Archive for the ‘uterus’ Tag

Fibroids: Treating Fibroids Without Surgery, Uterine Artery Embolization   Leave a comment

About Fibroids

Uterine fibroids are the most common pelvic tumors in women, occurring in approximately 30% of women over the age of 35. Although fibroids are benign (non-cancerous), they may produce a wide variety of symptoms including excessive bleeding leading to iron deficiency anemia, pain and pressure sensations, and even obstruction of the bowel or urinary tract. Women with fibroids often complain of painful intercourse, and the presence of fibroids may result in pregnancy loss. Each year, approximately 200,000 hysterectomies are performed in the United States for uterine fibroids. Despite this large number of operations, the vast majority of women with symptomatic fibroids are “silent sufferers.”

Until recently, the only effective treatments for fibroids were hormonal therapy and surgery. Because fibroids grow in response to the female hormone estrogen, anti-estrogen hormones such as progesterone can shrink fibroids and may result in dramatic improvement in symptoms. However, these hormones have many untoward side effects including menopausal symptoms and osteoporosis (softening of the bone). Consequently, hormonal therapy can only be used for a short time and, unfortunately, once it is discontinued, symptoms usually return. Therefore, hormonal therapy is most useful in shrinking fibroids prior to surgery.

There are two general types of surgery available for fibroids, hysterectomy and myomectomy. Hysterectomy is the complete removal of the uterus with or without removal of the ovaries. In some cases hysterectomy can be performed through the vagina, avoiding an incision through the abdominal wall. However, with large fibroids, an abdominal hysterectomy (that is, a hysterectomy through an abdominal wall incision) is often necessary. Abdominal hysterectomy is a major surgical procedure requiring general anesthesia, approximately 6 days of hospitalization, and at least 6 weeks of recuperation. Obviously, pregnancy is no longer possible following a hysterectomy.

Myomectomy is an alternative surgical procedure for the treatment of fibroids. The object of myomectomy is to remove only the fibroid while leaving the uterus intact and preserving reproductive potential. Depending on the location and size of the fibroid, myomectomy may require an abdominal incision or may be done through a laparoscope (a telescope-like instrument inserted through an abdominal wall puncture) or a hysteroscope (a telescope-like instrument inserted through the vagina). With larger fibroids, attempted myomectomy frequently results in hysterectomy due to uncontrollable bleeding in these highly vascular tumors. Even when successful, myomectomy offers only temporary improvement in about one-third of patients because smaller untreated fibroids continue to grow.

Frequently Asked Questions About Fibroids

Q: After menopause, how does estrogen/progesterone therapy affect the growth of uterine fibroids?

A: In a menopausal woman who chooses not to take hormonal replacement therapy, existing fibroids usually shrink because the body is producing less estrogen. New fibroids are unlikely.

Q: How common are fibroids?

A: Up to 40% of women past the age of 40 have fibroids and about 75% of women will never be aware of their existence unless they cause a problem.
Q: Do fibroids move to another part of your body?

A: Fibroids typically grow attached directly to the inside or outside wall of the uterus.
Q: I recently had very excessive vaginal bleeding from fibroids, which required a myomectomy and blood transfusions. Could this happen again?

A: In some cases, fibroids can return, even after a myomectomy. It is important that you have annual examinations with your physician (or sooner, if symptoms return). Bleeding can again cause anemia and should not go unchecked.
Q: I am 46 and have a uterine fibroid tumor that has been shown to be 6 inches in size as measured by a hysteroscopy and ultrasonography. My OB/GYN has recommended a hysterectomy. I do not intend to have children. Should I consider myomectomy or uterine artery embolization alternatives?

A: Your physician may be recommending a hysterectomy due to your history, the size, location, and/or your specific anatomy, etc. S/he may feel this is the best recommendation for your situation. As you are also aware, there can be other options and it would be to your benefit and mental ease to discuss this with your doctor or health care practitioner. If you feel that you want to pursue discussing the other options more thoroughly, you can always seek a second opinion. Second opinions reinforce or offer alternatives, depending on your specific situation.

