Ohh the woes perimenopause


[00:00:00] Okay, I'm talking about perimenopause again. Partially because I love talking about it, partially because it comes up every day in my office and partially because I literally just did, um, an Instagram live about fertility with Dr. Josh Horowitz and I literally am like a hot, sweaty mess tonight. Um, I don't actually get so many hot flashes anymore because of a lot of things that I'm doing that are helping my hot flashes, one of which is not drinking as much caffeine, but today. 

Hi caffeine day. Hence the reason I think I'm sweaty and schvitz. So it made me think, you know what, I'm gonna talk about py menopause again, people, um, maybe in a little bit of menopause as well. The reason it also bears repeating today is that I had a beautiful operating room case, um, a hysteroscopy, it's called, and it led me to have to teach the young resident who was with me, and I realized how. 

Perimenopause confounds us, and it's very confusing to many [00:01:00] people, including young, new ob gyn residents, by the way. So here it is in a nutshell, you've heard me say it before, if you listen at all, because I call it the other P word. The reason I call it the other P word is because when my sister and I were in our late forties, now I'm 51, she's 53. 

Anytime she would say, Ugh, I'm just so hot and sweaty, or, Ugh, I just had a bad night's sleep. I would say, well, you know, and she would stop me and go, if you're gonna say perimenopause again, I want you to shut up. I don't wanna hear that word. It makes me feel old. Something to that effect. And I would constantly say, you know what, here's the thing. 

I don't think of perimenopause as old. I mean, I'm pointing to myself, I'm menopausal. Um, but I don't think of perimenopause as old because to me, I think that perimenopause, if I describe it well to you, Actually will just help you understand what you are going through or what you might go. In your forties, which is a long period of time. 

And to um, avoid that conversation in an [00:02:00] effort to not make you feel old is actually gonna do you a huge disservice because inevitably, every woman ideally is going to make it to age 40 ish and make it even more so past 50 ish. I pray and hope. For the majority of us, and therefore you need to know what you might experience so that you don't think it's something dreadful and terrible, so that you don't think it means that you are unusual, so that it don't, you don't think it means something pathological. 

I find that we have, um, much more comfort in the events of our lives when we can. Realize that there's solidarity with the people around us, right? Going through any event can feel very isolating, but it feels worse when you truly think you're alone in that feeling, right? It's sad, it's annoying, it's frustrating to go through, but it's even worse when you think you're the only person on earth experiencing it. 

So let's start with the definition of menopause and work backwards. Menopause is a year with no period. So when you are a year with no. In a person where it makes sense that that lack of period comes from menopause. Meaning [00:03:00] typically in their late forties, early fifties, the average age is about 51 right now. 

So you're 51 ish, you've had a year with no period. You are menopausal. Okay? That means you've gone through menopause. Anytime after that is post-menopausal, that period is menopause. So in fact, Menopause in a way is like the day that you've had a year with no period, but none of us know that day. So we, we use those words interchangeably like, oh, I'm in menopause, or I'm post-menopausal. 

Really mean You've done with a year of, of not having your period. The confusion lies in many women conflating perimenopause in menopause because if we know that one year with no period is menopause, we know that up to 10, maybe more years, , you can start going through perimenopausal changes, which the hallmark is just irregularities in your cycle. 

Instead of having a nice sine wave, as I say, of your hormones going up and down where you can predict how you're gonna feel, your hormones will be potentially irregular any given day, week, or month. They might be regular for six months and then be irregular again. So [00:04:00] I always joke, it's not just irregularly irregular. 

Predictably, predictably, unpredictably, unpredictable, right? I can predict that it's gonna be unpredictably unpredictable. meaning I don't know what's gonna happen. So again, menopause is one year with no period, up to 10, maybe more years prior is perimenopause potentially. And that means that even at age 40 or 41 or even 39, you might start having perimenopausal changes. 

Well, how would you know? So let's say you came to me and said at age 40 or 41, gosh, I'm really hot at night. I'm a little schnitzer at night. I'm a little sweatier at night. My mood makes me wanna kill my family. Two days before my period, my boobs hurt right before my period. I think I'm feeling ovulation cuz I'm having a really intense pressure. 

Pain and it's two weeks before my period and it lasts for a day or two every single month on one side or the. , these ladies are all signs of perimenopause. Now, notice I didn't say anything yet [00:05:00] about my period, because let's say I said to you, huh, you know, could be P, and you say, no, no, no. Don't say perimenopause. 

