Each woman’s menopause experience is different. The greatest differences observed are between women who have natural menopause and those whose menopause is early or induced, which typically requires specialized care. Many women who have natural menopause report no physical changes at all during the perimenopausal years except irregular menstrual periods that eventually stop when menopause is reached. In addition to irregular menstrual periods, some women experience symptoms of hot flashes, difficulty sleeping, and/or vaginal dryness. The severity of these changes varies from woman to woman, but for the most part, they are perfectly natural and normal. In fact, some experts and women prefer not to call perimenopausal changes “symptoms,” a term usually reserved to describe diseases.
The most common menopause-related discomfort is the hot flash (sometimes called a hot flush). Although their exact cause is still a matter of speculation, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature. If the hypothalamus mistakenly senses that a woman is too warm, it starts a chain of events to cool her down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman perspire to cool the body down. An increased pulse rate and a sensation of rapid heart beating may also occur. Hot flashes are often followed by a cold chill. A few women experience only the chill.
The best treatment depends on how severe the hot flashes are, how much they interfere with a woman’s quality of life, her personal philosophy and preferences, and her health profile. If treatment is needed, hot flashes can usually be reduced or eliminated completely with lifestyle changes, nonprescription remedies, and prescription therapies. Systemic estrogen therapy is the only therapy approved by the U.S. Food and Drug Administration (FDA)—and Health Canada—for treating hot flashes.
Supplements and prescription drugs have a lot in common. Both are used in an attempt to improve health. But “natural” remedies marketed as “dietary” supplements (including even topical progesterone cream and other nonprescription hormone treatments) are missing something their prescription counterparts come with—a Patient Package Insert. This document, required by the U.S. Food and Drug Administration (FDA) for all marketed prescription medications, provides vital information on how to take a drug safely, identify its negative side effects, and avoid potentially dangerous interactions with other drugs.
In Canada, all natural health products require an eight-digit product license number before they can be sold. Homeopathic medicine that is approved will have a license number beginning with NPN-HM, indicating to consumers that the product has been reviewed and approved by Health Canada for safety and efficacy.
When purchasing supplements, it is preferable to choose specific brands that have been tested in clinical trials. Last but not least, proceed with caution. Consulting a healthcare provider is advisable prior to using any supplement.
Few scientific studies support the belief that menopause contributes to true clinical depression, severe anxiety, or erratic behavior. However, some perimenopausal women report symptoms of tearfulness, mood swings, and feeling blue or discouraged.
It is unclear whether these mood symptoms are related to the gradual decline in ovarian hormone levels, but sleep deprivation associated with night sweats often results in fatigue, irritability, and moodiness. Abrupt hormonal fluctuations during perimenopause may have an impact on these symptoms as well. During their reproductive years, most women become accustomed to their own hormonal rhythm. During perimenopause, this rhythm changes, and the erratic hormonal ups and downs—although normal—can create a sense of loss of control that can be upsetting.
Sometimes, coping skills and lifestyle changes are not sufficient to relieve symptoms of stress. These symptoms may be a side effect of medication, a symptom of a medical condition, or the result of clinical depression or anxiety. A healthcare provider can help determine the cause of mental health stressors, assess options, and prescribe appropriate treatment.
With aging come increased dental problems, including tooth loss, need for dentures, gum recession, higher risk of gum tissue injury, “burning” mouth and tongue, general hot and cold tooth sensitivity, and decreased bone mineral density (BMD) in the jawbone. While some of these problems are related to estrogen decline at menopause, other causes include advancing age, inadequate intake of calcium and vitamins, medication side effects, and medical conditions such as anemia or diabetes. Practicing good oral hygiene is extremely important. Brushing and flossing daily, regular dental checkups, and professional dental cleaning twice yearly are all recommended. A woman’s primary healthcare provider should be advised of any changes observed by her dental professional, as some of these changes can be indicators of serious health problems elsewhere in the body.
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