• Fri. Jun 2nd, 2023

Transitioning to Menopause

A monthly message from UC Health

Michael A. Thomas, MD

UC Health

Perimenopause, also called pre-menopause, is the time leading up to beginning menopause. Menopause means that you stop having menstrual cycles, hormone production from your ovaries is lost, and you no longer have the ability to become pregnant. The average age that women experience menopause is 51 years old; however, pre-menopause, or the transition from a normal cycle to menopause, can start as early as age 35 years old. 

Pre-menopause symptoms can be different for each woman and can last for about five years. During pre-menopause, you may experience a change from predictable monthly menstrual cycles to irregular cycles (shorter or longer spacing between cycles), heavy or lighter bleeding during menstruation, dryness of the vagina, hot flashes or flushes (sudden sense of heat and flushing of your face and chest with sweating and sometimes chills), changes in your mood, decrease in sex drive, and problems with sleep. These symptoms can range from mild to unbearable. Most of the symptoms that you experience during this time are due to changes in hormone levels, primarily a decrease in estrogen levels.

Treatment during this timeframe will depend on the problem:

  • Heavy bleeding. A complete gynecologic examination is needed, which may also include an ultrasound. During an ultrasound, sound waves are used to look at the uterus (womb) and ovaries. A physical examination and ultrasound may help to find problems that can cause bleeding including uterine fibroids, polyps and ovarian cysts. Depending on the problem, treatment to reduce bleeding may include:
    • Removing a small piece of the lining of the uterus for biopsy.
    • Prescribing medications.
    • Placing an IUD (intrauterine device) into your uterus.
    • Using injections of a progesterone-like hormone, progestin.
    • Wearing a birth control patch. 

If these do not stop the bleeding issues, a minor surgery may be needed.

  • Hot flashes. Estrogen will help to decrease or eliminate hot flashes or hot flushes. If you have not had a hysterectomy (surgical removal of the uterus), you still have your uterus, and your doctor prescribes estrogen, you will also need medication, an injection or an IUD with progesterone placed to decrease the risk of being diagnosed with cancer or being diagnosed with pre-cancerous cells within the lining of the uterus. For some women, herbal medicines or acupuncture may be helpful. Lastly, some studies have shown a decrease in hot flashes with the use of anti-depressant medication. If no medications are preferred, you should avoid caffeine and alcohol, keep your environment cool and wear lighter clothing.
  • Vaginal dryness. You may find relief of vaginal dryness or discomfort by using hormonal medications (gel, cream, medication or patches). Nonhormonal vaginal moisturizers and lubricants can also be used. Vaginal symptoms can be the easiest to treat.

Remember, all women experience pre-menopause. Though the time that it takes to reach menopause stage can vary from woman to woman, please call your doctor if your symptoms are negatively affecting your life in any way.

For more information, talk with your healthcare provider or call UC Health at 513-475-UC4U (8248).

Michael A. Thomas, MD, is chair of the Department of Obstetrics and Gynecology at UC Health and serves as professor at the University of Cincinnati College of Medicine.