 

Q: I have fibroids. My OB/GYN has suggested a treatment of Lupron. Do you have any information?

A: Lupron is a synthetic form of a natural hormone (LH-RH). LH-RH stimulates the production of testosterone in men and estrogens in women. However, when the synthetic LH-RH is given, it actually stops natural production of hormones. As a result, in women who are premenopausal, menstruation will stop. Essentially, it induces temporary menopause. That is the reason why it works for endometriosis and fibroids. That also explains why it works for advanced prostatic cancer-by stopping the hormone production, the tumor growth also stops.

Q: I have fibroids. My doctor put me on a low estrogen pill to regulate me. I’m still having irregular periods, feeling bloated, and bowel problems.

A: Fibroids can cause irregular bleeding, pain, and a swollen abdomen (bloated). The size and type of fibroid(s) can also be varied, as the hormone fluctuations in your body take place. Your physician probably prescribed the low estrogen to help regulate your hormone balances We recommend that you return to your physician and discuss your continued symptoms and further evaluate if your symptoms are related to the same fibroid(s) or any other underlying causes. Further testing may be warranted.

Q: Does natural progesterone have any effect on fibroids?

A: Natural progesterone may be used when a woman’s primary symptom is bleeding. This helps to prevent the endometrial lining of the uterus from building up too much. This may be an option when women are unable to modify their diets or when their symptoms aren’t alleviated by dietary changes (low-fat, high-fiber, even vegetarian). A low-fat, high complex carbohydrate diet may halt the growth of fibroids and in some cases, result in their disappearance.

Q: What’s the difference between a cyst and a fibroid?

A: A fibroid is a solid tumor containing mostly smooth muscle bound together by fibrous tissue commonly found within and around the uterus. A cyst is a fluid-filled pouch located on or in an ovary. Both are usually benign.
Q: Is a golf-ball sized fibroid considered large or small?

A: It could depend on the location of the fibroid and whether it is causing symptoms. Fibroids can be either much smaller or much larger.
Q: How are large fibroids surgically removed?

A: How fibroids are removed varies, depending on size, location and preference of the surgeon. The recovery period varies, depending on some of above variables.
Q: How reasonable is it to resist having a hysterectomy due to large fibroids?

A: Because fibroids tend to shrink after menopause, it depends on how close you are to menopause and also how severe your symptoms are. Also there is a relatively new technique that cuts off the blood supply to fibroids and causes them to shrink.
Q: If I wait until menopause, what are the chances my fibroids will shrink?

A: Even if fibroids do not shrink (and they often do) after menopause, at least they should stop growing.
Q: What is the most common symptom of fibroids?

A: Often the first indication is an increase of the amount of menstrual flow, including blood clots. Discomfort or pain may also accompany fibroids.
Q: How fast do fibroids grow?

A: Fibroids usually grow very slowly, however they grow more rapidly during pregnancy, or when taking oral contraceptives.

 

Uterine Artery Embolization

Embolization (embolotherapy) is a procedure used to block blood vessels from the inside. Embolotherapy is performed by Interventional Radiologists, physicians who specialize in the treatment of a variety of diseases using catheters (tiny tubes) and medical imaging techniques. For nearly thirty years, embolotherapy has been used as a means of stopping uncontrollable bleeding from the uterus due to cancer, blood vessel malformations, trauma, and complications of pregnancy. In the early 1990’s, investigators in France began using embolotherapy of the uterine arteries to prevent excessive bleeding in women about to undergo myomectomy for uterine fibroids. A surprising and wholly unexpected result of these uterine artery embolization procedures was that many of the patients had such significant improvement in their symptoms that surgery was postponed. Over the course of months it became clear that the improvement noted in these women was not only significant, it was durable. Consequently, a pilot study was begun to evaluate the long-term results of uterine artery embolization for the primary treatment of fibroids.

