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As if monthly periods and menopause's promised unease weren't already so daunting, here comes perimenopause offering women yet another period of distress, thanks to our changing bodies.
According to the United Nations Population Fund, perimenopause is when “the ovaries gradually stop working,” and by menopause, the ovaries have stopped releasing eggs for fertilization altogether. The latter “typically begins between the ages of 45 and 55.”
“‘Peri’ means around that time,” explains Dr. Marisa B. Reyes, who has had 30 years of private practice in obstetrics and gynecology. “So it’s the three to five years before menopause."
She adds that "menopause is when you have not menstruated for one year.”
Gynecologist and sexual medicine specialist Maria Sophocles, who has a spectacular TED talk on the “bedroom gap” between women and their sexual partners which happens during menopause, also notes that during menopause, “the ovaries make estrogen less consistently and eventually stop making it altogether.” It affects the vagina in that it has less collagen and the quality of the collagen “deteriorates from strong and stretchy to brittle,” and in that its blood vessels change, which in turn affects lubrication and arousal.
While Reyes says it's possible for women to have no symptoms during perimenopause and just stop menstruating without any warning, there is a misconception that it is normal for women to have heavy, prolonged, or frequent menses during perimenopause. (Prolonged bleeding means bleeding for more than eight days, even if this is just “patak-patak” or spotting.)
It is not.
What is normal for the perimenopause period is for menses to be become scantier, shorter, or even skip months.
And while some women do not experience symptoms associated with perimenopause and menopause, there are also others who do. Some of the symptoms include the following, according to the UNFPA:
- Hot flushes/flashes and night sweats. “Hot flushes refer to a sudden feeling of heat in the face, neck and chest, often accompanied by flushing of the skin, perspiration, palpitations and acute feelings of physical discomfort which can last several minutes.”
- Low libido
- Vaginal dryness, pain during sexual intercourse, and incontinence
- Difficulty sleeping/insomnia
- Brain fog, memory loss, difficulty concentrating
- Changes in mood, depression, anxiety
- Weight gain and slowed metabolism
- Pain in general, joint or bone pain, low mass density (osteoporosis)
- Increased frequency of urination and/or urinary tract infections
“‘Yung mga iba, akala nila lahat [ng sintomas ay kunektado sa menopause]. Kunwari headache, it may be caused by other conditions like hypertension, so they need a thorough check up by an internist for problems not necessarily due to perimenopause,” says Reyes.
(“Some women think that all symptoms [are related to menopause]. For example, headache, it may be caused by other conditions like hypertension, so they need a thorough check up by an internist for problems not necessarily due to perimenopause.”)
Once her patients hit their forties, she starts advising them to get themselves checked up by other specialists.
“Hindi ka na kagaya ng dati,” she says.
(“Your body is no longer like before.”)
Even if a patient doesn’t complain of related symptoms, Reyes still asks her to undergo tests like blood chemistry, electrocardiogram (ECG), or chest x-ray if she has a family history of diabetes or hypertension. Cancer of the breast, uterus, and ovaries can also be inherited, and Reyes makes sure her patients are able to monitor for these properly.
Pregnancy in perimenopause
Now remember, you can still get pregnant while you’re in perimenopause.
“As long as bigla kang nag-ovulate, as long as may eggs ka pa. Lumalabas ‘yung egg na ‘yun at [kapag] natiyempuhan, pwede pa talagang mabuntis,” Reyes says.
(“As long as you suddenly ovulate. As long as you still have eggs. That egg will be released and if there is a chance encounter, you can still get pregnant.”)
“The oldest patient I had who got pregnant was 47,” she adds. “Of course the chance of miscarriage is higher in an older woman.”
Her final advice for women nearing menopause is to get checked up if they haven’t menstruated for two months straight.
“Bibigyan ka ng pampa-mens. ‘Pag ‘di ka na nag-mens, most likely menopause ka na. ‘Pagka nag-mens ka pa, mabuti ‘yun kasi naprevent mo na mag-continuously thicken pa ‘yung endometrial lining—'yung lining of the uterus—which if you just wait [and not get checked up], sometimes magli-lead to heavy bleeding and madi-D&C ka pa or even surgery.”
(“Your doctor will give you something to induce menstruation. If you don’t get your period, you’re most likely in menopause already. If you do get your period, that’s a good thing because you’re able to prevent your endometrial lining or the lining of the uterus from continuously thickening, which, if you just wait [and not get checked up], sometimes can lead to heavy bleeding, and you might have to undergo D&C or even surgery.”)
For all the worries about the changes in your body, menopause can be a wonderful thing. It can even lower a woman’s risk for diseases related to her reproductive system. And for Reyes, who is now in her sixties, it has been absolutely freeing.
— LA, GMA Integrated News
