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Premenopause: when and with what symptoms it manifests itself, how long it lasts, how to deal with it

During premenopause, symptoms go far beyond the first irregularities of the cycle and a certain nervousness: in this phase of life, in fact, women run a 40% greater risk of suffering from depression. This was just revealed by a study by University College London (UCL) published in Journal of Affective Disorders, after examining data from seven studies involving 9,141 women from around the world. Which was followed by the authors' appeal to the scientific community, so that a completely underestimated chapter of female life is finally explored in depth. To allow women to deal with premenopause and its symptoms – physical and psychological – in the best possible way.

«By premenopause or perimenopause we mean a transitory and physiological phase of life, which leads to the end of the fertile age and which it begins when ovarian activity gradually begins to reduce. The consequence of which is a decrease in circulating sexual hormones (estrogens, progesterone and androgens), normally produced by the ovarian follicles brought to cyclical maturation during the menstrual cycle”, he explains Diana Pettinato, Medical Director in the Gynecology and Obstetrics Department of Humanitas San Pio X, in Milan. «As menopause approaches, the ovaries become increasingly smaller and atrophic, with increasingly reduced and irregular activity and with several anovulatory cycles. These are the changes responsible for the first symptom with which perimenopause begins to manifest itself and which often pushes the patient to turn to the gynecologist: the menstrual irregularities. The reduction and fluctuation of circulating sexual hormones, however, are responsible for the physical and psychological changes responsible for what are commonly recognized as symptoms of menopause.”

As a rule, when it appears and how long it lasts

«The average age for menopause is around 50while for the alterations relating to perimenopause there is no specific age of onset: they last on average 4-8 years, reaching 10 in some cases. The changes in the menstrual cycle and some of the typical symptoms of what will then be the picture of full-blown menopause, which we ascertain when faced with a clinical picture of amenorrhea (i.e. the absence of the menstrual cycle) of at least a year or to a hormonal laboratory picture with FSH, LH and estradiol values ​​referable to this phase of life. Let's talk about instead early menopause in case of disappearance of the menstrual cycle (and subsequent laboratory confirmation) before the age of 40: it is very important to recognize this condition, because, when possible, it deserves pharmacological treatment with hormone replacement therapy (HRT) to improve the quality of life and reduce the risk of cardiovascular disease and osteoporosis.”

What are the most common symptoms and problems?

«They can be substantially divided into two groups. On the one hand there are the symptoms relating to the phase of change in the hormonal state, which translate into alterations of the menstrual cycle both in terms of rhythmicity (often the typical cyclical nature of the fertile age is lost and menstrual cycles are found to be closer together, more distant or absent for some months); but also of intensity and duration, with scanty menstruation or, instead, of a hemorrhagic and long-lasting nature which they may even require specific medical therapy to avoid anemia. On the other hand, the symptoms of actual menopause begin to appear, due to the reduction of both female hormones (estrogens and progesterone) and male hormones (androgens): hot flashes (during the day, but especially at night); sleep disorders; increase and redistribution of body weight with increased abdominal fat; mood changes; memory impairment; widespread joint/muscle pain; decreased libido; reduction of vaginal lubrication and initial picture of atrophy-pain during sexual intercourse».

What lifestyle to adopt?

«It is very important to favor a varied diet – with measured portions of carbohydrates and preferring wholemeal ones – rich in fresh and seasonal fruit and vegetables, with a good supply of proteins and good fats. Hydration is also essential: drink about 2 liters of water a day, in order to keep the skin and mucous membranes well hydrated. Finally, to counteract the increase and redistribution of body weight, it is good to practice aerobic physical activity 3-4 times a week or even daily (even a brisk walk of 30-40 minutes is sufficient), not missing the opportunity to lead an active lifestyle by moving on foot and climbing the stairs (instead of taking the lift) to stimulate muscle tone and joints, possibly all open air, in order to also stimulate the production of vitamin D with the action of the sun's rays (never forgetting to apply sunscreen on the face to avoid the risk of hyperpigmentation of the skin)”.

Suggested medical checks

“Those gynecological examinations including examination and ultrasound they must certainly be carried out on an annual basis, or every six months in the case of very severe symptoms. Pap test and mammogram bilateral must be programmed according to the cadence defined by the screeningunless special indications are given. On an annual basis, it is also a good idea to carry out a cluster of general blood chemistry tests such as blood count, blood sugar, TSH-R, total cholesterol, LDL, HDL, triglycerides, liver and kidney function, electrolytes, dosage of vitamin D and calcium and phosphorus and protein electrophoresis. There MOC, on the other hand, is a test that directly evaluates bone density (which can reduce over the years following menopause), but is recommended to patients who have already been through menopause for a few years, except for particular conditions such as early menopause or a family history of osteoporosis. In addition, my advice is to contact collateral professional figures in particular cases, such as difficulty managing weight (nutritionist/dietitian/dietitian), not so much for an aesthetic question obviously, but because cardiovascular risk also increases with menopause: maintaining a correct body weight and eating in a healthy and complete way represent key points for reducing this risk, such as that of overload on some joints, for example the knees. For those who begin to experience joint/muscle pain of a certain extent, I often recommend contacting a physiatrist or, possibly, to a rheumatologist.”

Premenopause: what drugs and supplements?

«For menstrual irregularities, if very symptomatic, if there are no contraindications it is possible to prescribe a progestin-only or estrogen-progestin therapy with low-dose natural estrogens to accompany the patient until full-blown menopause. As regards actual HRT (Hormone Replacement Therapy), it is necessary to wait for full-blown menopause, but some of the menopausal symptoms can be treated with supplements or local therapies: dedicated detergents with hydrating and emollient action for daily intimate hygiene; ovules or moisturizing creams to be applied at the vulvo/vaginal level (a bit like applying face cream!), also estrogen-based if not contraindicated; lubricants to be used before intercourse.

As supplements, you can take pollen extracts to reduce hot flashes (start with one capsule a day and eventually move to two); as well as supreme magnesium and potassium, which also help in the prevention and management of widespread muscle pain, for tiredness and act as a support for energy metabolism and psychological functions (one sachet in the evening). These can be combined with derivatives of some plants, such as trans-resverantolwhich has an antioxidant action; probiotics (in particular those containing lactobacillus crispatus, for the prevention of infections of the urogenital tract to which vulvo-vaginal atrophy can predispose; and lactobacillus gasseri, which decreases the absorption of fats and promotes weight loss); vitamin D and calcium for bone health; griffonia, magnolia and melatonin to facilitate night rest. To these can then be added symptomatic treatments such as laser for vaginal rejuvenation, to break collagen fibers and restore elasticity to tissues in case of painful intercourse and cystitis. L'Finally, acupuncture can reduce hot flashes and improve mood if hormone therapy is contraindicated. Finally, it is always worth remembering that, despite the increase in anovulatory cycles and menstrual irregularities, At this stage of life it is still possible for pregnancy to occurand it is therefore advisable to continue using a barrier method (condom), the spiral (IUD) or oral contraception.”

Source: Vanity Fair

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