In the initial pilot study, 85% of women undergoing uterine artery embolization experienced significant improvement or complete resolution of symptoms. In 75% of cases the size of the uterus decreased by 20-80% within 3 months, and these results remained stable with an average follow-up of more than 18 months (11 to 38 months). In a second study from UCLA, 77% of patients reported “significant improvement” or “complete resolution” of their dominant fibroid symptom at 2 to 9 months follow-up. In this group, 2-month follow-up revealed an average 40% (22-61%) reduction in uterine volume with the dominant (largest) fibroid decreased by an average of 58% in 55% of the patients studied. In one-third of the patients the fibroids were no longer visible by ultrasound.

On the basis of these studies, uterine artery embolization programs for the non-surgical treatment of fibroids have been established at several academic medical centers in the United States. The experience gained at these centers will optimize treatment protocols and provide in-depth answers to questions regarding the durability of symptomatic relief and preservation of reproductive function.

The Uterine Artery Embolization Procedure

The uterine artery embolization procedure is performed by an Interventional Radiologist in the radiology department of the hospital. Although patients are awake for the procedure, they are sedated and often have no recollection of events during the embolization. The procedure itself consists of introduction of a tiny tube (catheter) into an artery in either the left arm or the groin under a local anesthetic. Except for the injection of the local anesthetic, there is little or no discomfort associated with the catheter insertion. Once in the artery the catheter is manipulated into the uterine arteries and angiography is performed. Patients may experience a mild sensation of warmth during the angiogram. When the catheter is positioned well within the uterine artery, tiny pellets of a material called PVA are injected. (Note: the chemical name for PVA is polyvinyl alcohol, but it is neither vinyl as in flooring nor alcohol as in alcoholic beverages. It is merely an organic [i.e., carbon-based] synthetic compound with properties that make it a useful embolic agent.) The PVA is carried by the flow of blood into the uterus and all of the fibroids present. The particles eventually impact in the very small arteries and produce blockage. Deprived of their blood supply, the abnormal cells in the fibroids die and are slowly removed by the body. Meanwhile, the body restores circulation to the normal tissue by both the in-growth of new arteries and the removal of a portion of the PVA from some of the existing vessels.

Immediately following the embolization procedure the catheter is removed and pressure is applied to the entry site for about 15 minutes to stop any bleeding. Almost all patients experience crampy abdominal pain following the procedure. Consequently, we provide patients with on-demand pain medicine through a device called a PCA (patient controlled analgesia) pump. Many studies have demonstrated that patients experience far less pain, yet actually use far less pain medication when this device is used. Patients are admitted to the hospital overnight and can usually be discharged home the morning following the procedure. Most patients can return to work within a few days. At the current time, we ask patients to return for an ultrasound examination two weeks and two to three months after the procedure to assess results. The patient will also be asked to complete a short mail-in questionnaire one year after embolization. Additional follow-up may be requested in the future

 

Frequently Asked Questions About Uterine Artery Embolization

Q: What are the risks associated with uterine artery embolization?

A: The potential risks of the procedure include bleeding from the catheter entry site, infection, adverse reactions to medications or contrast media, blood vessel injury, inadvertent embolization of other tissues. The risk of a significant complication is less than 0.5%.

Q: Does uterine artery embolization result in significant clinical improvement?

A: In all studies to date, embolization has resulted in significant improvement or resolution of symptoms in more than 75% of patients treated. With improvements in technique, it is anticipated that perhaps 90% of women treated will have substantial improvement in symptoms.
Q: What impact does uterine artery embolization have on reproductive function?

