Defining Perimenopause

0:07 Julia Cormano: In this episode of Motherhood TV,

0:10 we're fortunate to have doctor Kathryn Macauley here with us.

0:13 She's a clinical professor here at UC San Diego Health in the Department

0:17 of Obstetrics Gynecology and Reproductive Sciences

0:19 and is the director of the Menopause program.

0:22 Doctor Mccauley, thanks so much for being here with us.

0:25 Maybe we can start off if you would tell us what is perimenopause?

0:29 Kathryn Macaulay: Well, first of all, thanks for having me.

0:31 I'm always excited to talk about menopause, but to answer your question,

0:36 perimenopause is basically the transition into menopause.

0:40 It's the transition from the reproductive years to the menopause.

0:45 When fertility declines over this transition,

0:49 hormonal changes start, menstrual cycles start to change.

0:53 But we call it perimenopause,

0:55 but also it can be considered a transitional time period.

0:57 Julia Cormano: What are some of the things

0:59 that your patients come to you concerned about during perimenopause?

1:03 Kathryn Macaulay: A variety of things.

1:05 One can be irregular menstrual periods.

1:08 That's one of the first signs

1:09 that women see when they're approaching perimenopause

1:11 or when they're entering into perimenopause is

1:13 a change of their menstrual cycle length,

1:15 more than seven days, or they're actually starting to skip periods.

1:19 That can be concerning.

1:20 They can start to develop,

1:21 even when they're still having regular menstrual periods.

1:24 They can start to develop vasomotor symptoms,

1:26 which is having hot flashes during the day, or hot flashes at night,

1:29 which women experience as night sweats, which can cause sleep disturbance.

1:33 They can start to have a disconcerting symptom of brain fog,

1:38 which is really a constellation of different

1:41 memory and cognitive type changes that are temporary.

1:44 But that can be very concerning to women

1:46 because they can almost feel like they're developing dementia.

1:50 That can be quite concerning.

1:51 And also mood changes.

1:53 Some women are really blindsided by the mood changes that can happen,

1:57 and they just don't feel like

1:58 themselves They're feeling more irritable, depressed, anxious.

2:02 All of these can be part of the menopause transition,

2:06 as well as changes and starting to have changes in sexual function,

2:09 a primary one being decrease in libido or sexual drive.

2:13 Julia Cormano: How do you counsel women who are

2:15 interested in maximizing their health during the perimenopause period?

2:20 Kathryn Macaulay: A perimenopause and entering midlife is just a great

2:23 opportunity for women to start to look at their health overall,

2:27 looking at their weight, looking at their diet, looking at their exercise,

2:31 taking stock of assessment of their cardiovascular health,

2:35 screening for diabetes.

2:37 All these things are so important, looking at breast cancer risk factors.

2:40 It's a really good time to look at overall health.

2:43 Particularly weight management, I think women do.

2:46 We didn't talk about weight gain during perimenopause and menopause,

2:49 but that is also another big complaint.

2:51 Women just feel like they're gaining weight faster.

2:53 It's harder to lose weight.

2:54 If one wants to be proactive about perimenopause,

2:58 one really big thing I can tell them is to do your best.

3:01 If you're struggling with your weight,

3:03 let's try to really get your weight managed now before you really hit menopause.

3:07 We look at lifestyle, diet, exercise, maybe,

3:10 is there a need for medication for weight loss.

3:13 All the above.

3:14 Another important aspect of perimenopause that women need

3:17 to be aware of is the need for contraception.

3:20 Sometimes the most appropriate therapy for a perimenopausal

3:24 woman would be a hormonal contraceptive because they can get a triple benefit

3:27 from that if they're in need of contraception,

3:30 If they're also having abnormal bleeding,

3:32 the oral contraceptive will help to regulate their bleeding.

3:35 If they're having vasomotor symptoms,

3:37 the estrogen in the oral contraceptive pill will help

3:39 to ease those vasomotor symptoms like hot flashes and night sweats.

3:44 Then the other option is there's also a progestin releasing IUD that is

3:49 sometimes a nice option for women in perimenopause to bridge over to menopause,

3:53 particularly if they're having bleeding abnormalities.

3:57 Julia Cormano: Anything else that's really important for patients

4:00 to be thinking about during that perimenopause period?

4:03 Kathryn Macaulay: One thing they should be aware of is

4:05 they don't have to panic about this time period.

4:07 It's not always a terrible transition that's highly symptomatic.

4:11 Some women go through it with milder symptoms.

4:14 Certainly, there's a wide variation of how

4:16 women are going to experience their symptoms.

4:18 I do, as of late, have a lot of women, I think,

4:21 hearing some misinformation about menopause

4:24 and that they have to start hormone therapy

4:26 even when they're still having regular periods

4:28 to sort of get ahead of menopause, and I really don't think that's necessary

4:32 for most women when they're having regular cycles.

4:35 It's really an individualized decision what they need,

4:38 and I really just encourage women to not panic about this, but I

4:44 reassure them that I'll be there to help them through the transition.

4:48 Julia Cormano: That's terrific.

4:49 Thank you so much for your time.