Just when most women hit a rhythm in their careers, find balance with their families, and become experts with their periods, along with creeps in perimenopause. Sometimes it is less creeping and more like a full hurdle into chaos. Suddenly, our bodies become alien beings, not following any rhyme or reason. Skin starts to break out like a teenager, the weight begins stacking on despite our go-to diet plans, and one day you have your period, and the next day it is gone for months on end. Then the period comes back and doesn't stop.

The minor annoyance of dribbling urine with a hard chuckle turns into a full-open faucet with the tiniest laugh. WHAT IS GOING ON?

The biggest issue is that these changes are normal, but no one talks about them. We get classes in school about the menstrual cycle, but no one teaches you about the changes on the other end of reproductive life.   

As women, we are born with all the eggs we will ever have. Some eggs develop into pregnancy, while others never develop or are passed with menses. Eventually, we just run out of viable eggs, and our body senses this change with time. However, our body doesn't go down without a fight. As our hormones start to dwindle naturally, our body says, "Hey, what is going on? I am not letting this happen!" The body then tries to push out surges of hormones to stimulate ovulation and egg release, but the ovaries are yelling back, "Hey buddy, we are tired and done!" This fight within  the brain is trying to trigger hormone release and the slow retirement of the ovaries  turns into a wild roller coaster for women. Hormone surges cause a return or increase in oily skin and acne. Menstrual cycles become erratic, either stopping for months causing the inevitable panic of a surprise pregnancy, or lasting for weeks because the hormone levels don't balance enough to stop the bleeding. These hormone fluctuations lead to a whole host of other less-than-lovely side effects such as sleeplessness, moodiness, hot flashes, and changes in metabolism, leading to weight loss resistance.

Many women believe they can go to the doctor and be tested for menopause. Unfortunately, as medical professionals, we can only tell you that you are in the perimenopausal period, which last months to years.  There is no current medical test that will let us know when you will be finished with this time of your life.

As estrogen begins to dwindle, so does its effect on the lining of the vagina. The vaginal tissue begins to thin out. Conditions such as incontinence tend to worsen during this time. Without thick vaginal tissue from estrogen, one loses the support of the pelvic floor since the muscle begins to naturally weaken after our 30s. Pelvic ligament damage that may have happened during childbirth begins to unmask itself more and may present with worsening leaking or even prolapse, a drop of the bladder, vagina, and rectum. The vaginal tissue begins to dry out and become less elastic, making sexual activity uncomfortable and painful. 

Additionally, the vaginal tissue begins to thin, thus changing the pH acid level and reducing some of the beneficial bacteria that keeps the vagina healthy. Perimenopausal and menopausal women are at a higher risk of recurrent vaginal infections and even urinary tract infections due to these changes. 

So what can a woman do?

The first steps are to take a deep breath and accept this as a normal part of life. You are entering the next phase, which they term the "second spring" in Chinese culture. Yes, this is the wrap-up of your reproductive life, but the beginning of your "second act", the best part of your play of life. Due to advances in women's health, you don't have to go down with the ship. Instead, you can choose to play an active role and stay in control of your body. Some suggestions are to:

  • Talk to your health care provider about options to make the transition comfortable. This may include supplements or medications to help balance symptoms and hormone levels.
  • Consider using boric acid suppositories for pH balance that aids with odor and factors that contribute to recurrent infections
  • Look into options for supporting healthy vaginal tissue, such as topical hormone creams or laser rejuvenation.
  • Get 8 hours of sleep during this time to aid in weight loss, stress management, hormone balance, and overall well-being
  • Stay well hydrated. Urinating eight times a day is normal. Hydration is the number one secret to supporting weight loss and adequate sleep. 
  • If you are leaking urine, see a gynecologist, urogynecologist, or urologist for the newest options of minimally invasive treatments. Please make sure you use protective pads and change them frequently so that they don't hold in bacteria and contribute to infections. 
  • Keep up your kegel exercises. If you are unsure how to do them, consider seeing a pelvic floor physical therapist. 
  • Focus on healthy noninflammatory foods such as foods found naturally. Inflammatory foods such as processed foods, sugar, dairy, and gluten can add to hormone imbalances.   
  • Stay away from endocrine-disrupting substances. Endocrine disruptors are chemicals in our environment that trick the body into believing they are hormones. These chemicals hijack your hormones, throwing your system out of whack. Hormone disruptors are harsh cleaning agents, insecticides, pesticides, plastics, and chemicals. Consider eating organic or checking out your products with the Think Dirty app or the Environmental Working Group website. 
  • Take up a hobby, learn to meditate, spend time with friends, any activity that causes relaxation.  Lowering stress can aid in hormonal balance.