1. + Medcan Women’s Health Forum Smooth Sailing Through the Stresses of the Sandwich Generation

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3. + What is Perimenopause? The period of time leading up to Menopause Menopause= when a woman has not had a period for a period of one year unrelated to pregnancy, body weight or another medical condition Menopause is only ONE day Before=Perimenopause After=Postmenopause During Perimenopause periods tend to get heavier, closer together and then later further apart Perimenopause can last for years

4. + Symptoms of Perimenopause Hot flashes Mood Swings Irregular periods Breast tenderness Worsening PMS Decreased libido Minor Memory Problems Fatigue Vaginal Dryness Urine leakage when coughing, sneezing or laughing Urinary Urgency Difficulty Sleeping

5. + Hot Flushes/Flashes 2/3’s of women experience Momentary sensation of heat Sweating Fast heart rate May turn red or flush

6. + Treatments for Hot Flashes Avoid: Stress Caffeine Alcohol Spicy food Tight clothes Heat Tobacco Supplements and Meds: Vitamin B Vitamin E Ibuprofen SSRI’s Gabapentin Clonidine HRT

7. + Mood Swings and Worse PMS

8. + Why Mood Swings…

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11. + WHY Mood Swings…

12. + Why Mood Swings? “PMS” becomes disjointed from the period Fluctuating hormone levels (particularly estrogen) affect mood Stressors that are specific to this time period Lack of sleep and hot flashes contribute Feeling out of control of one’s body and reactions contributes

13. + Life Stressors Elderly parents Kids at home Kids leaving home Men and their mid-life crises Career Issues or Lack of Career Issues The Economy Being “on” 24/7

14. + What can a woman do?

15. + Eat Healthy!!

16. + Exercise!!

17. + Be with Friends!!

18. + Hormonal Options: See Your Gyn!

19. + Over the Counter Options…

20. + OTC: Supplements and Herbals Calcium 600mg twice a day- PMS Black Cohash Chasteberry Siberian Ginseng USP Progesterone Cream

21. + Prescription Medications Antidepressants (particularly Selective Serotonin Reuptake Inhibitors) Gabapentin (Neurontin) Sleep aides Avoid Benzodiazepines

22. + Practice Acceptance

23. + Practice Mindfulness…

24. + Mindfulness Defined

25. + Focus on the Here and Now

26. + Get Rid of Mind Clutter…

27. + Mindless versus Mindful Judging Opinionated Thoughts are real Focus on past and future Lost in Reaction Avoidance Reactive Impulsive Behavior STRUGGLE Non-judging: Accepting Based on fact Thoughts are mental events Awareness Calm and alert Interested, focused, attentive Focus on NOW ACCEPTANCE MindlessMindful

28. + Mindfulness Exercise

29. + Did you feel this way?

30. + Or this way?

31. + Ways to Practice Mindfulness Unplug! Eating Driving Exercising Sit outside Practice Meditation at a specific time each day Yoga When feeling stressed Hot flashes

32. + Ways to Practice Acceptance Practice Letting Go- first with small things then bigger ones Remember that 99% of what goes on with other people has nothing to do with you Stop trying to be perfect. Including with being Mindful. Stay positive- Exercise your brain by finding something positive about everybody and every situation you encounter. Including you! Use positive reinforcement, not negative, with others- you will find it empowers you.

33. + How Do You Know if Need to See a Doctor? Your mood swings seem extreme and cause you and everyone else distress Your mood is consistently low and is accompanied by hopelessness, lack of enjoyment and changes in sleep, appetite, energy and concentration If you have any thoughts of suicide or wishing you were dead You seems to have continual conflicts with everyone You have physical symptoms that seem extreme or unusual You are self-medicating with drugs or alcohol

34. + Remember: Depression is Treatable!

35. + Perimenopause: Hold on for the Ride!

36. + Thank You!