Learning About Perimenopause
- Gwyneth Paltrow, a 51-year-old Academy Award–winning actress and author of “New York Times”–bestselling cookbooks, opened up in a recent interview about dealing with perimenopause.
- According to the North American Menopause Society (NAMS), “the gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called perimenopause (literally meaning around menopause”).
- “It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some women, these symptoms are troublesome enough to need medical intervention.”
- As women age and their bodies go through changes, it’s important to understand the cancer risks that may arise and the critical screenings that need to be done.
- Know Your Screening Tests: Pap smears, annual mammograms, and colonoscopies are all key for women as they enter menopause and cancer risk increases.
- Dr. Zuri Murrell, a colorectal surgeon at Cedars-Sinai, told SurvivorNet, “It’s important for you to actually educate yourself and be your own health care advocate. You should lead each doctor’s appointment with a plan.”
The Academy Award–winning actress and author of “New York Times”–bestselling cookbooks spoke to PEOPLE this week, explaining, “I’m really in the thick of perimenopause.”
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Paltrow, a mom of two who previously dealt with postpartum depression, first noticed a “shift” in her body when she was 45 years old.
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She understands how hormone changes in a woman’s body can easy make someone feel as if they are “losing” their mind. However, she’s grateful more and more women are starting to talk about their body changes so they can feel less alone in the process and manage symptoms better.
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“I’m glad that there is a big change in the culture and women are talking about this now. Because in my mother’s generation that was not the case whatsoever,” Paltrow told PEOPLE.
She said, “It’s nothing to be hidden. I think it’s great, and I’m so happy that there’s a community now, and that there are these great startups springing up. There’s all these platforms that are being created to help women through it.”
The platforms Paltrow was referring to is Evernow, Midi Health, and Stripes.
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“There are a lot of great options available, whether it’s HRT or different supplements, but I’m just glad everybody’s talking about it because it used to be so full of shame and it’s just another chapter for us,” Paltrow added.
Understanding Perimenopause
According to the North American Menopause Society (NAMS), “the gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called perimenopause (literally meaning
around menopause”).
“It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some women, these symptoms are troublesome enough to need medical intervention.”
Meanwhile, when menopause (whether natural or induced) occurs when a woman is 40 years old or younger, it’s dubbed as premature menopause.
“This occurs in about 1% of women in the United States,” the NAMS explains. “Premature menopause that is not induced can be genetic, metabolic, autoimmune, or the result of other poorly understood conditions. Premature menopause should be evaluated thoroughly.”
Critical Cancer Screenings
As women age and their bodies go through changes, it’s important to understand the cancer risks that may arise and the critical screenings that need to be done.
For example, when it comes to scheduling a screening, older women sometimes may have different options depending on guidelines.
“A woman doesn’t need to come in for a pap smear every year, but can come in every three to five years, depending on her age,” Dr. Anna Beavis, a gynecological oncologist at John Hopkins Medicine, previously told SurvivorNet. “I still recommend that every woman go to their [gynecologist] every year for an exam, even if a pap smear isn’t being done.”
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According to Dr. Beavis, women should start scheduling their cervical cancer screenings starting at age 21 and continue until age 65. However, even if you’re 65 years or older, that doesn’t mean you’re necessarily off the hook. In order to skip these screenings, you’ll need to have had regular pap smears for the past 10 years in order to get the all clear. These screenings are extremely important, especially since cervical cancer doesn’t present symptoms until it has advanced. By following guidelines and regularly having pap smears, your doctor can catch the disease before it has progressed.
Dr. Beavis’ recommendation echoes that of the U.S. Preventative Services Task Force (USPSTF) guidelines, which state women starting at age 21 to age 29 should have a pap smear every three years. For women 30-years-old to age 65, guidelines recommend women should get a pap smear along with an HPV test (or an HPV test alone) every five years. The guidelines also specify which women qualify for three year screenings while others qualify for five. To determine this, it’s important to talk to your doctor as to whether you are “high-risk” of the disease or not.
Meanwhile, there is a wide consensus in the medical community that women have annual mammograms (to check for breast cancer_ between the ages of 45 and 54. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) said this year that women should start getting mammograms every other year at the age of 40, suggesting that this lowered age for breast cancer screening could save 19% more lives.
Women should also be sure of when to screen for colon cancer, also known as bowel cancer. Dr. Heather Yeo, a surgical oncologist and colorectal surgeon at New York Presbyterian Weill Cornell Medical Center, previously reminded SurvivorNet of the importance of colorectal cancer screenings such as colonoscopies because most colorectal cancers can be prevented early with screening.
“In the United States, on a national level, colorectal cancer has been decreasing for the last 20 years,” Dr. Yeo said. “And much of that is thought to be directly due to screening for colon cancer.”