A: Most studies published thus far have focused on women who did not desire pregnancy. However, pregnancies have occurred and been carried to term following uterine artery embolization for fibroids. Small studies of women who underwent uterine artery embolization to control bleeding complications of labor and delivery have shown the return of normal menses within a few months in all cases and all women desiring subsequent pregnancy conceived and were successful in carrying to term. Since the presence of fibroids already has a negative impact on pregnancy, determining the impact specific to embolization will be difficult and will require a very large number of patients.

Q: Does uterine artery embolization preclude other potential treatments? 

A: In the setting of uterine fibroids, this procedure began as a preoperative measure to control bleeding during myomectomy. Preoperative embolization is commonly used in a variety of settings because it makes surgery easier and safer. Since the only other definitive treatment for fibroids is surgical at this time, the only impact embolization would have on such treatment is complementary.
Q: Is uterine artery embolization cost-effective compared with conventional therapy? 

A: The overall procedure cost is significantly less than abdominal hysterectomy and moderately less than hysteroscopic and laparoscopic myomectomy. When one takes into account the potential economic losses during a 6-week recovery from abdominal hysterectomy, the cost differential becomes astronomical.

Q: Are results obtained with uterine artery embolization durable? 

A: Published reports have shown stable results with follow-up of more than 3 years in a few cases. For women approaching menopause, the results may well be permanent since estrogen production is declining and estrogen is required for fibroid growth. There is insufficient data at this time to predict the long-term durability in younger patients because estrogen secretion will continue for many years and, theoretically, may stimulate the formation of new fibroids. It may be several years before sufficient data is compiled to assess long-term results in younger patients. On the other hand, if fibroids do recur after several years, it should be possible to treat them with repeat embolization.

Q: Where can I find more information about uterine artery embolization?

A: You should first discuss this procedure with your primary care physician or gynecologist. Unfortunately, many physicians are unaware of this alternative treatment for fibroids despite the fact that this procedure has now been used to treat well over a thousand patients in the United States. For specific information on this procedure you should contact an Interventional Radiologist in your locale. For Kansas, Missouri, Arkansas, Oklahoma and adjacent areas of neighboring states you may find a local Interventional Radiologist in the MIRS Physician Listings. Additional information and Interventional Radiologists in other locales can be found at the Society of Cardiovascular and Interventional Radiology (SCVIR) site on the World Wide Web.

Polycystic Ovarian Syndrome (PCOS)   1 comment

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is a health problem that can affect a womanís menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics:

  • high levels of male hormones, also called androgens
  • an irregular or no menstrual cycle
  • may or may not have many small cysts in their ovaries. Cysts are fluid-filled sacs.

PCOS is the most common hormonal reproductive problem in women of childbearing age.

How many women have Polycystic Ovarian Syndrome (PCOS)?

An estimated five to 10 percent of women of childbearing age have PCOS.

What causes Polycystic Ovarian Syndrome (PCOS)?

No one knows the exact cause of PCOS. Women with PCOS frequently have a mother or sister with PCOS. But there is not yet enough evidence to say there is a genetic link to this disorder. Many women with PCOS have a weight problem. So researchers are looking at the relationship between PCOS and the body’s ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches, and other food into energy for the body’s use or for storage. Since some women with PCOS make too much insulin, it’s possible that the ovaries react by making too many male hormones, called androgens. This can lead to acne, excessive hair growth, weight gain, and ovulation problems.

Why do women with Polycystic Ovarian Syndrome (PCOS) have trouble with their menstrual cycle?

The ovaries are two small organs, one on each side of a woman’s uterus. A woman’s ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs are also called cysts. Each month about 20 eggs start to mature, but usually only one becomes dominant. As the one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release the egg so it can travel through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation takes place.

In women with PCOS, the ovary doesn’t make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a womanís menstrual cycle is irregular or absent. Also, the cysts produce male hormones, which continue to prevent ovulation.

What are the symptoms of Polycystic Ovarian Syndrome (PCOS)?

