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Perimenopausal issues in Women

Much of the gynecological clinic is attended by women during the perimenopausal phase for various woes. The commonest of these being irregular, heavy or painful menstruation, urinary complaints, moodswings, melancholy or genital tract laxity and displacements. Let us go through this space, identify the do’s and the don’ts to see what we should expect during this time and handle the change with confidence. The reproductive phase of woman begins with “menarche” that is the first menstruation and ends with “menopause” that is complete cessation of menses. Perimenopause is a terminology used to refer to the phase before menopause. This phase can be for several years and is characterized by various woes mentioned above. Many women do not suffer from such woes and are able to handle this transitional period with much confidence. To be able to do this it is important to understand the basis and thus be fearless due to the correct knowledge.What is the basis of the perimenopause and what are the symptoms? Which type of menstrual variation should be accepted as normal and which one can be pathological? Why are there mood swings or depression? Hormonal irregularities, due to reduced ovarian potential is the basis. The altering hormonal levels are responsible for the changes experienced by women. Symptoms : Irregular menstruation, heavy bleeding, frequent cycles, less bleeding during menses, sudden weight gain, mood swings, change in sexual libido, feeling of tiredness, increased forgetfulness, irritability, hot flushes. Urinary symptoms such as burning, frequency are the symptoms experienced by many women. Bleeding which is less in amount and is not heavy and frequent can be taken as a normal variation while bleeding which is heavy and is associated with clots, flooding, longer duration of bleeding is to be considered as abnormal and should be evaluated for underlying causes from a doctor These are associated or a result of hormonal deficiencies but many a times other associated factors are responsible. Children are grown and have left homes leading to the “empty nest syndrome”. Excessive weight gain leads to change in self-image, feeling of not being wanted, and weakness due to ageing, improper diet are other factors which contribute to the feeling of melancholy.

How does the doctor help in identifying abnormalities? What are commonest tests advised at this examination? Can any hormonal test predict or is done to diagnose menopause? What is a PAP test ? The doctor documents the menstrual events and other symptoms carefully with its frequency and severity. Careful clinical assessment of weight, blood pressure, systemic examination, signs of hormonal changes, breast examination, gynecological examination is done. Pelvic ultrasound and laboratory investigations are ordered. This assessment helps in identifying diseases such as hypertension, heart ailments, thyroid abnormalities, gynecological and breast pathologies. Assessment for anemia, diabetes, thyroid abnormalities, urinary examinations for infection and PAP test are commonly advised. Such tests are not necessary and therefore are not routinely done to diagnose menopause. At the time of gynecological examination the cervix which is the part of the womb placed in the vagina is visually inspected and the surface is gently rubbed with a spatula or a cell brush to sample the loosely attached sheddingcells. These cells are fixed and transferred on a slide or in a special solution to be stained and studied by the cytologist to diagnose any precancerous or cancerous condition of the cervix. It is important that every woman after 35 years of age gets herself PAP tested and regularly gets herself checked for the same thereafter. If a precancerous condition is detected early it is completely treatable. Why is a Pelvic ultrasound done ? What treatments are offered by the gynecologists? Pelvic ultrasound helps In diagnosis of conditions such as fibroids ( benign tumors of the womb ), adenomyosis ( inflamed and enlarged uterus ), pathologies of the lining of the womb such as polyps, excessive thickening, distortions of the womb cavity, abnormalities of the ovaries such as cyst, tumors or other nearby structural abnormalities. Today ultrasound is easily accessible, is harmless and a valuable tool to aid in clinical diagnosis. Various medicines to control excessive bleeding, hormonal preparations such a pills, injectable, intrauterine systems, hormone modulating medications are offered. Some conservative surgical procedures such as thermal balloon ablation or endometrial resection may be done. Nutritional supplements such as calcium, iron tablets, isofavones (natural occurring estrogen like substances sourced from plants) may be advised in addition to medications for any other specific diseases.

What is prolapse? How can I have a smooth transition through perimenopause? What is POF? Does every heavy menstrual bleeding need the uterus to be removed? Pelvic organs may get displaced towards or outside the vagina causing a feeling of mass coming out, lower back ache and problems with urination and defecation. This occurs due to the loosening of the attached ligaments caused due to hormonal deficiencies and excessive weight or lack of exercise. Proper dietary habits, regular aerobic and weight bearing exercises, pelvic floor strengthening exercises, avoidance of excessive alcohol, carbohydrates, trans fats, smoking, stress and the right attitude helps phenomenally to have a smooth transition. Also every woman at the turn of 35 and definitely by 40 must get herself checked thoroughly by a gynec. Premature Ovarian Failure is a condition when menopause occurs before the age of 40 as the menopausal age in Indian women is 47-52 years. It can be a result of medications, surgery, stress, debilitating illnesses and excessive obesity or very low weight. No, most of these conditions can be treated without removing the uterus as all the abnormalities are not always cancer. Some examples 1. Vaishali is 42 years of age and complains of irregular bleeding which is sometimes moderate and sometimes very slight. She also experiences such a slight bleeding after intimacy and feels it is due to dryness. She was checked and careful evaluation revealed that she was anemic, obese class 1 with 32 BMI, had hypothyroidism, pelvic ultrasound was normal and her PAP test showed a suspicion of a precancerous condition. She was treated with iron, calcium and thyroid supplements, weight control and dietary guidance was given. Colposcopy and excisional therapy was done for her abnormal Pap test and hormonal pills were used to regularize her cycles. Past three years she is normal 1. Shivali 44 years old, complains of heavy menstrual bleeding which is irregular. Test revealed anemia, pre-diabetic condition and USG showed thickened uterine lining. this was sampled and hyperplasia was diagnosed. A hormonal system was placed inside the cavity 3 years back and she is perfectly normal till date. 2. Pratima at 43 years, presented with excessive painful menstrual bleeding for which ultrasound was done. A fibroid was found inside the cavity and she was offered hysteroscopic excision of the fibroid and she requested for a hysterectomy.


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