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Even still, colorectal cancer cases are rising among younger people. And in the United States alone, rates have increased every year from 2011 to 2016 by 2 percent among people younger than 50. Because of this increase, the United States Preventive Services Task Force has recently updated its colorectal cancer screening recommendations to begin at age 45 instead of 50.
“We know that colon cancers can be prevented when polyps are found early,” Dr. Yeo said. “Lowering the screening age helps somewhat with this. But access to care is a real problem.”
Research suggests that tailoring colon cancer screenings to each person’s individual risk may be beneficial. If you are not yet 45 but have concerns about your risk, talk to your doctor. Ask about your individual risk based on your lifestyle and family history and find out when screenings would be right for you.
How Early Menopause Affects Cancer Risk
Luckily, a woman’s risk for breast cancer is reduced if she went through early menopause.
In an earlier interview with The University of Texas MD Anderson Cancer Center, Dr. Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center, offered some insight into the link between menopause and how it affects a woman’s cancer risk.
Dr. Bevers told Survivor Net that menopause doesn’t cause cancer, however, as women get older, their risk of developing cancer rises.
“Starting menopause after age 55 increases a woman’s risk of breast cancer and endometrial cancer. That’s probably because she’s been exposed to more estrogen,” Dr. Bevers explained. “During a woman’s menstrual cycle, estrogen stimulates the uterus and breast tissue. So the more menstrual periods a woman has, the longer these tissues are exposed to estrogen.”
She noted that women who begin the menopausal transition at a later age “also may have an increased risk of ovarian cancer, possibly because they have had more ovulations.”
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Dr. Bevers also suggested women try safer alternatives when coping with menopausal symptoms, instead of first trying hormonal therapy, as it’s been associated with an increased risk of certain cancers.
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She advises women to make “small lifestyle changes,” to reduce symptoms, like avoiding coffee before showering can make a big difference.
Other safe and health ways to manage symptoms, according to Dr. Bevers, include:
- Exercising regularly
- Reducing stress
- Getting enough sleep
- Avoiding hot flash triggers like coffee, tea and alcohol
- Quitting smoking
Exercise Can Lower Your Breast Cancer Risk
“The same ways you reduce your cancer risk before menopause: exercise, eat a healthy diet, don’t smoke and avoid secondhand smoke, and maintain a healthy body weight,” Dr. Bevers added.
“Research shows that gaining weight after menopause increases a woman’s risk of breast cancer, but losing weight after menopause can actually reduce your risk.”
Your risk for breast cancer comes from a variety of potential places. Some of these are risk factors you simply can’t change. Others you can impact by modifying your behaviors and that’s good news for people who want to take an active role in their personal risk reduction.
“Common causes include genetic predispositions, such as BRCA mutations or other mutations that cause breast cancer,” Dr. Sarah Cate, assistant professor of surgery Icahn School of Medicine at Mount Sinai, told SurvivorNet in an earlier interview.
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“Other causes are family history, obesity, radiation to the chest like is used in Hodgkin’s lymphoma, alcohol use, never having children, and certain types of abnormal breast biopsies.”
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These are factors we can’t control, but “what we can control are factors like diet and exercise, as well as alcohol,” Dr. Cate explains.
The Difference Between Menopause and Early Menopause
Menopause is described by the National Institute on Aging, as “a point in time 12 months after a woman’s last period.” Additionally, “The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.”
The average age women go through the menopausal transition, which usually lasts approximately seven to 14 years, ranges between ages 45 and 55.
“The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity,” the institute explains. “The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.”
As for early menopause, the National Cancer Institute says it’s a condition which causes the ovaries to stop working and menstrual periods to stop before a woman turns 40. It’s a transition that can lead to fertility issues and symptoms of menopause.
Additionally, early menopause is split up into two types, primary and secondary. According to the National Cancer Institute, “There are two types of early menopause, primary and secondary. Primary early menopause means that the ovaries do not function normally. This may be because they have been removed by surgery, or it may be caused by some cancer treatments and certain diseases or genetic conditions.
“In secondary early menopause, the ovaries are normal but there is a problem getting hormone signals to them from the brain. This is usually caused by diseases of the pituitary gland or hypothalamus. Some women with early menopause sometimes have menstrual periods and may be able to have children. Also called ovarian failure, ovarian insufficiency, and premature menopause.”
Advocating for Yourself
We’re delighted to see Paltrow talking about the changes her body is going through, even if it’s normal. However, when something seems off with your body, it’s always important to speak up for yourself and advocate for your health.
In a previous interview, Dr. Zuri Murrell, a colorectal surgeon at Cedars-Sinai, told SurvivorNet that people should educate themselves, go into their doctor appointment with a plan, and be pushy if necessary.
“It’s important for you to actually educate yourself and be your own health care advocate. And that’s something that I think is really important. You should lead each doctor’s appointment with a plan.”
Be Pushy, Be Your Own Advocate, Don’t Settle
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.