These are some of the symptoms of PCOS:

  • infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
  • infertility or inability to get pregnant because of not ovulating
  • increased growth of hair on the face, chest, stomach, back, thumbs, or toes
  • acne, oily skin, or dandruff
  • pelvic pain
  • weight gain or obesity, usually carrying extra weight around the waist
  • type 2 diabetes
  • high cholesterol
  • high blood pressure
  • male-pattern baldness or thinning hair
  • patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
  • skin tags, or tiny excess flaps of skin in the armpits or neck area
  • sleep apnea – excessive snoring and breathing stops at times while asleep

What tests are used to diagnose Polycystic Ovarian Syndrome (PCOS)?

There is no single test to diagnose PCOS. Your doctor will take a medical history, perform a physical examópossibly including an ultrasound, check your hormone levels, and measure glucose, or sugar levels, in the blood. If you are producing too many male hormones, the doctor will make sure itís from PCOS. At the physical exam the doctor will want to evaluate the areas of increased hair growth, so try to allow the natural hair growth for a few days before the visit. During a pelvic exam, the ovaries may be enlarged or swollen by the increased number of small cysts. This can be seen more easily by vaginal ultrasound, or screening, to examine the ovaries for cysts and the endometrium. The endometrium is the lining of the uterus. The uterine lining may become thicker if there has not been a regular period.

 

How is Polycystic Ovarian Syndrome (PCOS) treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatments are based on the symptoms each patient is having and whether she wants to conceive or needs contraception. Below are descriptions of treatments used for PCOS.

Birth control pills. For women who donít want to become pregnant, birth control pills can regulate menstrual cycles, reduce male hormone levels, and help to clear acne. However, the birth control pill does not cure PCOS. The menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone, like Provera, to regulate the menstrual cycle and prevent endometrial problems. But progesterone alone does not help reduce acne and hair growth.

Diabetes Medications. The medicine, Metformin, also called Glucophage, which is used to treat type 2 diabetes, also helps with PCOS symptoms. Metformin affects the way insulin regulates glucose and decreases the testosterone production. Abnormal hair growth will slow down and ovulation may return after a few months of use. These medications will not cause a person to become diabetic.

Fertility Medications. The main fertility problem for women with PCOS is the lack of ovulation. Even so, her husbandís sperm count should be checked and her tubes checked to make sure they are open before fertility medications are used. Clomiphene (pills) and Gonadotropins (shots) can be used to stimulate the ovary to ovulate. PCOS patients are at increased risk for multiple births when using these medications. In vitro Fertilization (IVF) is sometimes recommended to control the chance of having triplets or more. Metformin can be taken with fertility medications and helps to make PCOS women ovulate on lower doses of medication.

Medicine for increased hair growth or extra male hormones. If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the male hormoneís effect on hair. Propecia, a medicine taken by men for hair loss, is another medication that blocks this effect. Both of these medicines can affect the development of a male fetus and should not be taken if pregnancy is possible. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.

Surgery. Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to induce ovulation. The doctor makes a very small incision above or below the navel, and inserts a small instrument that acts like a telescope into the abdomen. This is called laparoscopy. The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But these effects may only last a few months. This treatment doesn’t help with increased hair growth and loss of scalp hair.

A healthy weight. Maintaining a healthy weight is another way women can help manage PCOS. Since obesity is common with PCOS, a healthy diet and physical activity help maintain a healthy weight, which will help the body lower glucose levels, use insulin more efficiently, and may help restore a normal period. Even loss of 10% of her body weight can help make a woman’s cycle more regular.

How does Polycystic Ovarian Syndrome (PCOS) affect a woman while pregnant?

There appears to be a higher rate of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, and premature delivery in women with PCOS. Researchers are studying how the medicine, metformin, prevents or reduces the chances of having these problems while pregnant, in addition to looking at how the drug lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

No one yet knows if metformin is safe for pregnant women. Because the drug crosses the placenta, doctors are concerned that the baby could be affected by the drug. Research is ongoing.

