Thinking About Perimenopause

It's time for me to read up about perimenopause and menopause. I usually do read about all these and extensively too since I can be a bit of a hypochondriac. But it's always good to throw out previous knowledge to re-read and re-evaluate and keep updated with the research about whichever topics or medical conditions that I'm fixated on at any one point.

Women who are friends might not even share similar perimenopause symptoms. Some of my friends are nearing this stage, some are already in perimenopause, some are in menopause, and others aren't. Who knows when our time will come. I can do a hormone panel test to see if I'm nearing perimenopause, but even so, the fluctuating levels of estrogen and FSH make it difficult to confirm. 

I don't think I'm in perimenopause yet, or near it. But I ought to be acutely aware of the changes in my body and investigate any abnormal or particularly severe perimenopausal symptoms that arise. As I transition to mid-life to the later years, I'm even more conscious of having to adapt my body to a slower (physical) pace that I might be resentful about. 

Perimenopause has been variously defined, but experts generally agree that it begins with irregular menstrual cycles — courtesy of declining ovarian function — and ends a year after the last menstrual period. 

Perimenopause varies greatly from one woman to the next. The average duration is three to four years, although it can last just a few months or extend as long as a decade. Some women feel buffeted by hot flashes and wiped out by heavy periods; many have no bothersome symptoms. Periods may end more or less abruptly for some, while others may menstruate erratically for years. Fortunately, as knowledge about reproductive aging has grown, so have the options for treating some of its more distressing features. 

~ 'Perimenopause: Rocky road to menopause', August 9, 2022, Harvard Health Publishing

Glad that our own news outlets are writing about it recently. Vanessa Chia's article on CNA Lifestyle published on May 1, 2023 is a pretty well written and researched introduction to perimenopause. She spoke with four doctors — respectively an ob-gyn at NUH, and another with her private practice at Mount Elizabeth Novena, and an endocrinologist, and an ob-gyn and urogynaecologist from Gleneagles Hospital.

I'm one of those who have been really lucky when it comes to menstruation symptoms and such. I've never had terrible cramps or too-heavy blood flow. Any declaration of cramps, especially during schooling years was a total excuse to dodge whatever social or physical activity that I had no interest in doing. 

I'm also thankful not to have PCOS or an increased proliferation of uterine fibroids and cysts. I'm mindful of cells mutating as the various hormones fluctuate. I wanted to do a hysterectomy a few years back, but a thorough medical examination convinced me to hold it off for a bit. I would like a hysterectomy done now, but apparently I'm not an approved candidate for it, and optional hysterectomy isn't allowed in Singapore. Bah. 

Food is always at the root of our health. Well, next to sugar, caffeine and alcohol intake, I guess. Surely we can all feel it as we age. First we decrease alcohol intake. Then we stop eating suppers. We eat earlier at 7.30pm instead of at 9pm. We generally eat less at meals; we avoid eating certain items that make us feel ill or those that don't quite agree with our digestive systems. We might down the intake of fried items, greasy meats, and rich foods high in cholesterol. 

I'm not that strict about food since I still eat what I like to eat, although those tend to be light and easy. But I'm just fussy. Heh. My newly-gleaned IBS also controls what I can eat. Full-cream milk + coffee is a no-no combination now. So I'm glad that currently fiery sambal, chilli and spices are still okay! 

Most dieticians and doctors would suggest eating not eating too much refined sugar and carbohydrates, and to take good amounts of calcium, soya and Vitamin D to alleviate many symptoms of various ailments. I dislike soya and beans generally. I can deal with edamame and tofu, and hummus, that's about it.

It may also be worth keeping a journal of your menopause symptoms, added Dr Tseng. “It helps you to figure out which particular foods trigger (or worsen) symptoms, to reduce or avoid consuming them completely.”

The combination of waning hormones together with lifestyle changes, genetics and age, makes weight gain even more apparent during menopause, said Dr Tseng. “Excessive body fat, especially around the waist, increases the risk of developing certain diseases and also worsens certain menopausal conditions”.

Of course this article tells readers not to neglect exercising — 'Get Moving: Embrace Exercise'. Easy HIIT is now a permanent inclusion in my exercise regime. I don't do this to lose weight. I don't want to lose any more weight. Weights and resistance training are compulsory because I need to maintain muscles to stave off osteopenia and osteoporosis. My ob-gyn has already ordered me to begin Vitamin D supplements last year, so that continues. 

Since perimenopause and menopause are a natural process of life, living and ageing, then this is what it is. Everyone feels it differently, and adopts a different approach to it. What works for K might not work for G. You read, and you do you. I would like mitigate any adverse effects before I feel them. I like how the article ends with this piece of advice to moderate our worries,

At the end of the day, it’s important to remember that menopausal changes happen gradually. And while some women experience symptoms during perimenopause when their hormones start to fluctuate, Dr Choo said there are other women who don’t feel anything at all. 

So try not to worry or overthink it. “Menopause is a natural progression in life that a woman goes through. It is not a death sentence and it certainly is not a disease. Millions have gone through it without any trauma and undue issues,” said Dr Lim.