Sun, 07 Dec 2003

Pre-menopause: A natural, manageable stage in a woman's life

T. Sima Gunawan, Contributor, Jakarta

That afternoon, it was not really hot and the wind blew gently, but she was all in a sweat.

"I didn't know why. I wasn't sick but my face and body was wet because of the perspiration. And if you looked at my hair, it looked like as if I had just taken a shower," said Rini (not her real name).

Rini, who is in her mid-40s, also did not understand why she got easily upset these days. "I often yelled at my only daughter for no reason," she said.

She decided to go to a doctor upon the suggestion of her husband, who thought that something was wrong after she rejected his amorous advances.

A gynecologist at a reputable hospital said she was experiencing symptoms of pre-menopause and recommended food supplements.

At the pharmacy, she was amazed to find out how expensive the supplements were. She paid Rp 480,000 for a bottle of 100 pills.

"Actually, there was another one that was cheaper, but the pharmacy had run out of stock," she said.

But what really bothered her was the pharmacist's warning.

"He warned me that while I take this supplement, I should drink a lot of water, or I could suffer kidney problems. I wonder why the doctor didn't tell me this."

She was also disappointed with the doctor, as he seemed to be reluctant about answering her many questions about the symptoms.

Pre-menopause, or perimenopause, is a natural stage in a woman's life.

Many women begin experiencing symptoms of pre-menopause several years before their menstrual cycle stops, or menopause.

The age at which pre-menopause occurs varies. Some experience pre-menopause in their early thirties, while others in their forties. Symptoms also vary from woman to woman, and some lucky women may not experience any symptoms at all, as with menstrual symptoms -- some women may suffer terrible cramps and are always in a bad mood, while some others may feel just fine.

In general, the pre-menopausal symptoms include hot flashes, night sweats, chills, irregular periods, sleeping difficulties, mood swings, heart palpitations, loss of or decreased sexual desire and vaginal dryness.

The symptoms usually stem from a hormonal imbalance of estrogen and progesterone.

Dr. Boyke Dian Nugraha, a gynecologist, said the production of certain hormones may drop by 80 percent during pre-menopause. This could also happen to men, but they are not highly affected, as the production level may drop only by one to 15 percent.

"(Pre-menopause) may be delayed, but you can't prevent it from happening," he said.

He said that many of his patients who experience pre- menopausal symptoms complained about losing their sexual appetite or having problems with intercourse due to the low production of vaginal fluids.

Even though women who are in the pre-menopause stage may face various problems, he said they should not worry too much as the problems can be overcome.

Dr. Boyke suggested that women experiencing pre-menopausal symptoms pay more attention to their diets and eat soybean-based foods, foods rich in calcium and low-fat foods, and decrease their salt intake. "Sun bathing and Kegel exercises are also good."

He elaborated that Kegel exercises helped women to strengthen the vaginal muscles. According to, Kegel exercises is alternate contraction and relaxation of perineal muscles for treatment of urinary stress incontinence.

It is also necessary to get a USG exam for breasts and uterus, as well as a pap smear, said Dr. Boyke.

As for food supplements, he said that they could help women cope with pre-menopausal symptoms.

Dr. Marius Widjajarta, head of the Indonesia Health Consumers Empowerment Foundation, however, warned consumers to be careful about taking food supplements.

He also emphasized that doctors should tell their patients to focus on good eating habits and nutritional intake instead of relying on food supplements.

Food supplements are not medicines and cannot cure diseases, and doctors should make this clear to their patients, he said.

Doctors should provide clear explanations, listen to their patients and answer their questions. Even if the patients do not have any questions, doctors should give them any necessary information about supplements and other treatment.

On the other hand, he said, patients should not hesitate to exercise their rights as stipulated in Law No. 8/1999 on consumer protection.

The law says that consumers are entitled to accurate and clear information, to be listened to and to safety and security.

Information Box:

Pre-Menopausal Symptoms

* Hot flashes and night sweats * Sleeping problems * Mood swings: anxiety, depression, irritability * Heart palpitations * Irregular periods * Dry skin or hair loss * Loss or decreased sexual desire * Vaginal dryness * Weight gain

-- Compiled from various sources