Does Polycystic Ovarian Syndrome (PCOS) put women at risk for other conditions?

Women with PCOS can be at an increased risk for developing several other conditions. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial hyperplasia or cancer. Women with PCOS are also at higher risk for diabetes, high cholesterol, high blood pressure, and heart disease. Getting the symptoms under control at an earlier age may help to reduce this risk.

Does Polycystic Ovarian Syndrome (PCOS) change at menopause?

Researchers are looking at how male hormone levels change as women with PCOS grow older. They think that as women reach menopause, ovarian function changes and the menstrual cycle may become more normal. But even with falling male hormone levels, excessive hair growth continues, and male pattern baldness or thinning hair gets worse after menopause.

An Introduction to Menopause and Perimenopause: Signs, Symptoms and Treatments   2 comments

MaryO’Note: Some of these links have been removed.


What is Menopause and Perimenopause?

Menopause is defined as the cessation of menstruation as a result of the normal decline in ovarian function. Technically, you enter menopause following 12 consecutive months without a period. Menopause has become increasingly medicalized, which means it is viewed as something that requires intervention and treatment rather than as a natural life transition that may benefit from support. Menopause signals the end of fertility and the beginning of a new and potentially rewarding time in a woman’s life. Part of the stigma of menopause is its association with aging, but we age no more rapidly in our 50s than in any other decade of life.

When Does Menopause Happen?

For most women, natural menopause occurs between the ages of 45 and 55, with the average age of onset being 51.4 years of age. In rare instances, menopause can occur as early as the 30’s or as late as the 60’s. Menopause is considered premature if it occurs before the age of 40, or artificial if radiation exposure, chemotherapeutic drugs, or surgery induces it. Other factors that may contribute to the early onset of menopause include a history of smoking, poor nutrition, a co-existing medical condition, or even a traumatic experience.

Until a woman is technically considered menopausal (aka postmenopausal), she’s considered to be premenopausal, also referred to as perimenopause. It’s during the perimenopausal phase that most women experience the worst symptoms.

Menopause (or postmenopause) occurs when a woman hasn’t had her period for 12 consecutive months. Once hormones have levelled off, most of the symptoms experienced during perimenopause will disappear — although some women have occasional hot flashes, anxiety, bouts of depression, et al, for a few years after they become postmenopausal.

The Physiology of Menopause

To best understand what occurs at menopause, it is helpful to know about the physiology of menstruation and the hormones that are involved in our monthly cycle. Hormones are substances in our bodies that act like messengers. They travel throughout the body and can bind to specialized areas of cells known as receptor sites, where they then initiate a specific chain of events. The first half of the menstrual cycle is dominated by estrogen, whose role is to build the lining of the uterus in preparation for a potential pregnancy. At approximately day 14 of the cycle, or two weeks prior to menstruation, an egg is released from the ovaries. This is referred to as ovulation.

As a result of ovulation the ovary begins producing progesterone. It is during this second half of the cycle that progesterone is dominant. Progesterone’s role is to change the character of the uterine lining to prepare for pregnancy, and to prevent further buildup of the lining by estrogen. At the end of the cycle, if the egg is not fertilized, estrogen and progesterone levels drop, causing a sloughing of the uterine lining, or menstruation. The body goes through this cycle every month to ensure a fresh uterine lining in preparation for a potential pregnancy.

If a woman fails to ovulate, however, she does not produce progesterone, and this may result in the experience of symptoms of hormonal imbalance. Women are born with a finite number of eggs that eventually runs out. At birth, a woman has close to a million eggs, by puberty a mere 300,000. In the 10 to 15 years prior to menopause, this loss begins to accelerate. Perimenopause is the term used to describe the time of transition between a woman’s reproductive years and when menstruation ceases completely. Typically perimenopause occurs between the ages of 40 and 51 and may last anywhere from six months to ten years. During this time, hormone levels naturally fluctuate and decline, but they do not necessarily do so in an orderly manner. Shifts in hormones are a major contributor to that sense of physical, mental, and emotional imbalance that may characterize a woman’s experience of menopause.

