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Perimenopause

Perimenopause is the time immediately before and after the menopause. Menopause is the normal physiologic event in which menstruation ceases permanently, resulting from ovarian follicle depletion (Figure 1) and the subsequent cessation of ovarian function. Some women may have distressing symptoms in perimenopause
(Table 1).

To reduce bone loss, perimenopausal women need to intake enough amount (about 1200mg) of calcium and perform adequate weight bearing exercise every day. Exercise can also help maintain body balance and hence reduce fall. Women need to avoid smoking, drinking and excessive tea and coffee. Besides, women need to have a positive attitude to face the physical and psychological changes resulting from the menopause.

Estrogen therapy can relieve perimenopausal symptoms. However, there were recent publications on the side effects of hormone replacement therapy including breast cancer, heart disease, thrombo-embolism and stroke. In women aged 50 to 79, the extra risks associated with an intake of estrogen therapy were around 7 to 8 per 10,000. Balancing the benefits and risks, women can consider taking estrogen under the following conditions:
(a)distressing symptoms including hot flush, palpitation, sweating, dryness of vagina
(b)early menopause.

In view of the side effects of estrogen therapy, women need to consult a doctor’s opinion before taking it. Taking estrogen therapy may lead to return of menstruation. If women do not want the latter, they can discuss with their doctors on the option of taking continuous combined therapy (estrogen plus progestogen). The risk of breast cancer is increased if women take estrogen therapy for five years or more. For an early detection, women can receive regular mammogram examination in addition to examination of breast by a doctor and themselves.

In the market, there is a lot of products targeted to perimemopausal women. Because of the lack of data in the literature, it is difficult to say whether these products are effective to relieve perimenopausal symptoms or not. If these products have the pharmacological properties of estrogen, it is possible that these products can relieve symptoms. However, further studies are needed to prove this hypothesis.

Lady Helen WOO Women’s Diagnostic and Treatment Centre is under the Department of Obstetrics and Gynaecology, the University of Hong Kong. All doctors inside the centre are specialists in obstetrics and gynaecologists. We manage both physical and psychological problems of perimenopausal women, and provide one-stop service.

Table 1. Problems resulting from estrogen deficiency

SHORT TERM	LONG TERM
Physical changes Irregular menstruation, excessive or too little flow Hot flush, sweating, palpitation, headache Dryness or itchness of vagina, loss of lubrication, dysparenia, urinary frequency Psychological changes Anxiety, distress, easy loss of temper, fluctuation of mood	Osteoporosis Heart disease

Figure 1. Number of ovarian follicle falls with age