Multiple approaches ease perimenopausal symptoms
By Penelope Morrison Bosarge, RNC, CRNP, MSN
Women's Health Nurse Practitioner
Teaching Faculty, Graduate Programs
University of Alabama School of Nursing
Birmingham
Now that we know how to recognize perimenopause (see Contraceptive Technology Update, April 1998, p. 53), where do we go as providers? What can we do to help women in their middle years feel good about aging and meno pause? Management of symptoms can be accomplished by medical and nonmedical interventions, and a combination of both may be best.
Some changes woman experience may be mistaken for medical problems and vice versa. For example, the differential diagnosis must be taken into consideration. Fatigue, excess perspiration, and vaginal itch may be from diabetes, not meno pause. Also, don't overlook a serious problem and tell the patient, "You know, you are at that age."
This column will offer approaches to three of the most common perimenopausal discomforts: bleeding pattern changes, sleep disturbances, and hot flashes.
Managing bleeding changes
Perimenopausal physiology causes fluctuating estrogen and progesterone levels, which result in various bleeding patterns. Cyclic progestin can be given, but erratic ovarian function may make it difficult to schedule. When given, it can help control bleeding and prevent possible hyperplastic changes in the endometrium. Estrogen alone is not recommended and is inappropriate because poses a threat to the endometrium.
The woman who is experiencing menses, even if irregular, still may be ovulating and could get pregnant. If contraception is needed, oral contraceptives (OCs) should be considered in healthy, nonsmoking women.
Women who have contraindications to hormonal therapy may opt for nonmedical management approaches for symptom relief. The following pointers offer something for everyone, even for those who choose hormonal therapy:
· Eat a healthy diet rich in iron.
· Get adequate rest and sleep at night.
· Increase vitamin A intake.
· Avoid alcohol.
· Avoid strenuous activity at the beginning of menses.
· Avoid aspirin and similar drugs that slow clotting.
Calming sleep disturbances
Medical literature varies when it comes to treatment of sleep disturbances during peri meno pause. In a sample of more than 1,000 middle-age women, there was no increase in sleep difficulties,1 while a double-blinded study of 34 perimeno pausal women who were experiencing sleep disturbances revealed a significant reduction in wakefulness when estrogen was administered.2
Keep in mind that factors other than perimenopause may affect sleep. Hormonal therapy, if so indicated, may result in more restful sleep and fewer awakenings. Oral contraceptives also represent a good choice in this situation, especially for those who are still menstruating.
Consider the following for nonmedical management of sleep disturbances:
· Avoid caffeine, alcohol, and exercise within three hours of bedtime.
· Cover with layers if sleep is disturbed by temperature fluctuations.
· Drink warm milk at bedtime.
· Try chamomile and other herbal teas.
· Try relaxation techniques and visualization to relieve stress.
Cooling hot flashes
Up to 85% of women experience vasomotor changes, primarily hot flashes, during the transitional period of perimenopause. Hormonal therapy or oral contraceptives will significantly improve this troublesome and embarrassing discomfort. In addition, determination of the triggering factors can help all women cope, whether or not they choose hormonal therapy.
Nonmedical suggestions shown to help in some cases include the following:
· Keep a diary to record activities preceding the flash.
· Avoid caffeine, alcohol, sugar, spicy foods, hot drinks, and large meals.
· Eat foods rich in vitamin E, such as vegetable oils, wheat and rice germ, legumes, corn, and almonds.
· Dress in layers made of natural fibers.
· Keep a fan nearby. Place a cool cloth on forehead.
· Take deep breaths.
· Take cool showers.
The literature is inconclusive concerning herbal remedies, but may some day reveal many solutions. Some herbal preparations can be toxic in inappropriate quantities and should be used with caution after discussion with health care providers.
Low-dose OCs can help
For the mid-years woman who needs contraception and is still menstruating, a combination of nonmedical management approaches and low-dose oral contraceptives may offer relief of perimenopausal symptoms. Along with symptom relief, low-dose OCs can:
· cause predictable, manageable bleeding;
· alleviate vaginal dryness;
· lower the risks of anemia and endometrial cancer;
· lower the risks of heart disease and osteoporosis.
At the determination of true menopause, women can make a smooth transition from oral contraceptives to hormone therapy and be assured of continued relief of the majority of menopausal discomforts.
Aside from the medical implications, there are a wide range of variables to be taken into consideration when working with women as they mature. Promotion of positive attitudes and self-esteem always should be part of your management plan. Add stress reduction and a healthy life style to make the perfect prescription for success.
References
1. Bungay GT, Vessey MP, McPherson CK. Study of symptoms in middle life with special reference to the menopause. Br Med J 1980; 281:181-183.
2. Thomson J, Oswald I. Effect of oestrogen on the sleep, mood, and anxiety of menopausal women. Br Med J 1977; 2:1,317-1,319.
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