Peri - menopause

Peri-menopause, What is It?

By Tori Hudson, N.D.
On average, the onset of perimenopause occurs around age 47 and the average duration is four to five years. Menopause is the proper term used after 12 months since the last menstrual period (LMP).More than ever before, women who are entering menopause are educating themselves, asking their doctors questions and requesting information about options for treatment. No two women’s menopause transition is alike. Together women, educators and health care practitioners are experiencing the challenge of evaluating and managing each woman individually to achieve optimal results and optimal health. Many women begin to experience an array of physical, mental and emotional symptoms long before they meet the definition of menopause. These changes, that occur over as many as several years (usually from around age 40 to 51), are a transition period called “perimenopause”. A narrower definition is the transition from regular to irregular menses. During perimenopause, several biological changes occur:

The number of ovarian eggs (oocytes) reach very low levels, from 1-2 million at birth to only a few thousand.
The menstrual cycle begins to vary; typically the cycle shortens from one menses to the next.
The levels of follicle stimulating hormone (FSH) in the body increase. This rise in FSH is one of the first signs of reproductive aging. Doctors often measure FSH levels to determine if the symptoms one is having are related to menopause. There are two problems with this test, however: One, varying patterns of FSH may occur even in the same woman. Two, the FSH is often normal even though the woman really is perimenopausal.
Ovarian production of estradiol, progesterone and testosterone levels decrease with the onset of true menopause.
Although hormone levels will eventually decrease, lower estrogen levels aren’t experienced until six months to one year before true menopause. It’s only in the last year of perimenopause that estrogen levels begin to decrease. Near menopause, estrogen levels rise very high and then drop very rapidly.
Eventually, the lower levels of estrogen are no longer adequate to cause a build-up of the uterine lining and there is not enough tissue to produce a menses. The average age of a woman’s LMP in the U.S. is 51.

The symptoms of decreased hormone levels and perimenopause are varied, unpredictable and often go unrecognized as perimenopausal symptoms. Due to problems in recognizing perimenopausal symptoms, the lack of precision in FSH testing and inadequate understanding of menopause by both patient and health care provider, many women become dissatisfied with their health care. The signs and symptoms of perimenopause can include menstrual irregularities, hot flashes, vaginal dryness and thinning, skin changes, fatigue, decreased libido, mood swings, depression, changes in memory and cognition, sleep disturbance, hair loss on head, hair growth and acne on face, palpitations, nausea, headaches, urinary tract infections, and the beginning stages of osteoporosis and heart disease. The symptoms can be mild, moderate or severe. Some women may have no significant menopausal symptoms and others may have symptoms that are progressive and problematic for many years to come. Natural progesterone cream can also be used very effectively in perimenopause. Problems that can be addressed include regulating the menstrual cycle, hot flashes, nightsweats, low libido, mood swings, premenstrual symptoms, vaginal dryness, and headaches. Most women in the perimenopause transition years will not need to take Hormone Replacement Therapy (HRT). It is this majority of women that will be able to ease their perimenopause symptoms with natural therapies both successfully and safely. In the menopause and postmenopausal years, choices about nutritional supplements, herbal therapies, and natural hormones versus HRT can be made on an individual basis. A health care practitioner who is educated about all the options can assess your individual needs and individual risks for cardiovascular disease and osteoporosis and determine which therapy, or combination of therapies, is right for you.

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