Eventually estrogen levels decrease to the point that the lining of the uterus no longer builds up and menstruation ceases. This is menopause. After menopause, estrogen levels off at approximately 40 to 60% of its premenopausal levels and progesterone falls close to zero. Although there are similarities in what happens hormonally, each woman’s experience can be very different. Genetics may play a role in the timing, but lifestyle can certainly influence a woman’s experience of menopause. Many women find that the right combination of herbs, exercise, nutritional support, and natural hormones helps them to manage most of their symptoms. Others find they may need some medical intervention and pharmaceutical agents. This site will help guide you in making the decisions that best support your individual needs.

How long does perimenopause last?

It varies. Women normally go through menopause between ages 45 and 55. Many women experience menopause around age 51. However, perimenopause can start as early as age 35. It can last a few months to quite a few years. There is no way to tell in advance how long it will last OR how long it will take you to go through it. Every woman is different.

I’ve been depressed in the past. Will this affect when I start going through perimenopause?

It could. Researchers are studying how depression in a woman’s life affects the time she starts perimenopause. If you start perimenopause early, researchers don’t know if you reach menopause faster than other women or if you’re just in perimenopause longer.

What should I expect as I go through perimenopause?

The 34 Signs/Symptoms of Menopause.

Some women have symptoms during this time that can be very difficult. Some of these symptoms include:

  • Changes in your menstrual cycle – i.e., longer or shorter periods, heavier or lighter periods, or missed periods
  • Hot flashes (power surges — sudden rush of heat from your chest to your head)
  • Palpitations, skipped heartbeats
  • Internal shaking / tremor-like feelings
  • Night sweats
  • Vaginal dryness
  • Dry skin and skin changes
  • Itching
  • Formication (feeling like ants are crawling on your body)
  • Insomnia and other sleep disturbances
  • Mood swings
  • Allergies, sinus problems
  • Wheezing, respiratory problems, coughing
  • Depression
  • Anxiety
  • Panic attacks
  • Crying for no apparent reason
  • General irritability and/or anger
  • Hair thinning or loss
  • Pain during sex
  • More urinary infections
  • Urinary incontinence
  • Decreased or non-existent libido
  • Increase in body fat, especially around your waist
  • Forgetfulness, brain fog, problems with concentration and memory

Additional Reading: The 34 Signs/Symptoms of Menopause.

There are numerous articles addressing all of these issues and more in Power Surge’s ‘Educate Your Body’ Library.

Excellent suggestions for coping with menopause in Power Surge’s Menopause Survival Tips

I don’t understand why I get hot flashes. Could you tell me what’s going on with my body?

Read What’s A Hot Flash? We don’t know exactly what causes hot flashes.
It could be a drop in estrogen or change in another hormone. This affects the part of your brain that regulates your body temperature. During a hot flash, you feel a sudden rush of heat move from your chest to your head. Your skin may turn red, and you may sweat. Hot flashes are sometimes brought on by things like hot weather, eating hot or spicy foods, or drinking alcohol or caffeine. Try to avoid these things if you find they trigger the hot flashes.

I feel so emotional. Is this due to changes in my hormones?

Your mood changes could be caused by a lot of factors. Some researchers believe that the decrease in estrogen triggers changes in your brain causing depression. Others think that if you’re depressed, irritable, and anxious, it’s influenced by menopausal symptoms you’re having, such as sleep problems, hot flashes, night sweats, and fatigue, and/or by issues you’re dealing with that aren’t strictly related to hormonal changes. It could also be a combination of hormone changes and symptoms. Remember, menopause doesn’t happen in a vacuum. All the issues you came into menopause with are only exacerbated by your changes.

