Hot flushes, anxiety, joint pain, brain fog – just a few examples of what women go through during perimenopause. While the severity and duration vary, many women agree that this phase can be uncomfortable, embarrassing and painful.
Perimenopause refers to the transition years before menopause, when oestrogen levels begin to decrease, leading to the end of your reproductive years.
Medication, wellness therapies, diet and even mental health techniques can help soothe perimenopause symptoms and give women some relief.
When it comes to medication, there is no one-size-fits-all solution as every woman experiences perimenopause differently.
Menopause hormone therapy (MHT) is often touted as the answer but certain factors (such as age and health history) need to be met before a doctor prescribes it.
Dr June Tan Sheren, consultant family physician at Tucker Medical, told CNA Women that contraceptive pills and patches may be an option to alleviate symptoms such as hot flushes, night sweats, mood swings, menstrual migraine and headaches. It does this by regulating hormone levels and reducing the fluctuations that lead to perimenopause symptoms.
“Menstrual cycle regulation with contraceptives also reduces heavy menstrual bleeding that can lead to iron-deficiency anaemia, which frequently occurs in perimenopause, and worsens fatigue and low mood,” she added.
There is no one-size-fits-all medication for perimenopause as every woman experiences this transition phase differently. (Photo: iStock/maruco)
Dr Sheren said a new and “more effective” non-hormonal drug called fezolinetant, already approved in the United States, the European Union and the United Kingdom, will soon be launched in Singapore. “This will be very helpful for women with symptoms who cannot take hormonal therapy due to various reasons,” she said.
Certain anti-depressant and anti-anxiety medicines have been useful in reducing hot flushes, night sweats and improving mood and sleep in perimenopause, she added.
The once commonly prescribed hypertension drug clonidine, used at doses lower than what is used for treating high blood pressure, can help reduce hot flushes, Dr Sheren said.
If you’ve been reaching for over-the-counter pain relief for sore muscles and joints, Dr Sheren recommended doing this for no more than one to two weeks without medical supervision.
A medical opinion should be sought if the pain is persistent. Also, Dr Sheren said that “pain is a signal from the body and if it doesn’t go away, it should not be ignored”.
“Even in perimenopause, sore muscles and joints are not always due to hormonal change alone – there are frequently other factors like activity, posture, lifestyle, weight or mental health,” she said.
Erratic, irregular periods: They can be longer or shorter than usual, with lighter or heavier flow, plus you could get them less or more often.
Hot flushes: A sudden, temporary increase in body temperature, commonly felt in the upper part of your body, especially your face and neck.
Sleep issues: Difficulty falling and/or staying asleep, plus night sweats (hot flushes that occur at night).
Joint and muscle aches: The top perimenopause symptom among Singapore women.
Brain fog: Difficulty focusing and thinking clearly, not being able to find the words to express yourself or remember names.
Mood swings and irritability: A result of hormone changes or a lack of sleep.
Vaginal dryness: Intercourse becomes painful and you could have more vaginal infections too.
Frequent urination: Urinary incontinence is also common.
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A quick Google search will give you a list of herbal medicines or supplements for perimenopause such as black cohosh, red clover extract, vitamin D and magnesium. There are even packs of supplements sold under labels such as ‘menopause relief’ or ‘menopause support’.
Dr Sheren said there is a lack of large, robust data on supplements. The supplements industry is also unregulated which means the purity and amount of ingredients is highly variable from one product to another. Little is known about potential drug interactions.
However, she acknowledged that there are women who have benefitted from certain supplements and if a patient reports benefits from it with no negative effects, she wouldn’t object to its use even if it’s a placebo effect.
“I should stress that supplements do not take the place of a healthy, balanced diet and healthy lifestyle,” she added.
A deficiency in vitamin D can make perimenopause symptoms worse – a blood test can determine what your levels are. (Photo: iStock/jarun011)
Dr Sheren added that there is no good scientific evidence that supplements need to be taken unless there are deficiencies to correct, such as Vitamin D, iron, calcium and vitamin B12.
