Premenopausal Syndrome: What's It All About?

Any condition described by the word "syndrome" can sound alarming. Syndrome simply refers to a collection of experiences and changes that often occur together. But premenopausal syndrome is nothing to fear; it's a perfectly normal phase of a woman's life signifying the beginning of menopause . The syndrome can cause hot flashes, night sweats, and inconsistent menstruation. Premenopausal syndrome may begin a few years before menopause actually occurs.

"There are much better things to call it than a syndrome," says Ann M. Voda, RN, PhD, the past president of the North American Menopause Society. "Women get confused when they hear that, because they think it's something that needs to be cured. It's not. It's all part of the transition in a woman as she gets older."

Changes: Physical and Emotional

Menopause itself is defined as the cessation of the menstrual cycle for 12 months, and it usually occurs around age 50. Perimenopause brings with it a host of well-known effects, including irregular periods, hot flashes, vaginal dryness, sleep interruption, and irritability.

In addition, women going through the menopausal years are at risk for conditions such as osteoporosis and various forms of heart disease .

And if all this weren't enough, the onset of menopause comes at a time in many women's lives when they already have enough to worry aboutelderly parents who may need special care, children leaving home, a marriage or relationship that is approaching a critical stage, and a job that may be making increasing demands. Who needs to go through a rite of passage when they have all this other aggravation? In an attempt to treat the side effects and to deal with the links between menopause and its physical and emotional symptoms, healthcare professionals came up with the term "premenopausal syndrome." The first menopausal effects occur when the ovaries stop producing eggs, a process that is as natural a part of aging as gray hair and wrinkles. This failure to produce eggs, say doctors, triggers menopause's side effects. These effects can be traced to a lack of estrogen and progesterone. Without eggs, the body doesn't produce enough of these two crucial hormones. Oral contraceptives are often the treatment of choice to relieve premenopausal symptoms. They provide contraception if needed and foremost eliminate or reduce hot flashes, vaginal dryness, and premenstrual syndrome. As one progresses from perimenopausal period to menopause, oral contraceptives can be substituted with estrogen replacement therapy that attempts to replace the lacking hormones.
Estrogen Treatment and Its Effects Hormone replacement therapy (HRT, which often includes estrogen and progesterone), in the form of pills or a patch has been in use for much of the last three decades. This is, however, a course that has elicited a number of concerns, with a fair amount of tussling between the pro- and anti-HRT camps. Their debate is centered around health risks associated with taking HRT. Recent results from the Women's Health Initiative (WHI) and other large studies in the five-year study suggested that estrogen plus progesterone therapy significantly increased the risk of breast cancer, heart disease, stroke , and blood clots in postmenopausal women. Because of these findings, the estrogen plus progesterone portion of the WHI was stopped early. The portion of the WHI investigating the benefits and risks of taking estrogen alone found less risks, but no overall benefit. Most health professionals agree that women who are going through the menopausal years should keep a number of factors in mind when considering HRT: How bad is bad? Taking HRT to relieve severe hot flashes, night sweats, and the like is one thing. But as many as three-quarters of menopausal women, says Dr. Johnson, don't experience severe side effects. In their case, taking estrogen to relieve a little discomfort may be too much of a good thing. Risks vs. benefits. The WHI showed that HRT decreased the risk of developing colorectal cancer and having fractures in postmenopausal women. On the other hand, the risks of developing breast cancer, heart disease, stroke, and osteoporosis significantly increased with HRT. Overall, the risks outweighed the benefits for long-term HRT use. There is still a role for HRT for the short-term relief of menopausal symptoms. Family history . Women whose mother or sister developed breast cancer at an early age must pay more attention to possible HRT links than women without a family history of breast cancer, or who had a close female relative develop the cancer late in life.
HRT is not the only possibility for dealing with the repercussions of menopause , although even its most ardent foes agree that it's the most efficient method. Equally important, a woman must maintain perspective in the face of all these changes. It's not a far stretch to say that menopause is as normal for women of 50 as puberty is for teenagers," says Dr. Johnson. "Just like puberty, it isn't to be feared. It's just a normal biological process." RESOURCES: Menopausal Hormone Therapy InformationNational Institutes of Health http://www.nih.gov The North American Menopause Society http://www.menopause.org References: Writing Group for the Womens Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the womens health initiative randomized controlled trial. JAMA . 2002;288:321-333. Last reviewed July 2006 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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