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Perimenopause: Puberty in Reverse

Laura Mueller, MD, an Ob/Gyn doctor with Park Nicollet Clinic has been interested in menopause for more than a decade. She spent a good part of her career preparing women for what to expect during perimenopause (the years leading up to menopause) and beyond. Today, she is even more in tune with what to expect.

"I started studying menopause way before I was going through it, but have learned there's nothing quite like personal experience," says Dr. Mueller, who is one of the 80 percent of women who experience hot flashes during menopause.

Besides telling women to dress in layers, she tells them to expect the unexpected and embrace this natural change, which she refers to as puberty in reverse.

"During puberty, girls go from having low levels of estrogen and progesterone to having higher levels," Dr. Mueller says. "But before they get into a nice, beautiful cycle, they go through a period of time – sometimes years – where their hormone levels are sporadic. That's what it is like with perimenopause, except in reverse."

What is perimenopause?
During perimenopause, which may begin in the mid-30s, a woman's levels of reproductive hormones, estrogen and progesterone, rise and fall unevenly, and commonly cause unpredictable periods. The cycles may lengthen or shorten, ovulation becomes irregular and the ability to conceive decreases. This monumental change often occurs quite subtly.

"A woman is officially postmenopausal after going 12 months without a period," Dr. Mueller says. "She won't know it's her last period until she realizes, ‘I haven't had a period in the last year.'"

Although it varies, the average age for this to occur is just over age 51. Menopause may occur earlier for women who smoke, those with a family history of early menopause and those who have had cancer treatment or had a hysterectomy with removal of ovaries.

What should I expect?
Perimenopause often is marked by menstrual irregularities, hot flashes, sleep problems, mood changes and decreased libido. During and after menopause, urinary problems may occur and vaginal dryness may occur later, after menopause.

"I empower women by teaching them how to make lifestyle changes that not only will help them through menopause, but also make them healthier for the rest of their lives," Dr. Mueller says. She commonly discusses nutrition, exercise and stress reduction and encourages women to talk to their ob/gyn doctors about specific symptoms, so they can formulate successful strategies together.

How can I maintain bone health?
With declining estrogen levels comes a higher risk of osteoporosis. To help build bone strength, Dr. Mueller recommends adequate amounts of exercise and calcium. "The impact of exercise is huge, for bone health as well as for weight management, heart health and overall well being," she says. "It's difficult for a lot of people to get started, so it's best to find out what activities they enjoy and take it from there."

Weight-bearing exercise is best for building bone density, so if a woman likes to walk, she can add ankle or wrist weights to her workout. Women who enjoy swimming also should incorporate resistance exercises into their daily routines to get the added bone-building benefits of weight-bearing exercise.

Although calcium is important at any age, it becomes increasingly important during the years leading up to menopause. According to Dr. Mueller, women under age 40 need 1,000 mg of calcium, plus 400 mg of vitamin D a day. After menopause, women should increase their calcium intake to 1,500 mg a day, if not on hormone replacement therapy, and up their vitamin D intake to between 600 mg and 800 mg a day. Vitamin D allows calcium to be absorbed into the body, including the bones.

What else should I keep in mind?
After menopause, a woman's risk for weight gain, heart disease and breast cancer also may increase. Dr. Mueller advises women to work closely with their doctors to decrease symptoms, help prevent complications and develop strategies for living long, healthy lives.

For more information on Perimenopause, go to stayhealthymin.com

Categories: Health & Wellness, Women's Health,

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