For example, the drop in oestrogen during perimenopause affects bone health so you might want to get a blood test to check for Vitamin D deficiency.
“Vitamin D deficiency can exacerbate perimenopause symptoms such as fatigue, muscle aches and joint pains, anxiety, depression and sleep disturbances,” Dr Sheren said. “Low vitamin D and insufficient calcium intake also contribute to bone loss – osteopenia followed by osteoporosis – in perimenopause through post-menopause.
“There are no symptoms of osteopenia or osteoporosis until a fracture occurs. Prevention therefore is key,” she added.
There isn’t enough scientific evidence that supplements need to be taken unless there are deficiencies, such as in vitamin D, iron, calcium and vitamin B12. (Photo: iStock/Doucefleur)
Dr Sheren warned not to over-supplement calcium as excessive calcium is not good for the body. The best sources of calcium are from whole foods and the Health Promotion Board recommends 1,000mg of calcium daily for adults 51 years and above.
When it comes to evening primrose oil, which some women take for pre-menstrual syndrome, Jaclyn Reutens, a dietitian at Aptima Nutrition, said it has shown to help with reducing hot flushes, inflammation and mood swings.
Reutens added that magnesium supplements can help with sleep and anxiety, as well as bone health.
Reutens said that diet can help alleviate perimenopause symptoms such as hot flushes, reduced quality of sleep and increased abdominal fat accumulation.
She recommended eating foods that contain phyto-oestrogens as they can mimic oestrogen activity. Examples include seeds and soya products such as flax seeds, tofu, soya milk, chickpeas and lentils.
Flax seeds, tofu, soy milk, chickpeas, lentils and other phyto-oestrogen-rich foods can alleviate perimenopause symptoms. (Photo: iStock/tbralnina)
Eating low-fat dairy foods that are high in calcium – such as low-fat yoghurt, cheese and milk – can replenish calcium loss from bones. If you have an issue with lactose, Reutens suggested high-calcium foods like tofu, sardines, ikan bilis (dried anchovies) and calcium-fortified soya milk.
Eat regular meals to give yourself sustained released of energy throughout the day; this promotes good sleep too. Reutens said to ensure meals are nutritionally balanced with carbs, protein and fibre.
She also advised not to overeat or go on fad diets as they can lead to sudden weight gain and increased abdominal fat.
If you’d rather not reach for a pill of any sort, Dr Natalie Games, a clinical psychologist at Alliance Counselling, said that cognitive behavioural therapy (CBT) is highlighted as one of the most effective non-drug therapies for women to manage perimenopause.
Several studies have shown that it helps not just with emotional and psychological symptoms but also distressing physical symptoms such as hot flushes and night sweats
“Paced breathing, using the diaphragm, helps to lessen the impact of a flush. It also gives you something calm to focus on, so you are not thinking negative thoughts,” Dr Games explained. “Women who wake up at night because they are sweating are more likely to go back to sleep if they learn how to remain calm rather than get distressed.”
Paced breathing helps lessen the impact of a hot flush and gives you something calm to focus on. (Photo: iStock/VioletaStoimenova)
Dr Games said that stress is one of the most significant contributors to the hormonal imbalances
She recommended mindfulness practices such as deep breathing, meditation and body awareness exercises.
“By fostering an awareness of the present moment and promoting relaxation, mindfulness can help reduce the negative impact of stress on the body and mind,” she explained. “Furthermore, mindfulness-based techniques can help women develop greater emotional regulation which has a knock-on effect of improving mood and reducing the intensity of emotional fluctuations.”
Dr Games advised that CBT and mindfulness-based techniques be part of a holistic treatment plan incorporating exercise, nutrition and other lifestyle factors.
Julie Low, senior physician at Oriental Remedies Clinic, explained how, in traditional Chinese medicine (TCM) theory, perimenopause symptoms are often attributed to a decline in kidney energy, particularly kidney yin energy, which disrupts the balance of yin and yang in the body.