I still get my period. I'm not in perimenopause. Ha ha. The answer is you could still be in perimenopause because perimenopause doesn't, by definition mean you're stopping your period. It just means your hormones are fluctuating. So what might happen with your bleeding during peri. Well, you might have very normal periods during perimenopause. 

You might have very irregular periods during perimenopause. You might bleed heavier, lighter, longer, shorter, more, less. That's how I describe it to patients. Any of those things could happen and they still could be part of Mary Pen perimenopause. What I try to encourage patients to understand is if you're bleeding less, meaning, less frequent, less heavy, fewer. 

Not a big deal. That's actually okay provided you don't have any other symptoms that make us think of other hormonal entities. If you're bleeding more meaning heavier, longer, bleeding, more frequently than usual, bleeding in between periods, it's still likely just perimenopause. But you do need at least a [00:06:00] brief workup, especially a pelvic ultrasound, to ensure that you don't have any other reason for that heavy, irregular, longer. 

Bleeding or bleeding in between periods because you wanna make sure it's not a polyp, a fibroid, God forbid, something in the lining of the uterus. Make sure your pap smear is up to date. So again, let's review all those symptoms. I said hot and sweaty, breast hurting, ovulation, hurting mood, being pissy. I didn't say even a atrophy of the vagina, meaning your vagina feels less elastic. 

These are all potential signs of perimenopause. Okay, well, can you check my hormones and prove it? No, I can't. In fact, I cannot prove it. I can merely say to you, the onus is on me to disprove anything else that could be causing this, that I could fix. For example, let's make sure it's not your thyroid, because that can be causing you to have a lot of, um, being very hot, for example, or some of the mood changes. 

So let's make sure your thyroid hormone is up to date and then you've had it checked usually with your primary care doctor or the gynecologist can check it if you're bleeding. , let's make sure we do an ultrasound to prove there's nothing else. So those are the [00:07:00] two common things I would do to disprove any other medical condition. 

But then I'll default back to it's not your thyroid. There's nothing in the lining of the uterus that I'm worried about. Therefore, your sweatiness, your breast tenderness, your mood changes, your ovulation pain, and even your heavy irregular bleeding are all probably. Perimenopause. Well, why can't we check my hormones? 

Well, I can check them, but it's not gonna give you any value because remember I said the hallmark of the perimenopause is that you are fluctuating your hormones potentially every day, week, month. So I will check today. And your hormones in particular, the two hormones are F, s, H, and estradiol. Those two hormones might look completely normal, meaning normal. 

I'm not in menopause. My hormones are. to which I would reply, yes, I know you're normal and not in menopause because you're getting your period still and menopause is a year with no period, so your hormone levels looking normal is not going to refute that. Nor is the opposite true. Let's say your F s H and your estradiol are in a range that looks as if your menopausal like, but your a. 

[00:08:00] 40 again, three year old woman with an F S H that's elevated, let's say, and an estradiol that's lower than you might say to me. But that means I'm in menopause. But I just got my period and I would say back to you again, that's not menopause. Menopause is defined by a year with no period, so merely having slightly irregular periods. 

Even having eight months of no period with an elevated FSH and a low estradiol still does not mean you are in menopause. It merely means you are perimenopausal until you've had a year with no period. So I hope that makes sense. We will talk again at some point about this cause I love talking about it. 

You can certainly try to fix your symptoms. You can do things to decrease hot flashes. You can do things to decrease the ovulation pain you. Decrease your breast tenderness and certainly decrease your vaginal atrophy most of the time. The easiest way to fix all those at once is go on birth control pills for the flashes, the ovulation pain, the breast tenderness, the heavy bleeding, but that won't fix your vaginal atrophy. 

That's usually topical estrogen. But [00:09:00] certainly there are a variety of other things. People can take low dose of antidepressants for hot flashes, they can certainly take, um, Bioidentical hormones, which is a whole nother topic. They can do acupuncture, they can increase their vitamin D three level and they can take over-the-counter herbs. 

Those are all things to improve the flashes and sweats that come along with perimenopause. Okay. I hope that helped. Literally feeling like I'm having another hot flash in a second with my shininess, my beacon. Um, okay. And just a shout out, if you guys don't know about Tribe called. Go to tribe called, sign up for our email list. 

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More intense, more in-depth videos about stuff like this, menopause, perimenopause, cancer screening, mood changes, libido, pap smears, hpv, herpes, like all the things that women deal with. [00:10:00] Okay, I hope that was helpful. Bye.