What is Perimenopause? Q&A with Dr. Cindi Buxton

“Doctor, what’s happening to me?”

The dreaded menopause … we all know its most notorious side effects (hot flashes, weight gain, mood swings). However there are irksome symptoms that come well before menopause that often get overlooked - like uncomfortable sex and vaginal dryness. We spoke with Dr. Cindi Buxton, ND and LAc, about perimenopause– the time before menopause– and what to expect. If the symptoms she describes sound familiar, check out our Pulse personal lubricants H2Oh! and Aloe-ahh that Dr. Cindi developed with us.

Pulse: What is perimenopause, and how is it different from menopause?

Dr. Cindi: Perimenopause is a vague term for “the time before” or “the time around menopause” when a woman's hormones begin to change. She may notice changes in many different areas of her health including her body, mood and wellness. Sometimes these changes are subtle and tend to be written off due to stress. For other women, symptoms hit them suddenly and cause the woman to feel as if she is going crazy.


Pulse: What causes perimenopause?

Dr. Cindi: Perimenopause results from a normal response to the aging and slowing down of our reproductive capacity, and changes to our bodies’ hormonal balance between Estrogen and Progesterone levels.


Pulse: What are the most common perimenopause symptoms and signs?

Dr. Cindi: Symptoms vary and depend on an individual’s hormonal levels. But the most common complaints are bloating, irritability, breast tenderness, lowered libido, trouble sleeping, and/or irregular periods (often coming a few days to week early). Some patients describe reduced sexual interest, depression, irritability, fatigue, trouble with memory, focus or concentration, hot flashes, night sweats, weight gain around the belly, and even drooping breasts and chin hair. Vaginal dryness and painful sex are also common during perimenopause.




Pulse: Which of my hormones are affected during perimenopause?

Dr. Cindi: The hormones responsible for the reproductive cycle are impacted and often thrown out of balance during perimenopause: Estrogen, Follicle Stimulating Hormone (FSH), Progesterone, and Luteinizing Hormone (LH).


Pulse: How are my hormones out of balance during perimenopause?

Dr. Cindi: Perimenopause disrupts your normal cycle, leading to two hormonal imbalances:

  • Estrogen Dominance: As a woman enters perimenopause, her follicles might still be releasing Estrogen, but the corpus luteum released at ovulation may not release as much Progesterone in the second half of the cycle.  This can cause a condition called Estrogen Dominance and when I see patients with this condition they often tell me that they feel bloated, irritable, have breast tenderness, lowered libido, trouble sleeping, and/or irregular periods (often coming a few days to week early). If her Estrogen level is too high compared to Progesterone, she may also experience extremely heavy flow since Estrogen is responsible for creating the buildup of bloody lining inside the uterus each month.
  • Estrogen Deficiency: At other points in perimenopause the follicles become weaker and don’t release as much Estrogen. A woman with this hormonal condition may describe reduced sexual interest, depression, irritability, fatigue, trouble with memory, focus or concentration, hot flashes, night sweats. She may also notice weight gain around the belly and possibly drooping of breasts.  


Pulse: But, I’m still getting my period. Does that mean I’m not in perimenopause?

Dr. Cindi: You’ll still get your period during perimenopause, though you may notice your flow is shorter and more scanty, and periods are a bit more irregular. Remember: perimenopause is not the same as menopause, which is defined as having no menstrual periods for 12 months.


Pulse: What’s with the night sweats?

Dr. Cindi: When Estrogen is too low, or levels are inconsistent, the pituitary gland tries to remedy this by secreting more Follicle Stimulating Hormone (FSH); it’s an attempt to “push” the ovaries to develop more Estrogen-producing follicles. Rising FSH levels with lowered Estrogen unfortunately can cause hot flashes and night sweats, the severity of which can range from mildly annoying to extremely distressing and disruptive.


Pulse: I’m noticing vaginal dryness. What’s causing this?

Dr. Cindi: Another common and frustrating problem caused by Estrogen deficiency is vaginal dryness and painful sex. The vaginal and vulva tissues are dependent on proper Estrogen levels to remain elastic, moist and supple. Western medicine uses a somewhat affronting term called “vaginal atrophy” or “atrophic vaginitis” to describe the adverse effect of low estrogen levels on the vagina and vulva. The shock of having sex turn from a pleasurable act to a painful act can be demoralizing and very stressful for both a woman and her partner.   


Pulse: How can I deal with painful sex caused by vaginal dryness?

Dr. Cindi: Personal lubricants can be very helpful in combatting vaginal dryness. But beware of lubricants that are very concentrated as these types can make you more susceptible to developing a vaginal infection because they tend to dry up and damage cervical and vaginal cells and disrupt the normal vaginal flora and immune system. A more natural water-based lube with a lower osmolality can help. You can also try to layer lubricants by massaging a little silicone-based lubricant into the vulvovaginal area before initiating sex and then using plenty of a natural water-based lube during sex.


About Pulse

We’re proud to offer two personal lubricants: Aloe-ahh, a silicone-based formula with aloe and vitamin E, and H2oh!, a natural, water-based formula with pure chia extract. Both were developed for women experiencing vaginal dryness or painful sex due to perimenopause and menopause. We also offer our unique Pulse Warming Dispenser, it’s a mess-free, easy to-use, touchless device that dispenses perfectly warmed lubricant, keeping you and your partner in the most important place: the moment.

About Dr. Cindi Buxton, ND, LAc

Dr. Cynthia Buxton received her Masters of Science degree in Acupuncture and her Naturopathic Doctorate from Bastyr University. Dr. Buxton listens to her patients  from her heart and creates a sacred, caring space for healing to begin. Dr. Buxton’s mission is to provide holistic natural health care focusing on the whole person. She utilizes nutrition, therapeutic supplementation, acupuncture, Western and Chinese herbal medicine, homeopathic medicine, and healthful lifestyle counseling to relieve disease, restore balance, creativity and optimal health. Dr. Buxton also believes that the freedom to express creativity and joy is critical to vibrant health. It’s part of why she enjoys dancing, singing and music in the maintenance of her own well-being. Dr. Buxton is licensed as a Naturopathic Physician and an Acupuncturist in Washington state, and is a member of the Acupuncture Association of Washington, the American Association of Naturopathic Physicians, and the Washington Association of Naturopathic Physicians.




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