Herbal medicine, acupuncture and moxibustion (a form of heat therapy where dried plant materials are burned on or very near the skin) help address hot flushes, night sweats, poor sleep, mood swings, fatigue and stress.
Low recommended incorporating yin-nourishing foods like black sesame seeds, goji berries and walnuts to support kidney health and improve overall vitality.
Also, reduce your intake of fried and spicy foods to help manage heat buildup in the body, especially if you’re dealing with hot flushes and night sweats.
Pilates helps with perimenopause symptoms such as joint and muscle pain through low-impact exercises. (Photo: iStock/FG Trade)
Pek Li Jun, co-founder of HER Wellness Club and executive director of Pilates Connect, said that pilates helps with perimenopause symptoms such as joint and muscle pain, through low-impact exercises.
If you’re experiencing frequent urination or incontinence because of weakened pelvic floor muscles, pilates helps to activate and strengthen your pelvic floor through deep core engagement, breath and visualisation techniques.
“And if you have weight gain, especially around the middle, pilates focuses on engaging both deep and more superficial core muscles for a more toned waistline,” said Pek, who has been Pilates for Menopause-certified by The Center for Women’s Health and Fitness in the United States.
Dr Games encouraged women to embrace perimenopause as a time of reinvention and growth – it can be seen as a transition to reflect on their identity, desires and life goals.
She recognised that this time can bring up feelings of loss, frustration and even grief over changes in your body and identity, and advises women to validate these feelings as normal.
Also, acknowledge that you need to be gentle with yourself by allowing yourself the space to experience these changes without self-criticism.
“Accept imperfection as this is a developmental phase, one in which you haven’t been through since adolescence or childbirth/motherhood, depending which you last experienced,” said Dr Games.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...
Perimenopause refers to the transition years before menopause, when oestrogen levels begin to decrease, leading to the end of your reproductive years.
Medication, wellness therapies, diet and even mental health techniques can help soothe perimenopause symptoms and give women some relief.
PERIMENOPAUSE HELP #1: MEDICATION
When it comes to medication, there is no one-size-fits-all solution as every woman experiences perimenopause differently.
Menopause hormone therapy (MHT) is often touted as the answer but certain factors (such as age and health history) need to be met before a doctor prescribes it.
Dr June Tan Sheren, consultant family physician at Tucker Medical, told CNA Women that contraceptive pills and patches may be an option to alleviate symptoms such as hot flushes, night sweats, mood swings, menstrual migraine and headaches. It does this by regulating hormone levels and reducing the fluctuations that lead to perimenopause symptoms.
“Menstrual cycle regulation with contraceptives also reduces heavy menstrual bleeding that can lead to iron-deficiency anaemia, which frequently occurs in perimenopause, and worsens fatigue and low mood,” she added.
There is no one-size-fits-all medication for perimenopause as every woman experiences this transition phase differently. (Photo: iStock/maruco)
Dr Sheren said a new and “more effective” non-hormonal drug called fezolinetant, already approved in the United States, the European Union and the United Kingdom, will soon be launched in Singapore. “This will be very helpful for women with symptoms who cannot take hormonal therapy due to various reasons,” she said.
Certain anti-depressant and anti-anxiety medicines have been useful in reducing hot flushes, night sweats and improving mood and sleep in perimenopause, she added.
The once commonly prescribed hypertension drug clonidine, used at doses lower than what is used for treating high blood pressure, can help reduce hot flushes, Dr Sheren said.
If you’ve been reaching for over-the-counter pain relief for sore muscles and joints, Dr Sheren recommended doing this for no more than one to two weeks without medical supervision.
A medical opinion should be sought if the pain is persistent. Also, Dr Sheren said that “pain is a signal from the body and if it doesn’t go away, it should not be ignored”.
