Menopause Transition
What Is Menopause Transition?
There are three major intervals in a woman's reproductive life. The first begins with the onset of menstrual periods and includes your fertile years until the beginning of decline of ovarian function. The third interval begins with the completion of all natural menstrual periods and is called menopause. The interval between these two is called menopause transition (or peri menopause). It can last from six months to ten years, but usually persists for only 2-3 years before true menopause. In most women, menopause transition begins in the early to mid 40's, but can occur earlier or later.
What Causes Menopause Transition?
As a woman matures, the number of eggs in her ovaries progressively declines. Pituitary hormone levels (called FSH & LH) progressively rise in an attempt to stimulate the ovaries to release these more resistant eggs. The ovaries may first not respond (resulting in low estrogen levels), and then may over-respond (with high estrogen levels and even cysts on the ovaries) as might be seen with fertility drug treatment. Rarely, women become pregnant at this time, and should use contraception if pregnancy is not desired.
What Are The Signs Of Menopause Transition?
The first sign of menopause transition is often a shortening of menstrual cycle length from the usual 28 days to 23 - 25 days apart. Another sign can be irregular or very long cycles of 60 or more days in length. You may experience hot flushes or other symptoms even though your menstrual cycles appear relatively normal.
What Will I Feel During This Time?
Many women describe menopause transition as "like being on a hormonal roller coaster”. Menopause transition is often a more difficult time of your life than menopause itself. Because the ovaries can both under and over respond during this time, you may have days or weeks of highs or lows. During times of low estrogen, you may experience hot flushes, mild depression, vaginal dryness, and sleep disturbances similar to menopause. When estrogen levels are higher, you may experience breast tenderness, irritability, headaches, fluid retention, or "PMS-like" symptoms. For many women, these symptoms severely interfere with their life routines and are highly unpredictable. The good news is that they are all normal and will resolve when you enter menopause.
Is There Any Treatment For My Symptoms?
The treatment of menopause transition depends on your specific symptoms. Some women can be treated symptomatically with medications such as ibuprofen (Advil, etc.) or water soluble vaginal lubricants. Many women will benefit from a low dose estrogen replacement program as would be used for menopause symptoms, and some women may require a program which temporarily suppresses their own hormones such as low dose oral contraceptives. You may need to try more than one of the options to see which works best for you. Almost all women can achieve satisfactory control of their symptoms if they are persistent.
Do I Need To Worry If I Skip Periods?
If you go longer than 6-8 weeks without a menstrual period, we recommend that you call the office for instructions and possible progesterone treatment. During menopause transition, you may still be producing estrogen even though you are not ovulating and therefore are not having regular periods. This "unopposed estrogen" stimulation to the lining of the uterus (called the endometrium) can eventually lead to cancer of the uterus in some women. Regular progesterone treatment to bring on a menstrual period has been shown to protect against this problem.
Are There Any Other Problems With Menopause Transition?
Menopause transition is a time of potential rapid loss in bone density, which can predispose you to future bone thinning or osteoporosis. Adequate calcium intake, regular exercise, and maintenance of normal estrogen levels with replacement hormones will help prevent this problem. Irregular vaginal bleeding can be normal for menopause transition, but may also signal abnormal changes of the uterine lining including endometrial cancer. Uterine sampling such as a D & C may be necessary to screen for these problems.
Is There Anything I Can Do For Menopause Transition?
Maintaining a healthy lifestyle is very important during this time of your life. Following a regular exercise program, maintaining a healthy weight, avoiding smoking or excess alcohol intake, and eating a healthy diet are all especially valuable. Regular health care visits at least annually are recommended, and more frequent visits are often necessary while symptoms are changing. For these or any other problems, be sure to call your doctor for directions on when medical intervention may be necessary or beneficial.
