When Your Period Goes Haywire

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The Change Before the Change

"Perimenopause" is a term that gets tossed around a lot without people knowing exactly what it means. As Crandall learned, doctors define it as the transition period when normal menstrual cycles begin to change in frequency and duration and ending at menopause, which you reach after 12 months with no period. Although menopause is technically just one day in your life (after that you are "postmenopausal"), you can be in perimenopause for 10 years or longer, during which time you are still very much capable of becoming pregnant. The average age for reaching menopause not brought on by surgery or chemotherapy is 51.4, according to JoAnn V. Pinkerton, MD, medical director of the Midlife Health Center at the University of Virginia. Only about 1 percent of women reach it before 40 and an additional 5 percent between 40 and 45.

Perimenopause's swings in hormone levels are what spark abnormal bleeding. Expect two distinct phases: First, periods become shorter and come closer together as the egg sacs (follicles) in the ovaries produce less progesterone. Over time, estrogen production also drops and women enter the later stage: "Women are still producing some estrogen, but it's not enough to necessarily stimulate the endometrium and ultimately result in a period," says Isaac Schiff, MD, a professor of obstetrics and gynecology at Harvard Medical School. This makes periods even more unpredictable and other symptoms more intense. Intervals ?between ?periods can be shorter or longer, and blood flow may be scanty to profuse.

As ovulation becomes more erratic, diminishing levels of progesterone (the hormone that prevents too much tissue buildup in the uterus) may lead to longer and heavier periods. You might go a few months without a period and worry you're pregnant -- and then get one again. Or you might actually be pregnant.

Although fertility declines with age, women in their 40s are second only to teenagers in their rate of unintended pregnancies, says Dr. Pinkerton, who is also on the board of the North American Menopause Society. "Because they are not ovulating regularly, perimenopausal women are at risk for getting pregnant throughout their cycle, even when they are bleeding," she says. "As a consequence, they really need to be conscientious about contraception."

Decreasing hormone levels also increase vulnerability to some diseases. Lower estrogen levels make the body start to lose bone faster than it can replace it (the greatest loss in women not on hormone therapy [HT] is in the six years after menopause and then the decrease levels off), which in turn increases the risk of osteoporosis. There may also be changes in blood cholesterol levels, such as a rise in the "bad" LDL cholesterol and a decrease in the "good" HDL, which make us more susceptible to heart disease. They also produce other uncomfortable symptoms -- eyes may get drier, night sweats can cause insomnia, and vaginal tissue can become thinner, with lessened lubrication, which can make sex uncomfortable.

Unpredictable periods and haywire hormones can also inhibit libido, making women less interested in having sex. ?Recent research indicates that about a third of pre- and postmenopausal women have sexual problems. Yet other studies suggest that our menopausal status isn't the sole culprit: Too much stress and other problems with mental and physical well-being can also be factors.

Continued on page 3:  Are You in Perimenopause?


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