Peri-Menopause

Definitions

Peri-Menopause refers to the time in a woman's life a few years before actual menopause. The average age of menopause is about 51 years, and the average onset of peri-menopause is about age 45, although it can occur even during the 30's. While menopause implies the cessation of female hormone production, peri-menopause can be much more dramatic due to the potential for wide hormone swings resulting in a myriad of symptoms.

Medically, menopause occurs when the ovaries have completely stopped producing estrogen and there are no more eggs to be released. The consequences of this are that the menstrual periods stop, the patient can no longer become pregnant, and there may be symptoms related to the loss of estrogen such as hot flashes, night sweats, sleep disturbances, mood changes, decreased libido, vaginal dryness and others.

Some women have severe symptoms, some have minimal or none.

The hormonal roller-coaster

Peri-menopause occurs when the ovaries begin to function more erratically as they get closer to the actual cessation of estrogen production. This condition is marked by estrogen fluctuations from lows to highs. Mood swings, menstrual irregularity, and menopause-type symptoms that come and go are typical. Additionally, higher than normal levels of estrogen can be released, leading to abnormally intensified PMS symptoms, worse breast tenderness, heavy periods or rarely "hemorrhaging." The ovaries can still release eggs, but more unpredictably, so pregnancy can still occur during the peri-menopause. Lastly, methods of birth control dependent on timing or counting the days of the cycle become very undependable.

Peri-menopause can be like a hormonal roller coaster ride. Highs and lows separated by relative calm which continue to recur until the ride is over. It has been described as going through puberty in reverse. For some women the ride is not so bad, and therefore they do not seek medical attention. For others, the symptoms are intense, at times disabling and disruptive to their quality of life.

Fortunately, there is treatment.

Don't stop birth control

One important principle to keep in mind is that birth control is still needed during the peri-menopause. Although the chance for pregnancy is lower, it is not zero. Imagine thinking that your missed periods are due to menopause, only to learn at age 45 that you are pregnant!

For some this would be wonderful, for others this would be a tragedy.

Other Health Issues

Another health concern is bone strength and calcium intake. Hormonal fluctuations can lead to increased bone loss during the peri-menopause. Lost bone is extremely hard to replace, and excessive bone loss can lead to osteoporosis, a dangerous condition that can cause spine and hip fractures. For maximum prevention of bone loss, calcium intake of at least 1200 milligrams daily (4 servings of dairy) is advised, as is weight-bearing exercise such as walking, running, swimming at least 3 times per week for 30 minutes or more.

The ideal treatment

The ideal treatment for patients suffering with excessive peri-menopausal symptoms would be to restore regular cycles, prevent hormonal fluctuations and provide birth control at the same time. Surprisingly, all of this can be accomplished using birth control pills.

There is growing evidence to support the safety and effectiveness of using the Pill to treat peri-menopausal suffering. The Pill restores estrogen levels so bone loss is prevented and it regulates the menstrual cycle preventing heavy periods. Additional benefits of the Pill are that fibroids tend not grow, ovarian cysts can be prevented, PMS is lessened, breast tenderness is usually prevented and of course the Pill provides reliable birth control.

Women aged 40 and older can safely take the Pill as long as they do not smoke and do not have specific health conditions such as high blood pressure, previous breast cancer, a history of blood clots, heart attack or stroke or severe liver disease. The Pill has not been proven to increase the risk of breast cancer, and has been shown to reduce the risk of ovarian cancer by half. There is a rare risk of serious complications from the Pill, but when compared to the benefits above the experts generally agree that the benefits of being on the Pill far outweigh the risks.

Other treatments

Other medications used to treat peri-menopausal symptoms include estrogen supplementation, progesterone supplementation, antidepressants such as Effexor or Zoloft, soy extracts and herbs and vitamins. None of these approaches provide as consistent and predictable benefits as the Pill. Increased exercise can also help peri-menopausal symptoms.

Another option is the use of a low dosage of natural estrogen. This can help alleviate many of the distressing symptoms during peri-menopause, but the patient has to be carefully evaluated and monitored to make sure she is not getting too much estrogen.

Conclusion

If a woman remains on the Pill for peri-menopausal treatment she will still go through menopause but it will happen invisibly. One of the only signs of this is that during the 4th week of the cycle when she takes the placebo pills, there may be noticeable hot flashes. We would normally continue the Pill until about age 52 to 55, when the ovaries have likely completely stopped functioning and the patient has entered menopause, although with almost no symptoms.

The "roller coaster ride" will end. It then becomes time for new decisions to be made regarding either switching to hormone replacement therapy or going off the Pill to see what nature has in store for this new phase of life.

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