Perimenopause (cont.)

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What is perimenopause?

Perimenopause refers to the time period that begins when the ovaries begin to decline in function and continues until menopause (defined as the total cessation of menstrual flow for one calendar year) has been reached. Perimenopause has been called the "change of life" or "transition period." It usually begins in the 40s, but may start as early as the late 30s. During this time, a woman may exhibit a number of symptoms that are largely due to abnormal hormonal fluctuations.

Perimenopause has the potential to become a difficult period in a woman's life, as the ovaries begin to become depleted in eggs and produce hormones in reduced amounts. It is important that each woman attempt to understand the alterations that her body is undergoing and attempt to proactively manage these physiological changes. Moreover, she should not attempt hide her feelings and symptoms from others involved in her life, as this may lead to misunderstanding and frustration. Professional help is available, and new products and technologies are constantly being developed to assist with the symptoms of perimenopause that may develop. With appropriate dialogue between a woman and her health-care professional, most women can navigate this potentially difficult period of her life.

1. Irregular vaginal bleeding or menses

The ovaries are responsible for the production of the hormone estrogen in a reproducible pattern. As the ovaries become deficient in eggs (ova), the production of estrogen becomes less regulated. Estrogen is the hormone that, when produced in the normal sequence and concentration, results in the orderly shedding of the uterine lining. If the estrogen production is not regular, the uterine lining or endometrium may be shed off in small amounts, resulting in irregular vaginal spotting. The time interval between ovulatory events may lengthen. During that longer interval the endometrium continues to grow and may become quite thick. When the ovary finally releases another egg and subsequent shedding of a thickened uterine lining occurs, the menstrual flow may be extremely heavy and associated with severe cramps.

2. Hot flashes or flushes

Hot flashes are episodic sensations of heat rising over the neck and facial areas of a woman's body, followed by profuse sweating. They can be extremely disturbing and may result in difficulties with concentration. Hot flashes are thought to be due to transient dilation of the blood vessels near the surface of the body due to estrogen deficiency. They frequently persist for years after menstruation has ceased (i.e. a woman has experienced menopause).

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