“Even in perimenopause, sore muscles and joints are not always due to hormonal change alone – there are frequently other factors like activity, posture, lifestyle, weight or mental health,” she said.
PERIMENOPAUSE SYMPTOMS CHECKLIST
Erratic, irregular periods: They can be longer or shorter than usual, with lighter or heavier flow, plus you could get them less or more often.
Hot flushes: A sudden, temporary increase in body temperature, commonly felt in the upper part of your body, especially your face and neck.
Sleep issues: Difficulty falling and/or staying asleep, plus night sweats (hot flushes that occur at night).
Joint and muscle aches: The top perimenopause symptom among Singapore women.
Brain fog: Difficulty focusing and thinking clearly, not being able to find the words to express yourself or remember names.
Mood swings and irritability: A result of hormone changes or a lack of sleep.
Vaginal dryness: Intercourse becomes painful and you could have more vaginal infections too.
Frequent urination: Urinary incontinence is also common.
Collapse Expand
PERIMENOPAUSE HELP #2: SUPPLEMENTS
A quick Google search will give you a list of herbal medicines or supplements for perimenopause such as black cohosh, red clover extract, vitamin D and magnesium. There are even packs of supplements sold under labels such as ‘menopause relief’ or ‘menopause support’.
Dr Sheren said there is a lack of large, robust data on supplements. The supplements industry is also unregulated which means the purity and amount of ingredients is highly variable from one product to another. Little is known about potential drug interactions.
However, she acknowledged that there are women who have benefitted from certain supplements and if a patient reports benefits from it with no negative effects, she wouldn’t object to its use even if it’s a placebo effect.
“I should stress that supplements do not take the place of a healthy, balanced diet and healthy lifestyle,” she added.
A deficiency in vitamin D can make perimenopause symptoms worse – a blood test can determine what your levels are. (Photo: iStock/jarun011)
Dr Sheren added that there is no good scientific evidence that supplements need to be taken unless there are deficiencies to correct, such as Vitamin D, iron, calcium and vitamin B12.
For example, the drop in oestrogen during perimenopause affects bone health so you might want to get a blood test to check for Vitamin D deficiency.
“Vitamin D deficiency can exacerbate perimenopause symptoms such as fatigue, muscle aches and joint pains, anxiety, depression and sleep disturbances,” Dr Sheren said. “Low vitamin D and insufficient calcium intake also contribute to bone loss – osteopenia followed by osteoporosis – in perimenopause through post-menopause.
“There are no symptoms of osteopenia or osteoporosis until a fracture occurs. Prevention therefore is key,” she added.
There isn’t enough scientific evidence that supplements need to be taken unless there are deficiencies, such as in vitamin D, iron, calcium and vitamin B12. (Photo: iStock/Doucefleur)
Dr Sheren warned not to over-supplement calcium as excessive calcium is not good for the body. The best sources of calcium are from whole foods and the Health Promotion Board recommends 1,000mg of calcium daily for adults 51 years and above.
When it comes to evening primrose oil, which some women take for pre-menstrual syndrome, Jaclyn Reutens, a dietitian at Aptima Nutrition, said it has shown to help with reducing hot flushes, inflammation and mood swings.
Reutens added that magnesium supplements can help with sleep and anxiety, as well as bone health.
PERIMENOPAUSE HELP #3: DIET
Reutens said that diet can help alleviate perimenopause symptoms such as hot flushes, reduced quality of sleep and increased abdominal fat accumulation.
She recommended eating foods that contain phyto-oestrogens as they can mimic oestrogen activity. Examples include seeds and soya products such as flax seeds, tofu, soya milk, chickpeas and lentils.
Flax seeds, tofu, soy milk, chickpeas, lentils and other phyto-oestrogen-rich foods can alleviate perimenopause symptoms. (Photo: iStock/tbralnina)
Eating low-fat dairy foods that are high in calcium – such as low-fat yoghurt, cheese and milk – can replenish calcium loss from bones. If you have an issue with lactose, Reutens suggested high-calcium foods like tofu, sardines, ikan bilis (dried anchovies) and calcium-fortified soya milk.
