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Excerpt
They lasted for 4 years.
Finally, she’d had enough. She visited her gynecologist and told him about the hot flashes. He drew a follicle-stimulating hormone (FSH) level, which is a good indicator of whether a woman is menopausal. As estrogen production from the ovaries decreases, the pituitary gland releases additional FSH to compensate. This stimulates a recruited follicle to grow and produce estrogen.
A woman is considered menopausal when her FSH reaches 40. Anna’s level had shot beyond that to 135.
Anna’s gynecologist explained that the hot flashes she’d had over the past 4 years were symptoms of perimenopause—the transitional period from normal ovulatory cycles to menopause. As they discussed other symptoms, Anna realized that her uncharacteristic outbursts of anger and rage followed by deep sadness were hormonally related and not signs of clinical depression. At the time, though, Anna had thought she was having a breakdown because she felt far too young for “the change of life.”
Anna isn’t alone: Few women know what perimenopause is or that it encompasses many of the changes they experience at midlife. In this article, we’ll separate the myths about perimenopause from the facts and tell you what you need to know.
Q: What is perimenopause?
A: As mentioned above, perimenopause is a time of transition in a woman’s menstrual cycle. “Literally, perimenopause means around menopause,” says Melinda Dunham Noonan, RN, MS, a visionary leader with more than 20 years of experience in women’s health. Now president of the Chicago-based consulting company M.D. Noonan, Inc., she is the president of the National Association for Women’s Health.
The North American Menopause Society defines perimenopause as the entire menopausal transition plus 1 year after the final menstrual period. During perimenopause, changes associated with upcoming menopause are experienced.
Perimenopause usually begins in a woman’s mid-to late 40s; the average age at menopause is 51. In general, perimenopause lasts about 4 years, but this varies from as little as 2 years to as long as 10 years (maybe even longer). Such factors as how old your mother was when she entered perimenopause, whether you smoke now or you used to smoke, whether you were ever pregnant, and whether you used birth-control pills play a role in the duration of perimenopause. (Smoking usually means an earlier beginning to perimenopause; pregnancy and the Pill may delay onset.)
According to Noonan, most women don’t know when they’re perimenopausal. “They might be having some hot flashes or sleep disturbances,” she says. “If they go to a health care provider with these symptoms—and if that person is listening—an FSH level might be run,” she says.
Q: What are the symptoms of perimenopause?
A: Perimenopause is associated with erratic fluctuations in reproductive hormone levels. This frequently leads to irregular menstrual cycles, vasomotor symptoms (hot flashes often followed by chills), changes in mood or cognition, and sexual dysfunction.
Twenty percent of women are asymptomatic, according to Noonan. Twenty percent have extreme symptoms. And everyone else falls in between. Also, heavier women tend to have less symptomology because estrogen is stored in adipose tissue.
“I don’t think there is a way to predict who’s going to fall where,” she says. “Studies on patterning hot flashes and other symptoms showed no strong correlations to one’s family history.
