Feature Archive

The Change Before 'The Change'

Hot Flashes, Infertility, Happen Earlier Than You'd Expect

By Jeanie Lerche Davis
WebMD Feature

Reviewed By Charlotte Grayson

Mom put up with hot flashes and night sweats. We used to think they meant menopause. Well, guess again. Many women experience these symptoms in their 40s, even 30s.

"Everybody used to think 'this can't be happening to me, I'm still menstruating,'" says Laura Corio, MD. "Doctors were saying to patients, 'I can't do anything for you, you're still having your period.'"

It's a transitional time of life called perimenopause, and as early as age 35, women can begin feeling the symptoms, says Corio, a gynecologist and instructor at Mount Sinai Medical Center in New York. She is author of the book, The Change Before the Change.

"I empathize with my patients," Corio tells WebMD. "It's not fun."

Every woman's tale is different, she says. "Some will sail right through it without anything, others might have every symptom in the book -- irregular periods, hot flashes, vaginal dryness, mood swings, fatigue, heart palpitations, decreased libido."

Despite the numbers of women hitting their perimenopausal years, a lot of doctors still have their heads in the sand when it comes to recognizing and treating symptoms, says Corio. "It's a fallacy that nothing can be done."

Used to be, doctors said the same thing about cramps, adds Elizabeth McGee, MD, assistant professor of obstetrics, gynecology, and reproductive sciences at Magee-Womens Hospital in Pittsburgh.

"It wasn't that long ago that doctors told women they didn't have cramps, that it was all in their heads," McGee tells WebMD. "Now we know cramps do exist, that the pain is real, and we have very effective treatments for it. It's the same thing with perimenopause."

There's another reason why women need to know about all this, says Corio. Your chances of becoming pregnant dwindle after age 24. "I see it so often, 35-year-olds and 37-year-olds, and the egg quality is just not there," she tells WebMD. "They're in perimenopause and they don't even know it."

It's All About Estrogen

Recognizing perimenopause isn't easy for doctors: "Patients will complain of hot flashes, but hormone levels will be normal, so the patient isn't really taken seriously," says Bill Meyer, MD, associate professor of obstetrics and gynecology and a reproductive endocrinologist at the University of North Carolina Hospital in Chapel Hill.

It's not all in your head, he says. "We know that these symptoms do occur," Meyer tells WebMD. "There are some huge and wide fluctuations in estrogen levels that cause these symptoms -- the irregular uterine bleeding, vaginal dryness."

Wild-flying estrogen levels also wreak havoc on your mood. "When estrogen levels are high, more mood-elevating chemicals -- like serotonin, dopamine, norepinephrine, and opiates -- are free to circulate in your bloodstream," writes Corio. "Low levels of these chemicals cause depression."

However, perimenopausal mood swings are often mistaken for depression, says Corio. "A woman suffering insomnia, fatigue, weight gain, problems in concentrating, and loss of interest in sex might be diagnosed as mildly depressive whereas she's in perimenopause."

In other cases, low estrogen levels can make existing depression worse, adds Meyer. Thyroid problems may cause depression-like symptoms as well as irregular bleeding.

That's why it's important that your doctor look at the big picture -- testing your hormone levels rather than just handing you a prescription for an antidepressant, says Corio. Estrogen could help your antidepressants work better, adds McGee.

Taking Stock of Life, Lifestyle

As her estrogen declines, the 40ish woman is at increasingly higher risk of certain health disorders. Her bones, reproductive organs, breasts, and heart all become vulnerable.

"During this period, bones start changing because you're losing estrogen and progesterone," Corio tells WebMD. "Dwindling estrogen puts women at higher risk for uterine cancer, breast cancer, ovarian cancer, heart disease, diabetes."

It's a time to consider your lifestyle -- and your level of stress, says McGee. "Perimenopause is a time of life, not a condition, something to be diagnosed," she tells WebMD. "Women are going through a lot of changes, and some of those are society pressures -- they have parents, grandparents to take care of. Women in their 40s and 50s have a lot of stress."

If you have symptoms, talk to your doctor, someone who takes you seriously, who is sympathetic, says Meyer. "Go to another doctor if that's not happening."

You don't have to put up with the symptoms, says Corio. "There's no need to be a martyr," she writes. "Practically every week new studies are showing that simply incorporating particular vitamins, minerals, herbs, and foods into your diet and making certainly lifestyle adjustments can counter many of the annoying, uncomfortable, and sometimes painful effects of perimenopause."

There are also numerous synthetic and natural "bioidentical" estrogen products to help stabilize your hormone levels, including mini pills and patches, she adds.

For heaven's sake, take control of your weight, says Corio. "I don't believe HRT causes breast cancer. There are many reasons why it occurs, but I think weight is one big reason. Women need to get their weight under control -- and the younger they start, the better."

Other good advice: Get your cholesterol level checked, get on a healthy diet, stop smoking, start taking a multivitamin, get regular exercise -- "good, common-sense things," says McGee. "It's a matter of learning to take care of yourself."

"Women are living longer than ever before," McGee tells WebMD. "Now, when you reach 40, it really is midlife. Women live one-third or more of their lives after menopause. We have to take care of our bodies so they last that long."

Originally published May 13, 2002.

Medically updated Feb. 24, 2003.

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Last Editorial Review: 1/31/2005 1:12:38 AM



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