Melissa Benoit

Hot flashes, sleeplessness, nervousness....perimenopausal symptoms....what to expect!

Perimenpause and Menopause

As a woman reach middle age, she will start having symptoms related to so-called "change of life". Actually, it simply reflects that she is transitioning into her perimenopause period and subsequently reaching menopause.

Menopause is defined as one year without menstrual flow. However, all women go through the journey of perimenopause along with some of the unique signs and symptoms due to hormonal changes before the finally reaching menopause.

Perimenopause (‘peri' meaning around) is defined as the period immediately prior to menopause and one year after menopause. Women may feel their first sign of perimenopause anywhere between their 30s and 50s. Women may also experience symptoms of perimenopause for 6 to 8 years.

Due to hormonal changes during the period of perimenopause, women may experience different physical symptoms and psychological stresses that can affect their quality of life. Therefore, it is helpful to gain knowledge about the changes that occur during this period and learn to deal with them with healthy and positive approaches.

The 5 Phases:

Zala, Swan and Prior, the authors who wrote an excellent book called "Transitions through the perimenopausal years" divided the period of perimenopause into five phases. However, these phases are not completely clear cut, so some women may find themselves having symptoms belonging to one or more of these phases. Since each woman is goes through her perimenopause in her own unique way, it is entirely normal to have symptoms that belonging to more than two phases at the same time. However, each perimenopausal phase can be explained by changes in the level of specific female hormones that are essential for a normal menstrual cycle.

Phase I:

The first phase of perimenopause occurs when a woman reaches age about 40 to 45 years old. During the phase, follicle stimulating hormone (FSH) secretion is normal; estrogen is high and progesterone may be normal or low.
During this phase, woman experiences exaggerated symptoms of pre-menstrual cycle particularly breast tenderness, headaches and nausea.

Phase II:

This phase occurs around 42 to 47 years of age. At this phase, FSH is intermittently high, estrogen is high and progesterone level is low.
The this stage, a woman will experience additional symptoms such as increased menstrual flow, hot flashes, night sweats and sleep disturbances.

Phase III:

This phase begins at around 45 to 49 years of age. During this phase, the body is trying hard to stimulate follicles to produce a mature egg but only small numbers of potential eggs are available. At this point, FSH is high, estradiol is normal or high but progesterone is often low. As mentioned previously, progesterone normally rises after ovulation because progesterone prepares the uterus (womb) for conception. In this case, when ovulation is unsuccessful, progesterone levels will be low.
During this phase, the woman may have irregular cycles without skipping, heavy, prolonged periods with blood clots or alternating heavy and light flows. She may have mood swings, weight gain. Her breasts may become lumpy and tender before menstrual flow. She may experience night sweats and onset of daytime hot flushes.

Phase IV:

It occurs around 47 to 52 years of age. During this phase, the FSH continues to be high trying to stimulate and potential eggs to ripen. The estradiol level is normal or occasionally very high but progesterone remains low.
Women start to have skipped periods. The cycle becomes longer than 56 to 60 days. The perimenopausal symptoms are becoming more pronounced such as mood swings, restless sleep, heart palpitations, severe hot flashes, night sweats, joint stiff ness and muscular discomfort and lower sex drive.

Phase V:

This is the stage when a woman finally reaches menopause i.e. no menstrual cycles for one year. On the average, it occurs at 51.4 years of age though it varies form woman to woman. During this phase, FSH remains high and estradiol is typically reduced. However, estradiol can still be high at times but progesterone remains low.
In general, most symptoms are reduced at this point. However, some women continue to suffer dramatic sleep disturbance and night sweats.

Specific to Women with CF...

Women with CF may experience symptoms of perimenopause and reach menopause 3 years earlier than women in the general population (women without CF) as demonstrated by recent study conducted in our CF clinic by nurse practitioner Anna Tsang. It was also noted that sleep disturbances appeared to be the most dominant symptom If you have symptoms, questions, or concerns please do not hesitate to speak with your CF care team.

Positive Message

It is important to remember that despite all the uncomfortable symptoms that you might be facing during perimenopause and menopause, it is a natural phase in life, and also a wonderful indication of improved survival in CF! Studies have shown that entering this special time with a positive attitude and a healthy lifestyle including exercise, many women report having a much better experience.

Source:Transitions through the perimenopause years: demystifying the journey
Lissa Zala, Andrea Swan, Jerilynn C Prior.