Scott Webb (Host): Though menopause in women seems to get most of the headlines, if you will, perimenopause begins much earlier for women and brings with it lots of physical and emotional changes and challenges. And my guest today, nurse practitioner Jean Miller, is here to explain perimenopause and the ways that Franciscan Health can help.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Jean, it's so nice to have you here today. We're going to talk about perimenopause. Let's just start maybe with the most obvious one, just some background on what perimenopause is.

Jean Miller: Perimenopause is the transition that occurs between a woman's reproductive years and menopause. So, a woman's reproductive years is when she's having periods. And then menopause is when periods stop. So, menopause is defined as the time when a woman has her final period. So, perimenopause is this time that leads up to the last period. And perimenopause typically starts for most women seven to 10 years prior to their final period. So, the normal age of a woman's final period is 45 to 55, with the average age in the United States being 51. So, this means that perimenopause symptoms can start for women as early as 35, but most women start to experience these symptoms in their 40s.

Host: I have to say, it does seem like it's a long protracted sort of period. And I guess I'm wondering, you know, what are some of the common physical symptoms that patients might experience that'll let them know, "Okay, I'm now in perimenopause"?

Jean Miller: During perimenopause, we know that the estrogen levels start to drop, and what happens is the body starts to respond to that dropping estrogen level. And this is what leads to the physical symptoms that women experience. And what we also know from some research that was done just in the 1980s is that it's not a steady decline in estrogen. It's actually a very turbulent time for the hormones. So, there's a lot of spikes in the hormone levels, they can be normal at some times and not normal at other times. And so, this is where the symptoms come from and what we also know is that there are estrogen receptors in all different organ systems in the body, all the different organ systems. So, the symptoms can be varied and they can affect all different areas of the body.

The first symptom that women usually experience is changes in their monthly periods. So, their periods become more irregular, meaning that the amount of days between their periods either become shorter or longer by seven days or more. The bleeding with their periods can become heavier, lighter, it may last longer, it may stop earlier than expected. And this can vary from month to month. And so, that's the first symptoms that women usually notice. But once that starts to change, that's when women start to experience some of these other symptoms that are more common. So, hot flashes, night sweats, inability to fall asleep or stay asleep at night. A lot of changes to the genitourinary system, so vaginal dryness, painful intercourse, decreased sexual desire, frequent vaginal infections, urinary tract infections, sometimes even bladder incontinence, where women leak urine more often or aren't able to hold their urine the same way. It also affects the body composition of a woman. So, there's a loss of lean muscle mass, typically there's some weight gain because fat stores increase and then fat is stored differently, so more in the midsection, I get that complaint a lot from patients. Skin is affected as well. It becomes drier. There's a loss of elasticity in the skin. A lot of women experience mood changes. They have increased anxiety, panic attacks, irritability. Some women even experience a lot of anger or rage that seems to happen for no reason or happens in situations that typically didn't cause that reaction in the past. Some women experience memory loss, so they struggle to remember things that they're told or to learn new things. There can also be new onset of joint pain and muscle aches that doesn't seem to be associated with exercise or an increase in activity. So really, the symptoms can vary greatly and can affect all different parts of the body.

Host: Yeah. And I feel like I should apologize to women. You know, I hear this long list of things that women, you know, could be suffering from or may suffer from. And I just want to say, sorry, you know, because it doesn't sound like a pleasant time. It sounds, like you say, like kind of a turbulent time.

Jean Miller: It can be. And that's why a lot of women are seeking help for these symptoms that they're having.

Scott Webb: For sure. And it makes me wonder too, Jean, is there an emotional side of this? Are there some emotional aspects to perimenopause?

Jean Miller: Oh, absolutely. And it's not for every woman, but for a lot of women, there is. It can be difficult due to the mood changes that I just described and, basically, just not feeling like themselves. So, we know that hormone fluctuations cause mood changes. We see it with PMS, we see it in pregnancy, we see it in the postpartum period, and those are all times of extreme hormonal change. We also know that there can be dysregulations in the mood because of hormones, so things like premenstrual dysphoric disorder, postpartum anxiety and depression.

And so, because perimenopause is the time of turbulent hormone change, we see a lot of mood changes in women during this time. The things that I talked about, like the anxiety, there can be fixation or worry on specific things that have never been an issue before, the increased irritability. They could cry more easily. Some women start to experience depression or a feeling of hopelessness that they've never experienced before. They may lose pleasure in activities that they've enjoyed in the past and they may have a really difficult time feeling motivated to do things and have difficulty functioning because of these symptoms. And it's really important for women to monitor these symptoms and understand how it's affecting their quality of life. Because if it's making their life unmanageable, it's really important for them to talk to their women's healthcare provider about what the treatment options are.