Menopause doesn’t happen in a vacuum. It’s part of the bigger transition of “aging.” Other things that could cause depression and/or anxiety include:

  • Having depression during your lifetime
  • Feeling negative about menopause and getting older
  • Increased stress (look at the world we’re living in)
  • Having severe menopause symptoms
  • Children growing up and leaving home – empty nest syndrome
  • Smoking
  • Being sedentary – not being physically active
  • Not being happy in your relationship or not being in a relationship
  • Not having a job, or being unhappy in your current job
  • Continuing working during a difficult menopause
  • An unfulfilling marriage / marital problems
  • Financial problems
  • Low self-esteem (how you feel about yourself)
  • Not having the social support you need
  • Feeling isolated
  • Not having anyone to talk to (Use our message boards)
  • Regretful that you can’t have children anymore

What can I do to prevent or relieve symptoms of perimenopause?

  • Read the Power Surge Recommendations for treating various menopause symptoms.
  • Read Power Surge’s Menopause Survival Tips
  • Keep a journal for a few months and write down your symptoms, like hot flashes, night sweats, and mood changes. That can help you figure out the changes you’re going through
  • Record your menstrual cycle, noting whether you have a heavy, normal, or light period
  • Find a physical activity that you’ll enjoy doing
  • If you smoke, try to quit. There are areas, such as A Breath of Fresh Air! for help.
  • Keep your body mass index (BMI) at a normal level. Figure out your BMI by going to www.nhlbisupport.com/bmi/bmicalc.htm
  • Network with other women who are in perimenopause or menopause. Most likely, they’re going through the same things you are!
  • Do something new: start a new hobby, do volunteer work, take a class
  • Learn meditation and breathing exercises for relaxation
  • Use a vaginal lubricant for dryness and pain during sex Read the article on Midlife Sexuality / Vaginal Dryness for more information.
  • Dress in lighter layers (preferably cotton), so if a hot flash comes on, you can peel away the top layer (without getting arrested!)
  • Try to figure out (and avoid) those triggers that may cause hot flashes, such as spicy foods, caffeine, or being outside in the heat.
  • Talk with your health care practitioner if you feel depressed, or have any other questions about how to relieve your symptoms
  • Educate yourself about what tests you need when entering perimenopause. Oftentimes, doctors won’t prescribe them unless YOU ASK for them!
  • An excellent resource for your questions about menopause — < Ask Power Surge’s Experts!

I’m going through perimenopause right now. My period is very heavy, and I’m bleeding after sex. Is this normal?

Irregular periods are common and normal during perimenopause, but not all changes in bleeding are from perimenopause or menopause. Other things can cause abnormal bleeding.

Talk to your health care provider if:

  • The bleeding is very heavy or comes with clots (although clotting isn’t uncommon during perimenopause)
  • The bleeding lasts longer than 7 days
  • You have spotting or bleeding between periods
  • You’re bleeding from the vagina after sex
  • Can I get pregnant while in perimenopause? Yes. If you’re still having periods, you can get pregnant. Talk to your health care provider about your options for birth control. Keep in mind that methods of birth control, like birth control pills, shots, implants, or diaphragms will not protect you from STDs or HIV. If you use one of these methods, be sure to also use a latex condom or dental dam (used for oral sex) correctly every time you have sexual contact. Be aware that condoms don’t provide complete protection against STDs and HIV. The only sure protection is abstinence (not having sex of any kind). But appropriate and consistent use of latex condoms and other barrier methods can help protect you from STDs.For women under 50, it is recommended that you continue some form of birth control even after your period has stopped for one year (24 consecutive months). For women over 50, it is recommended that birth control be practiced for one year after entering menopause.For perimenopausal women, it is essential that you continue some form of birth control while your periods are erratic — even if you’ve been without a period for six or seven months — you can still get pregnant. For women whose periods have stopped for twelve consecutive months, it is still recommended that you practice some form of birth control for approximately one year after entering menopause.