Eat regular meals to give yourself sustained released of energy throughout the day; this promotes good sleep too. Reutens said to ensure meals are nutritionally balanced with carbs, protein and fibre.
She also advised not to overeat or go on fad diets as they can lead to sudden weight gain and increased abdominal fat.
PERIMENOPAUSE HELP #4: MENTAL HEALTH THERAPIES
If you’d rather not reach for a pill of any sort, Dr Natalie Games, a clinical psychologist at Alliance Counselling, said that cognitive behavioural therapy (CBT) is highlighted as one of the most effective non-drug therapies for women to manage perimenopause.
Several studies have shown that it helps not just with emotional and psychological symptoms but also distressing physical symptoms such as hot flushes and night sweats
“Paced breathing, using the diaphragm, helps to lessen the impact of a flush. It also gives you something calm to focus on, so you are not thinking negative thoughts,” Dr Games explained. “Women who wake up at night because they are sweating are more likely to go back to sleep if they learn how to remain calm rather than get distressed.”
Paced breathing helps lessen the impact of a hot flush and gives you something calm to focus on. (Photo: iStock/VioletaStoimenova)
Dr Games said that stress is one of the most significant contributors to the hormonal imbalances
She recommended mindfulness practices such as deep breathing, meditation and body awareness exercises.
“By fostering an awareness of the present moment and promoting relaxation, mindfulness can help reduce the negative impact of stress on the body and mind,” she explained. “Furthermore, mindfulness-based techniques can help women develop greater emotional regulation which has a knock-on effect of improving mood and reducing the intensity of emotional fluctuations.”
Dr Games advised that CBT and mindfulness-based techniques be part of a holistic treatment plan incorporating exercise, nutrition and other lifestyle factors.
PERIMENOPAUSE HELP #4: WELLNESS PRACTICES
Julie Low, senior physician at Oriental Remedies Clinic, explained how, in traditional Chinese medicine (TCM) theory, perimenopause symptoms are often attributed to a decline in kidney energy, particularly kidney yin energy, which disrupts the balance of yin and yang in the body.
Herbal medicine, acupuncture and moxibustion (a form of heat therapy where dried plant materials are burned on or very near the skin) help address hot flushes, night sweats, poor sleep, mood swings, fatigue and stress.
Low recommended incorporating yin-nourishing foods like black sesame seeds, goji berries and walnuts to support kidney health and improve overall vitality.
Also, reduce your intake of fried and spicy foods to help manage heat buildup in the body, especially if you’re dealing with hot flushes and night sweats.
Pilates helps with perimenopause symptoms such as joint and muscle pain through low-impact exercises. (Photo: iStock/FG Trade)
Pek Li Jun, co-founder of HER Wellness Club and executive director of Pilates Connect, said that pilates helps with perimenopause symptoms such as joint and muscle pain, through low-impact exercises.
If you’re experiencing frequent urination or incontinence because of weakened pelvic floor muscles, pilates helps to activate and strengthen your pelvic floor through deep core engagement, breath and visualisation techniques.
“And if you have weight gain, especially around the middle, pilates focuses on engaging both deep and more superficial core muscles for a more toned waistline,” said Pek, who has been Pilates for Menopause-certified by The Center for Women’s Health and Fitness in the United States.
Dr Games encouraged women to embrace perimenopause as a time of reinvention and growth – it can be seen as a transition to reflect on their identity, desires and life goals.
She recognised that this time can bring up feelings of loss, frustration and even grief over changes in your body and identity, and advises women to validate these feelings as normal.
Also, acknowledge that you need to be gentle with yourself by allowing yourself the space to experience these changes without self-criticism.
“Accept imperfection as this is a developmental phase, one in which you haven’t been through since adolescence or childbirth/motherhood, depending which you last experienced,” said Dr Games.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...