Menopause and Perimenopause


For most women menopause is established around age 50. About 5 years before menopause, women go through a period called perimenopause.

Perimenopause is triggered by the gradual aging of the ovaries, producing less estrogen, so she is not ovulating every month and menstrual periods becoming irregular. Her periods may be very heavy, even “flooding”. This may leave her anemic.

Symptoms of perimenopause include facial wrinkles, “turkey neck”, floppy breasts, all body hair becomes thin and starts to turn grey. The skin under her arms and at the back of her thighs becomes wobbly, her waist thickens as more fat is deposited around her abdomen. Some women are aware of heart palpitations or an occasional irregular heart beat.

The mucous membrane of her genitals thins out and becomes dry. Because there is less fat behind the walls of the vagina, and there is much less lubrication, intercourse may become painful. This is called dyspareunia. There may be a significant decrease in sexual arousal and fewer orgasms. She may also experience some loss of bladder control so she may dribble or spurt urine when she laughs, sneezes or coughs. Before you buy a package of “Attends” or “Tema”, do start doing Kegel Exercises frequently and regularly. You may also be prone to urinary infections.

During perimenopause, most women report hot flashes and night sweats; they complain of insomnia resulting in fatigue and she may have difficulty concentrating on her work, become confused or forgetful. Women call these times “menopause moments” but I prefer to think of them as a “brain fart”.

Unbeknownst to you, calcium may be coming out of your bones, leaving them porous, weak, and they may break easily, especially wrists, ankles, hips and spine. Called OSTEOPOROSIS, your family doctor will probably prescribe a “Bone Density” test as a base line. “Osteo” seems to affect thin, blond, white Anglo-Saxon women. Women of colour and heavy women seem to be exempt. Women who smoke, drink alcohol and who are sedentary are at increased risk. You will see older women who have developed a “Widows Hump”, their back becomes totally rounded from Osteo. If you develop Osteo, your doctor may prescribe alendronate (Fosomax) taken once a week.

Psychologically, many women become depressed and have difficulty coping. If this is a problem, please talk to your family doctor. Anti-depressants, (SSRI's) such as Effexor are effective. Many women experience low or no sex drive, dramatic mood swings, and are irritable and cranky.

I am not painting a pretty picture, but not all women have all these signs and symptoms. About 1/3 of women sail through peri- and menopause with little discomfort, 1/3 are moderately affected and the other 1/3 are really whacked by every symptom in the book.


You are menopausal when you have not menstruated for one year but you will still have many of the above signs and symptoms. Do see your family doctor; they may prescribe “hormone replacement therapy” (HRT) which is estrogen and progesterone for a two year period to get you over the worst of peri and menopause.

Because there is an increased risk of developing cancer on long term use of HRT, most doctors are reluctant to prescribe it long term, especially if there is a family history of cancer.

Do tell your doctor if the genital dryness is inhibiting your sexual pleasure; there are low dose Estrogen creams that you can apply daily.

Androgens are the male sex hormones, of which one of them is testosterone. It is well known that women do produce small amounts of testosterone.

Testosterone is the hormone that affects sexual desire, sexual response and psychological well-being. In small doses, testosterone can reduce body fat and increase mean muscle mass. As women age, they gradually produce less testosterone, this reduction results in loss of sexual desire, increase in body fat and reduction of mean muscle mass. If a doctor is prescribing Estrogen to their menopausal patients, they may also prescribe low dose testosterone if she complains of low sex drive, and dyspareunia.

A blood test is essential to determine if a woman needs testosterone therapy. Testosterone is available as a body cream, or a genital cream, a patch or a pill.


Avoid tea, coffee, smoking, alcohol - these prevent the absorption of calcium. Include calcium rich foods in your diet: milk, cheese, low fat cottage cheese and yogurt, green leafy vegetables, tofu, all soy products, shellfish, and salmon canned in water.

Exercise regularly, especially “foot to ground exercise” such as walking, speed walking, even jogging are best for preventing bone loss and increasing mean muscle mass.

Here are a few of the herbal remedies that you may wish to try:

Vitamin D. 800 IU daily to reduce bone loss.
Black Cohosh 250 mgms. Daily
Vitamin B Complex containing Niacin, Vit.B 6, B12, Folic Acid
Vitamin C 500 mgms daily.
Vitamin E up too IU daily.
Vitamin K to regulate calcium levels and blood clotting.
Beta Carotene 10,000 IU. Daily.
Coenzyme, Q10 boosts the immune system.
Ginseng, 1000 daily provides oxygen to your body.
St. John's Wort 300 mgms daily for depression.
Dong quai to relieve symptoms of menopause, headaches.
Soy Isoflavins100 mgms daily for heart and menopausal symptoms.
Valerian, short term treatment for sleep disturbances.
Calcium. You need about 1500 mgm. Daily. Supplements are not as good as milk, cheese, yogurt etc.


Some women celebrate menopause. It is the beginning of the last 1/3 of her life. No more menstrual periods, no more worrying about getting pregnant, no more PMS, no more hormonal highs and lows, fibroids may shrink, endometriosis is not as much of a problem.

Reasons to celebrate!:

Many women start to enjoy their body more, may start to pleasure themselves, and many find they have an increased sex drive and are more uninhibited in their sexual relationships. There is evidence that women who continue to be sexually active will continue to produce more lubrication and prevent vaginal atrophy.

They may find that the “urge to merge”, to have intercourse decreases, but the desire for intimacy, hugging, cuddling, snuggling, touching and genital stimulation increases dramatically.

The best medicine for women during menopause is to have a positive attitude, a strong support system already established. An understanding supportive partner, children who know and accept what is happening, and other women friends who may be at the same stage of their lives – these factors will make the transition a helluva lot easier and let you get on with it!