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The Peri-Menopause
DR CMC DEHAECK
The peri-menopause can be defined as the stage preceeding the menopause. There is no real definition of how long the peri-menopause exactly lasts, but it has its own difficulties to deal with. The menopause itself is usually identified in retrospect. From the day of the last period and 6 months without any periods usually accompanied with symptoms like hot flushes, insomnia, irritability, vaginal dryness and many more.
The peri-menopause is the stage when your hormones are winding down, fluctuating and then creating the false impression that one has approached the menopause.
So what exactly is going on in the body bringing about all the change?
Basically it is puberty in reverse. During puberty there is severe fluctuation in hormone levels, which are the FSH (Follicle Stimulating hormone) and LH (Luteinizing hormone) produced by the pituitary gland as well as the Oestrogen and Progesterone. Once this becomes more formalized there is a regular pattern which happens during the fertile years.
Towards the end of the fertile years theoretically the ovaries are more resistant to ovulation. There is also a fluctuation of Oestrogen and the FSH and LH start rising and dipping in response to this fluctuation. The symptoms of the peri-menopause are symptoms often not of low Oestrogen, but rather of high Oestrogen like breast tenderness, headaches, increased vaginal lubrication and then follows the occasional symptoms of low Oestrogen which are hot flushes, insomnia, fuzzy head, memory loss, and of course the unpredictability of what is going to happen to the menstrual cycle.
One could skip a month or even two, then suddenly have a haemorrhage. The cycle can become closer together, bleeding every three weeks even every 2 weeks or it can slowly stretch out to every 2,3,4 months less and less heavy. One can see why life in the peri-menopause is so unpredictable and is actually quite a difficult stage in a woman's life.
This explains why one cannot just do a blood test and say exactly where one is and the cycle, or how long it will be before the menopause. There is a paucity of literature and things to read on the peri-menopause, and therefore it is not surprising that most women, when they start feeling different think it is the menopause.
The peri-menopause on average can last from 3-6 years although it's unpredictable, and individual to each woman. Commonly what is happening is that women who are 40-50 years old, have known their body pretty well, but are suddenly confronted with a completely different scenario. There are a range of symptoms that can present and I will list but a few. If any of these symptoms pertain to you that means you are pretty normal, not going crazy, do not have a hormonal imbalance, but are just in the peri-menopause.
Even though one should not medicalize this, some of these symptoms can be so debilitating that medical management is indicated.
One has to be very careful as sometimes the blood levels that are being sent off can be in the menopausal range, and a 43 or 44 year old woman could be told that she is in the menopause. (This happened to my friend and to her horror at age 43 was told she was in the menopause, found out 4 months later that she actually was pregnant, so beware!)
Another problem around the peri-menopause and menopause is that at the same time one is also getting older and things are starting to change because of the middle age, so some of the mood swings, some of the depressions can be caused by other circumstantial situations. The body because of ageing and middle age also goes through physical changes, which are not really attributed to a hormonal situation. I tend to say to my patients when you are in the menopause you know what you are dealing with, when you in the peri-menopause you never know what the next day is going to bring!
Here is a list of some of most common peri-menopausal symptoms:
- Menstrual irregularity
- Hot flushes
- Occasional night sweats
- Vaginal dryness
- Insomnia
- Fuzzy sensation in the head
- Waking in the early hours of the morning
- Fluctuation in the sexual drive and sexual response
- Bloated feeling
- Chills or periods of extreme heat
- Indigestion
- Flatulence
- Rogue chin whiskers
- Overnight appearance of a long fine facial hair
- Periods of a rapid heart beat
- Crying for no reason
- Aching joints
- Frequent urination
- Light headedness
- Weight gain in unusual places
- Sudden and inappropriate burst of anger
- Panic attacks
- Anxiety
- Depression
- Migraines and disturbing memory lapses
As mentioned before during the peri-menopause these symptoms can intermittently happen with normal regular menstruation and feeling somewhat more normal for a couple of months. It can also fluctuate from day to day.
So while you are still having menstruation you go upstairs to get something, and by the time you get there you can't remember what, you look in the mirror you suddenly see these two hairs on your chin. You become so angry about it that you hit the wall and hurt your hand. On your way down you shout at your kids and then you burst out crying! Now you must know your are a pretty normal peri-menopausal woman.
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