What is Perimenopause?

Perimenopause is defined as the TRANSITIONAL period from normal menstrual periods to no periods at all. The transition can, and usually does, take up to ten years. During the perimenopausal transition you may experience a combination of PMS and menopausal symptoms or no symptoms at all.

According to Stedman's Medical Dictionary, menopause is defined as the permanent cessation of the menses. This condition may be diagnosed in retrospect when 1 year has passed since the last menses. Well that’s pretty cut and dry and its nice to know it was menopause you were going through LAST YEAR!

But what can you do now? We know the average age of menopause is between 40-51, but menopause starting at the age of 40 is considered normal. So what if you're having irritability, mood swings and irregular periods now and you're not 51? Can it be PMS? Is it premature menopause? Or is it the perimenopause ? Can you still get pregnant? What are your treatment options? Do you need hormones or Prozac or just vitamin E? These are difficult questions and although there is a blood test for menopause (FSH), the test can only tell you if you are firmly IN menopause. However, by the time the test is positive it's quite obvious that you are into menopause.

PMS on the other hand can occur at any age but is more common in your 30's and 40's. The diagnosis and treatment of PMS has been hampered by the fact that there has not been a reliable definition for the condition. The American Psychiatric Association created a condition called the Premenstrual Dysphoric Disorder (PDD) which should not be confused with their earlier creation, the Late Luteal Phase Disorder (LLPD). Physicians have always viewed women as more vulnerable to mental disorders than men and have attributed it to the instability of their reproductive systems. Premenstrual Dysphoric Disorder (PDD) consists of a well defined set of symptoms but out of the estimated 30-60% of women who experience PMS symptoms only 3-5% of women meet the standards for PDD. But what if you don't meet the criteria? Doctors don't like to hear these questions because there is no good, simple and reliable test. There are ways to figure it out, but many physicians and patients just don't want to take the time and effort. However, it is important to figure it out because the treatments are different. So where do you start?

You start with your past. The age your mother or older sisters began menopause can have a bearing on when you will begin menopause. If your mother went through menopause in her late 40's and you're 34 it is most likely PMS. If your mother suffered from PMS then you are more likely to suffer as well. However, your mother might not remember when she went through menopause and your older sister may not admit to it. The only other reliable factor is if you smoke. If you smoke, you can count on menopause starting 1-2 years earlier than if you don't. Pregnancies, birth control pills, your age when you first began menses or breast-feeding have no impact on the age of menopause. If you are on oral contraceptives or other hormones such as Depo-Provera or estrogen, these can have an effect on mood, irritability, hot flashes, depression and your periods. Women who can't tolerate birth control pills are more likely to develop PMS and have a difficult perimenopause. Adjusting the dose, brand or time you take these medications can sometimes relieve unwanted side effects.

Some of the symptoms of depression are found in both PMS and perimenopause. Depression is not caused by menopause, but it can run in families. If feelings of depression, loss of appetite, insomnia, and general loss of interest or pleasure in life are at the top of your list you may be suffering from clinical depression. These feelings should be brought to the attention of your health care provider. Depression and PMS can occur together and it's not uncommon for anxiety or depressive disorders to worsen during the week before your period and at menopause. Sound confusing? Well, it can be. All of the above statements are generalizations but you have to remember that you are a unique individual.

After reviewing your family history for age of menopause and occurrence of PMS and depression, you should complete a symptom diary or calendar. This will be a unique record of your feelings on a daily basis. For three months keep track of your menses along with a daily record of your symptoms. Ideally, you should review your calendar with a health care provider but first there may be a lot you can learn on your own. There are two things you should look for. First look for patterns. In PMS you will generally see an increase in emotional symptoms beginning at mid cycle (around day 14). In the week before your period emotional symptoms will increase and physical symptoms may begin. In the last few days emotional symptoms will peak and then rapidly disappear after your menses start. There are variations of this pattern, but the key is symptoms that increase BEFORE and are relieved AFTER your period. Now that you have your symptoms calendar before you, look for depression that lasts most of the month. This could be a clue that you are depressed and need professional evaluation.

If your menses are occurring sooner than 21 days it may be perimenopause or a more serious gynecological condition and you need to be evaluated by your health care provider. Menses occurring later than 45 days is more consistent with menopause or perimenopause. If physical symptoms predominate, especially hot flashes, vaginal dryness and night sweats, and if they last throughout the month unrelated to menses think more about menopause. Remember menopause before the age of 40 is called premature menopause and is rare. However perimenopause can begin before age 40. Surgical removal of the ovaries is the most common cause of premature menopause. Hopefully you know if your ovaries have been removed, but you may not. Years ago doctors routinely removed ovaries in women undergoing a hysterectomy (removal of the uterus). Now many gynecologists do not remove the ovaries.

Until you are firmly in menopause, that is, no periods for one year, you can still get pregnant. If you don't smoke, low dose oral contraceptives can be used right up to menopause. Hopefully your calendar will help you become more familiar with your symptoms. From here you can design a PMS / perimenopause - menopause treatment plan. The Menopause Experience

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