Early this spring, in between the snowstorms and heat waves just days apart, my husband joked, “Mother Nature is perimenopausal!

She needs some serious hormone therapy!” Funny guy. But as any woman in the throes of this “natural” midlife stage of life will tell you (loudly, and often), perimenopause is no joke.

In fact, the very beginning stage is generally the most difficult for women, says Dr. Anthony Retodo, director of medical services at Kaiser Permanente Folsom. “Women are experiencing a dramatic physical realization that things can’t remain the same; that we’re human, and we age. We all have to accept a certain level of change.” Traditionally, notes Dr. Retodo, women have had a hard time dealing with the drama of perimenopause without much support. “For years, women were told ‘it’s all in your head’ or ‘get over it.’ But it’s a true obstacle, and we need to work through it.”

Perimenopause describes the stage in a woman’s life when her ovaries start producing less estrogen and progesterone – the hormones responsible for ovulation and menstruation, commencing anytime between the late 30s and early 50s, with the average age of menopause being 51. Declining levels of estrogen and progesterone result in “just about every symptom you can imagine,” marvels Dr. Timothy Phelan, of Folsom’s Creekside OB/GYN: from the most common (menstrual irregularities, vaginal dryness, difficulty sleeping, hot flashes, loss of libido) to some surprising issues (depression, severe itching, increased libido, hair loss and thinning, an inability to heal from injuries, headaches). “One of the things my patients complain most about...is the loss of focus. They report not feeling as productive as they once were,” says Phelan.

When midlife interferes with life, a patient should seek immediate relief. “It may in fact take a couple visits to tease out what’s going on,” Dr. Phelan explains. “We rule out other suspects like early diabetes, depression or thyroid disorder.” Blood work, pelvic exams and baseline hormone measurements are completed. Treatment options are then discussed. If the symptoms are severe, medications are available: low-dose birth control pills can get menstrual irregularities and pain under control; an antidepressant can help with depression; sleep aides for insomnia; and lubricants to alleviate dryness.

Hormone replacement therapy (HRT) is no joke, either. Doctors tend to be conservative when it comes to hormone replacement products (including topically applied creams). Dr. Christine Cambridge of Marshall Medical OB/GYN in Cameron Park says, “The evidence currently supports the use of HRT in healthy women in early menopause with vasomotor symptoms and the therapy should be limited to the treatment of these symptoms, as well as be prescribed at the lowest effective dose for the shortest period of time.” Dr. Retodo cautions, “Bioidentical hormones have provided some relief, but they haven’t really been studied. It’s a buyer-beware situation.” Dr. Phelan, however, is one of the few doctors in this area who works with compounding pharmacies, which are able to individualize a patient’s HRT treatment. 

There are also natural-treatment alternatives, including soy, black cohosh, green tea, valerian root and ginkgo biloba. Karen Pan, founder of the Folsom Chinese Acupuncture Center, has “successfully” treated peri- and post-menopausal women with acupuncture and Chinese herbs. “A healthy lifestyle is the best basis for navigating this stage of life successfully. Stop smoking, cut out the booze, maintain a healthy weight with diet and regular exercise. More sleep, less caffeine. There’s no harm in taking a multi-vitamin,” says Dr. Phelan.

Seeking treatment for perimenopause is just the first step; it’s imperative that women work with a doctor who is willing to take the time to go over treatment options, says Dr. Phelan. “All the pros and cons, to allow patients to make an informed choice.”