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What are Pre-menopause, Perimenopause and Menopause?

Pre-menopause -

Pre-menopause is a stage before perimenopause which eventually leads to Menopause. To be more specific, it is the period between first menstruation till the onset of perimenopause.

Women specifically don’t experience any symptoms during pre-menopause other than certain hormonal shifts. The symptoms are generally noticed during perimenopause when the ovaries produce less oestrogen.



Perimenopause –

Perimenopause (peri means around) stage is when you are around or when you are about to get your “Menopause”, a natural transition, which marks the end of your reproductive years. Perimenopause is also known as the Menopausal Transition phase.

The perimenopause phase cannot be defined at a specific age as it differs from woman to woman, for example, some women experience it in their 40’s while some after 45 years or some have seen it around the mid-’30s as well, and this phase can last around 7 years or longer than that. it’s different for each woman associated with profound reproductive or hormonal changes.


A common symptom during perimenopause is irregular menstruation. The female hormone Oestrogen in the body rises and falls unevenly during the perimenopausal phase. The days of menstruation can vary as it can go long or in some cases short or the ovulation (release of eggs from the ovaries) doesn’t happen even when you had a menstrual cycle that month. And the bleeding can be lighter or heavier than normal menstruation. Women will get to know if they are in perimenopause or about to start perimenopause if the length of the menstrual cycle differs by 7 days or more or even less but still have at least one period in 3 months.

Even if these symptoms are normal during the perimenopause stage, still make sure to consult a doctor if:

  • The bleeding is very heavy and continues for more than 15 days

  • When you experience bleeding after missing your menstrual cycle for a year

  • If you are diagnosed with Polycystic Ovarian Syndrome (PCOS) in past

Towards the end of 1-2 years of perimenopause, the drop in oestrogen accelerates. And at this stage, people might start experiencing menopausal symptoms. Around 1 in 5 women will experience multiple severe symptoms which disrupt their daily lives such as Vaginal dryness, Mood swings, Hot flashes, Sleep problems, Anxiety, Low libido, Weight gain, and in some women extreme tiredness and difficulty in concentration also reported during their perimenopausal phase. Perimenopause lasts until menopause.


Menopause

Menopause is clinically defined as a complete year without a menstrual cycle, the time that marks the end of reproductive age- the end of the menstrual cycle which is a natural biological process as part of ageing in women. If a woman has undergone a Hysterectomy (ovaries surgically removed), also go through sudden surgical menopause.

The reproductive cycle slows down as age progresses and prepares to stop which has been functioning since puberty. During menopause, ovaries will no longer release eggs and you will have the last menstrual cycle. Physical change happens as the body adapts to hormonal ups and downs.


Premature Menopause or Early Menopause

Some women experience natural menopause which is usually referred to as Primary Ovarian Insufficiency or as a result of surgical removal of ovaries, or damage to the ovaries due to chemotherapy at an earlier age than expected.

The symptoms experienced during perimenopause will be severe during Menopause.

Slow metabolism, thinning hair and dry skin, night sweats, chills etc are commonly seen along with other symptoms such as vaginal dryness, hot flashes, sleep disturbances, Mood changes etc. Some may experience headaches, palpitation, and joint or muscle aches which are the signs of increased fluctuations of hormones and less oestrogen to no oestrogen.



Are hot flashes a concern?

Hot flashes are one of the classic symptoms of Menopause which is a temporary sensation of heat. The intensity, frequency and duration of hot flashes differ for each individual. A few things which we include in our daily life also lead to increase hot flashes such as overconsumption of Caffeine, Smoking, Spicy foods, Alcohol, Stress and anxiety and sometimes hot weather as well.


Stress/Anxiety/Depression

Your body goes through extreme hormonal variations and due to hot flashes and chills there can be sleep disturbances, stress, mood swings and anxiety which eventually leads to depression. Talk to a professional to help you to cope and meditating and practising yoga help in getting through this phase.


Long-term health risks of Menopause

Osteoporosis

Oestrogen plays an important role in maintaining and preserving bone mass and calcium absorption in the body. Women lose an average of 25% of their bone mass during menopause and as a result, there can be a loss in bone mass. Doing a Bone Densitometry test can assess bone density and oestrogen hormone therapy helps in the effective management of osteoporosis.

Coronary Artery Disease

During the menopausal phase, the body produces less oestrogen. This increases the risk of coronary arteries narrowing down and accelerates the risk of developing coronary heart disease. Studies conducted by British Heart Foundation found that women having early menopause are at a higher risk of premature coronary heart disease.

Management of Menopause

Hormone Therapy

If the symptoms are severe causing disturbances in your daily routine, Doctors prefer Hormonal therapy. Hormone Therapy is used to improve hormone levels and reduce the symptoms of Menopause.


Generally, there are two types of Hormone Therapy –

Oestrogen Therapy – Low dose of oestrogen is usually prescribed to relieve menopause symptoms in the form of pills by doctors.

Progestin Hormone Therapy / Oestrogen progesterone Therapy – is known as combination therapy, which combines doses of oestrogen and progesterone.


Non-Hormonal Therapy - Diet

Following a healthy dietary pattern- a well-balanced meal, regular exercise, reducing weight if obese or overweight, getting enough sleep and reducing stress with help of yoga and meditation can help you relieve symptoms of menopause.

Include foods rich in phytoestrogens such as tofu, whole grains, beans and lentils, flax seeds, berries, and steel-cut oats to help in relieving hormonal fluctuations.

Eat a heart-healthy diet, including at least five portions of different coloured fruit and vegetables, plenty of fibre-rich cereal foods, nuts & seeds (unsalted), peas and beans.

Aim for two to three portions of calcium-rich foods every day.


Non-Hormonal Therapy - Exercises

Exercising will help in relieving insomnia and improving mood swings effectively. Moderate aerobic activity for at least 150 minutes per week or vigorous aerobic activity for at least 75 minutes per week is recommended. Strength training exercises are recommended at least twice a week.



Yoga for relieving stress as well as managing Menopausal Symptoms

Many studies among women have found that yoga has helped in relieving menopause physical and physiological symptoms and managing hormonal imbalances. Yoga helps in rebalancing your emotions, restoring depleted energy, and improving metabolism. There are a few yoga poses that you can try :

  1. Shoulder stand otherwise known as Salamba Sarvangasana

  2. Marichi’s pose or Marichyasana

  3. Head to knee forward bend or Janu Sirsasana

  4. Reclining bound angle pose or Supta Baddha Konasana

  5. Bridge pose or Setu bandha sarvangasana


Conclusion:-

Menopause is a natural part of any woman's lifespan, but it can be very difficult to deal with and understand. Knowing what to expect can help you not only get through this change in your life but also lower your risk of dangerous complications. Communicating with your healthcare provider about menopause is just as important as the above lifestyle changes, so don't hesitate to ask questions!

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