March 3, 2009 in Features

Perimenopause symptoms can differ widely

Not all women experience classic menopause symptoms
Liz Atwood Baltimore Sun
 

Perimenopause is that transitional time when a woman goes from having regular periods to ending menstruation. Dr. Howard A. Zacur, professor of reproductive endocrinology and director of the division of reproductive endocrinology and infertility at the Johns Hopkins Medical Institutions, says not all women experience the same symptoms; some may not experience perimenopause at all.

Question: At what age do women typically go through perimenopause?

Answer: Since the duration of perimenopause is variable, and since some women may not even experience it, the average age remains unknown.

Q: How long does perimenopause usually last, and what are the signs?

A: Perimenopause occurs before menopause, and if it does occur, it may last for four years or more. During this time, a woman’s period may temporarily stop for several months at a time, and she also may have the classic menopausal symptoms of hot flashes, insomnia, vaginal dryness and mood changes. These symptoms tend to disappear when menses – the monthly flow of blood and cellular debris from the uterus that begins at puberty in women and ceases at menopause – resume. Not all women have these symptoms, and their degree of severity is highly varied. There is no way to predict when or if they will occur, or when and if they will all disappear.

Q: How is perimenopause diagnosed?

A: Doctors can check hormone levels to determine whether a woman has begun perimenopause. Levels of follicle-stimulating hormone circulating in the blood may be elevated and estradiol levels may be lowered when menopausal symptoms are present. But FSH levels may fall and estradiol levels rise when the menopausal symptoms disappear. So the practical diagnosis of perimenopause is best made when the menstrual cycle becomes irregular and the symptoms of menopause begin to wax and wane.

Q: How do perimenopause symptoms differ from menopause symptoms?

A: Symptoms of perimenopause are the same as those of menopause, when menses do not occur. Yet the symptoms of perimenopause disappear when menses resumes. During actual menopause, the symptoms of menopause may remain indefinitely or may become less bothersome. Menopause for a normal middle-aged woman is clinically defined as not having a menstrual period for one year.

Q: Are there any health risks associated with this transition phase?

A: As menopause nears, bone loss may accelerate. Women also tend to gain weight, which can be associated with increased risk for high blood pressure and diabetes.

Q: What treatments are available to ease the discomforts of perimenopause?

A: Symptoms of perimenopause or menopause may be relieved through the use of hormonal therapy given either as low-dose oral contraceptive pills or as estrogen and progestin supplements. When hormone therapy is given to women during perimenopause, it will alleviate symptoms during those times when there are no menses. When these women do ovulate and secrete their own estrogen and progesterone, a state of “hormone excess” may cause abnormal uterine bleeding, as well as fluid retention and mood changes.

Since ovulation cannot be predicted during this time, if a woman is taking hormone replacement, she may stop the therapy if she suspects that she has begun to ovulate again. She may then restart the hormone therapy if the symptoms of menopause return, but it may take two weeks of therapy before an effect on symptoms is seen.

Nonhormonal therapies have been recommended by some to treat one of the most bothersome perimenopausal symptoms: hot flashes. Unfortunately, these therapies have not undergone the rigorous clinical trials required by the (Food and Drug Administration) to become approved medications for menopausal symptoms, and they have their own known as well as unknown risks of side effects.

Q: Are there risks associated with hormonal treatments?

A: Hormonal therapy for menopausal symptoms is FDA-approved, and large clinical studies have identified some risks. The relative risk of deep venous thrombosis and stroke has received attention and caused alarm, but the absolute risk of these side effects from hormone therapy is small overall. Increased risk of breast cancer has also received attention. … Some women may be at higher risk than others for hormone-therapy side effects, so all women should be evaluated by a knowledgeable medical practitioner before beginning such treatment.


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