Private Nurse Practitioner Services
NP Megan Dunn
Perimenopause & Menopause
Menopause is a natural biological process that marks the end of a women's reproductive years. As the ovaries stop functioning to release eggs, there is a hormonal shift and decline in estrogen, which may results in a variety of symptoms. Typically, menopause is diagnosed when someone has gone 12 months without a menstrual periods. The average age of natural menopause in Canada is 51 years old, with 90% of women experiencing menopause between the ages of 45-55 years old. Thereafter, you are considered to be postmenopausal.
Perimenopause refers to the transitional phase before official menopause, during which time women may experience irregular periods and some of the physical and emotional changes that accompany the decline in estrogen. Perimenopause can last for up to 8 years.
Common symptoms of concern include: vasomotor symptoms (hot flashes, night sweats), genitourinary symptoms (vaginal dryness, irritation, urinary concerns), sexual concerns, mood changes, cognitive changes, and sleep concerns. Declining estrogen and progesterone also negatively impacts bone health and cardiovascular health. Ultimately, these changes can have a significant impact of quality of life and well being. Fortunately, there are many safe non-hormonal and hormonal treatment options available.
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Vasomotor Symptoms - Hot Flashes & Night Sweats
Hot flashes and night sweats are the most well-known and frequently reported symptoms of menopause. These symptoms are due to hormonal changes, particularly a decrease in estrogen, and they can vary greatly in frequency and intensity.
Hot flashes are sudden and intense sensations of heat that can affect the upper body, particularly the face, neck and chest. They are often accompanied by flushing and sweating. Hot flashes can last from a few seconds to several minutes and may be followed by chills.
Night sweats are episodes of excessive sweating during sleep, often accompanied by a feeling of intense heat. They are often disruptive to sleep and lead to fatigue and daytime sleepiness.
Triggers for hot flashes and night sweats can include hot weather, stress, spicy foods, alcohol, caffiene, and tight clothing. Identifying and avoiding triggers can help reduce the frequency and severity of these symptoms.
In addition to trigger avoidance, lifestyle changes, non-hormonal prescription medications, and Menopausal Hormone Therapy (MHT) can help manage vasomotor symptoms.
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Genitourinary Syndrome of Menopause (GSM)
GSM is a common condition that affects many women experiencing menopause, resulting from the hormonal changes that occur, particularly the decline in estrogen levels. It involves a range of symptoms related to the genital and urinary tract, including: vaginal dryness, vaginal atrophy, vaginal itching or burning, painful intercourse, urinary frequency, urinary urgency, and recurrent UTIs.
Treatment opens for GSM aim to alleviate symptoms and improve overall comfort. They include: vaginal moisturizers, lubricants, pelvic floor physiotherapy, non-hormonal prescription medications, and Menopausal Hormone Therapy (MHT).
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Sexual Concerns
The most common sexual concerns associated with menopause are loss of libido (sex drive) and pain with sex (dyspareunia). Many factors can affect sex drive, including menopause. Other factors include stress, body image, past sexual experiences, partner factors, medication and drugs, and other personal health/medical issues. In addition, the vulva and vaginal changes associated with the Genitourinary Syndrome of Menopause (GSM) can affect desire, and cause discomfort or pain with sex.
Up to 50% of women report low sex drive. Sexual problems can be more common in women who undergo surgical menopause, or who undergo early menopause (before the age of 45).
Sexual function is multifactorial, and there is no normal. Any sexual issue that causes distress is worth discussing to determine treatment strategies to optimize sexual function and well being.
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Mood Changes
Depressive symptoms can increase in the menopausal transition. Women who have a history of depression, major depressive episodes, premenstrual syndrome (PMS) and postpartum depression may be at higher risk of having these symptoms occur. Mood changes have been observed in up to 25% of women.
The menopausal transition can also be a time where women are at risk of developing anxiety, either new-onset, or recurrent. This can also be associated with the frequency and intensity of vasomotor symptoms, such as hot flashes and night sweats.
Mood can be affected by many factors, including changes in hormones associated with menopause, menopausal symptoms, sleep disturbance, and chronic medical conditions.
There are many treatment options for mood changes that occur during as a part of the menopausal transition. The best outcomes generally result from a combination of multiple approach. This may include Cognitive Behavioural Therapy (CBT), antidepressant medications, Menopausal Hormone Therapy (MHT), regular exercise, and mindfulness based therapies.
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Cognitive Changes
It is estimated that half of women report cognitive changes. This is one of the most commonly reported symptoms of people undergoing the menopausal transition.
Many women experience increased forgetfulness and difficulty with concentration during the menopausal transition, which is sometimes referred to as “brain fog”. This can worsen in the first year after the last menstrual period. Vasomotor symptoms, depression, and anxiety can also have an effect on cognitive function.
Cognitive function can be optimized through diet, exercise, and quitting smoking. Sometimes, treating hot flashes, night sweats and mood symptoms can help to improve brain function. Many conditions, other than menopause, can affect cognition, making it an important symptom to discuss with a healthcare provider.
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Sleep Concerns
Disrupted sleep and poor sleep quality are common issues experienced during the menopausal transition, affecting up to half of women. Vasomotor symptoms (hot flashes and night sweats) may be a significant contributing factor, however, many women without vasomotor symptoms begin to have trouble falling asleep or staying asleep during this time. Sleep can be affected by stress, sleep apnea, restless leg syndrome, overactive bladder, and certain medications.
Difficulties with sleep results in daytime fatigue and irritability, which can further exacerbate other symptoms and have a significant impact on function and well being.
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