with your doctor when menopause truly sets in.