Everything You Need to Know About Perimenopause

Our experts answer your questions about the mood swings, hot flashes, and other symptoms that may hit in the decade before your periods stop.
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Important Q&As

Q. What is perimenopause, anyway, and how can I tell if I'm in it?

A. The average woman goes through natural menopause (meaning she's had no period for 12 months) at around age 51, but changes in your body begin years earlier. The years leading up to menopause are called perimenopause. It's just a process, not an illness. In fact, some lucky women hardly notice the transition. But others experience annoying symptoms. Here's why: In perimenopause your ovaries start to produce less estrogen as your follicles (the sacs that hold your eggs) diminish. You may not produce enough estrogen one month to stimulate your ovaries to release an egg. If that happens, your brain may try to compensate by sending more follicle-stimulating hormone (FSH) into your bloodstream. As a result, you can have high levels of estrogen some days and low levels on others. This unpredictable hormonal activity confuses your body and causes the common symptoms of perimenopause: hot flashes, night sweats, breast tenderness, decreased vaginal lubrication, and mood swings. On average, women have these symptoms for five to eight years.

Q. I've heard birth control pills can help you manage symptoms, but are they safe for women in their 40s?

A. Today's lower-dose oral contraceptives are safe for many women. The pill stabilizes hormone levels in the blood and can help manage hot flashes and irregular periods, says Isaac Schiff, MD, chief of the department of obstetrics and gynecology at Massachusetts General Hospital. Oral contraceptives also protect against pregnancy and bone loss. They are the preferred hormone treatment for perimenopausal women, but they do have potential side effects. Your risks rise with age if you're overweight, a smoker, or have a history of blood clots, hypertension, stroke, or diabetes. You and your doctor can make a decision on what's best for you after reviewing your health history as well as your symptoms.

Q. How do I know if I'm having a hot flash and what can I do about it?

A. Your first hot flash will take you by surprise. You get a sudden sensation of heat in your face and chest, and then you sweat as the flash dies down and your body tries to cool off. Before the hot flash, some women feel anxious and have a rapid heartbeat. During it, your face may get red and flushed. Afterward you may get the chills. Hot flashes usually last less than five minutes and they can happen several or many times a day. The only thing known to eliminate hot flashes is estrogen, says Lauren Streicher, MD, an assistant clinical professor of obstetrics and gynecology at Northwestern University's medical school in Chicago. But since stress is a trigger, getting regular exercise can help. You should also dress in layers you can remove easily and keep the thermostat low. At night wear light pajamas and sleep with a fan by your side of the bed. And keep track of your personal triggers, which could include not only stress but alcohol, spicy food, or too much caffeine.

Q. What does it mean if my usual, like-clockwork periods get very unpredictable? Do I need to see my doctor?

See your gynecologist if you have extreme bleeding patterns such as very heavy periods or bleeding that lasts more than seven days in a row. If you have spotting and bleeding between periods or bleeding during or after sex, it's also smart to get checked out. "Most women fear the worst and assume that heavy or continuous bleeding is a sign of cancer," says Dr. Streicher, a member of the LHJ Medical Advisory Board (learn more about her and other board members at LHJ.com/advisoryboard). But most abnormal bleeding, she says, is a result of those fluctuating hormones, which can cause the lining of the uterus to build up more tissue than usual. Your body has to shed it, just as it does when you get your period. While cancer is a rare possibility, heavy bleeding could also signal noncancerous growths such as polyps or fibroids, so it's important to tell your doctor about any symptoms.

Continued on page 2:  Important Q&As, cont'd.


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