Host: Yeah. That leads right into my next question, Jean, is what are the treatment options, right? We want to help, of course, as much as you can, so, you know, treatment options to maintain more of a healthy life balance while they're experiencing perimenopause.

Jean Miller: So, the good news is that we do have treatment options when it comes to the perimenopause symptoms I will say sometimes we do need to rule out that there is any other medical condition that's causing the symptoms. However, many of these treatments can be started before we have that information.

So, as far as treatments go, the most effective treatment that we have is actually hormone replacement therapy. And this is where we use a combination of estrogen, progesterone, and/or testosterone to help with these declining hormone levels. Just like most medications, hormone replacement therapy does have risks and benefits. However, much of the risk that was attributed to hormone replacement therapy early on in research, now with some larger, more well designed studies and some reevaluation of that information, we have learned that the risks aren't quite what we thought they were. And it is a really good option for a lot of women. And it's important that it's an individualized approach. And there's things that we can do to help reduce some of the risk. For example, we can give it in a patch form instead of a pill and things like that. And the risk is especially low for women when they're going through this perimenopause transition. So, prior to full menopause, the risk is low when we use hormone replacement therapy for women.

However, besides hormones, we do have some non-hormonal options that are especially effective when we're treating hot flashes and mood changes. Medications that are typically used to treat anxiety and depression have been found to be very effective for treating hot flashes, and there's the added benefit of helping, you know, with some of those mood changes that they're experiencing. There's also a class of medications that targets hot flashes where they start in the brain. So, this is also a non-hormonal option to help treat the hot flashes.

Host: Well, it's definitely good to hear. It's encouraging to hear that there are options, of course. And wondering, are there also maybe some lifestyle things that women can do? Is it maybe picking up a pickleball, for example, or yoga?

Jean Miller: Yeah. Both of those things, actually. There are several lifestyle changes that can help combat the symptoms of perimenopause. Pickleball, for example, is one of them because it would increase your activity levels. So, increasing your activity level is a good thing. Yoga is great, because it is a stress reliever. So, those definitely work. There's dietary changes that women can try. There's techniques to help optimize sleep. So, regular exercise is one of those, decreasing caffeine, waking up at the same time every morning, avoiding daytime sleeping, developing a sleep routine at night, increasing the exercise and outdoor activities, so exposure to the sun, with sunscreen of course is helpful. Anything that helps reduce stress, that will help improve your mood and can help improve your sleep and avoid unintended weight gain. So, stress reduction activities like regular exercise, yoga. There's a technique called grounding where you use your hands and your feet to touch natural surfaces and that has been shown to help reduce stress. I also recommend to a lot of my patients trying therapy or counseling to help develop tools to deal with some of the strong emotions that they're feeling. And if that doesn't work or in conjunction with that, support groups are good to talk to other women who are going through the same thing. And an added benefit of increasing your social network is to help maintain your cognitive function too, as well.

Host: Boy, it's a lot to take in. It's great to have you here and your expertise. So much great information today. I just want to give you a chance here as we wrap up. Anything else, you know, final thoughts, takeaways? What haven't you already told us about perimenopause?

Jean Miller: Well, I've told you a lot, but the things that I want women to remember is that this Is treatable and that you don't have to suffer with these symptoms. The treatments are not a one-size-fits-all approach. It's important that you seek the guidance of a woman's health care provider as to the treatment options, the risks, the benefits, what you think will work best for you. It's important to be knowledgeable too. It's good to find reliable evidence-based resources where you can get information. So, the North American Menopause Society is one of those resources that's a really good place for women to find information about the different treatment options. I always caution women that there is a growing market for treating menopause symptoms, so it's important to make sure that you're getting this information from reliable sources.

And I just want to say, in conclusion, for patients to make sure to treat themselves with grace and patience and kindness. Our bodies are amazing things and they've done a lot and this transition period doesn't last forever. These symptoms can be very challenging and difficult to deal with, especially when you don't feel like yourself, but it's really important to reach out and enlist the help of your woman's healthcare provider to help you gain knowledge and find treatment options that'll work for you.

Host: Yeah, that's perfect. You know, in my experience, some folks, Jean, suffer in silence. And then, some don't suffer in silence. But the suffering, you know, there are so many great options today.

Jean Miller: There are. And I do believe that, because I have a lot of patients that will tell me, "My mom never told me about this."

Host: Right.

Jean Miller: And so, we didn't talk about it a lot, maybe in the past. But now, we are talking about it and there are resources being put into finding treatment options that will really help patients deal with these symptoms.

Host: Yeah. And they didn't have podcasts back then, right? And there's just things that people didn't talk about. And I'm sure perimenopause is probably pretty high on that list. So, great to do that today. Great to benefit from your expertise. Thank you so much.

Jean Miller: Thank you.

Host: And to learn more, please visit franciscanhealth.org and search perimenopause. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.