Physical signs of menopause may begin several years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning “around menopause”). It can last 6 years or more. Menopause, by definition, is the final menstrual period, which can be confirmed after going 12 consecutive months without a period.
Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen and progesterone. During this transition, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can be even higher than during the reproductive years. Common changes during perimenopause include:
· Irregular menstrual periods
· Hot flashes
· Sleep disturbances
· Mood swings
· Low libido (sex drive) and/or vaginal dryness.
During perimenopause, a woman may still be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause (one year past the last menses!) is reached.
Step Two: Go Through Perimenopause
When a woman suspects she is experiencing perimenopause, it is an excellent time to have a complete medical examination by a qualified health professional. The diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms.
At present there is no commercially available test to predict when menopause will occur. However, there is interesting ongoing research on Anti-Mullerian Hormone (AMH) that has been shown to have some promise for estimating the timing of menopause. Commercial salivary testing for estrogen has not proven accurate or reliable, and desired levels of hormones in postmenopausal women have not been established.
What about testing for follicle-stimulating hormone (FSH)? Sometimes, elevated FSH levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries’ production of estrogen declines, the pituitary gland releases more FSH into the blood to try to stimulate estrogen production. When a woman’s FSH level is consistently elevated and she is no longer having menstrual periods, it is generally accepted that she has reached menopause. However, a single test can be misleading because estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid.
Step Three: Stay Healthy During Postmenopause
Check the calendar, check for signs and symptoms and discuss with your healthcare provider how to stay healthy for the rest of your life. Visit The North American Menopause Society for ongoing information and guidance about perimenopause, postmenopause and healthy aging.
Welcome to the club!