What Is Perimenopause?

According to Stedman's Medical Dictionary, menopause is defined as the permanent cessation of the menses. This condition may be diagnosed in retrospect, when one year has passed since the last menses. Well thats pretty cut and dry and it's nice to know it was menopause you were going through last year.

But what can you do now? We know the average age of menopause is 51, but menopause starting at the age of 40 is considered normal. So what if you're having irritability, mood swings and irregular periods now and you're not 51? Can it be PMS? Is it premature menopause? Or is it the perimenopause? Can you still get pregnant? What are your treatment options? Do you need hormones or Prozac or just vitamin E? These are difficult questions and although there is a blood test for menopause (FSH), the test can only tell you if you are firmly in menopause. However, by the time the test is positive it's quite obvious that you are into menopause.

Perimenopause is defined as the transitional period from normal menstrual periods to no periods at all. The transition can, and usually does, take up to ten years. During the perimenopausal transition you may experience a combination of PMS and menopausal symptoms or no symptoms at all.

PMS on the other hand can occur at any age but is more common in your 30's and 40's. The diagnosis and treatment of PMS has been hampered by the fact that there has not been a reliable definition for the condition. The American Psychiatric Association created a condition called the Premenstrual Dysphoric Disorder (PDD) which should not be confused with their earlier creation, the Late Luteal Phase Disorder (LLPD). Physicians have always viewed women as more vulnerable to mental disorders than men and have attributed it to the instability of their reproductive systems. Premenstrual Dysphoric Disorder (PDD) consists of a well defined set of symptoms but out of the estimated 30-60% of women who experience PMS symptoms only 3-5% of women meet the standards for PDD. But what if you don't meet the criteria? Doctors don't like to hear these questions because there is no good, simple and reliable test. There are ways to figure it out, but many physicians and patients just don't want to take the time and effort. However, it is important to figure it out because the treatments are different. So where do you start?

You start with your past. The age your mother or older sisters began menopause can have a bearing on when you will begin menopause. If your mother went through menopause in her late 40's and you're 34 it is most likely PMS. If your mother suffered from PMS then you are more likely to suffer as well. However, your mother might not remember when she went through menopause and your older sister may not admit to it. The only other reliable factor is if you smoke. If you smoke, you can count on menopause starting 1-2 years earlier than if you don't. Pregnancies, birth control pills, your age when you first began menses or breast-feeding have no impact on the age of menopause. If you are on oral contraceptives or other hormones such as Depo-Provera or estrogen, these can have an effect on mood, irritability, hot flashes, depression and your periods. Women who can't tolerate birth control pills are more likely to develop PMS and have a difficult perimenopause. Adjusting the dose, brand or time you take these medications can sometimes relieve unwanted side effects. Some of the symptoms of depression are found in both PMS and perimenopause. Depression is not caused by menopause, but it can run in families. If feelings of depression, loss of appetite, insomnia, and general loss of interest or pleasure in life are at the top of your list you may be suffering from clinical depression. These feelings should be brought to the attention of your health care provider. Depression and PMS can occur together and it's not uncommon for anxiety or depressive disorders to worsen during the week before your period and at menopause. Sound confusing? Well, it can be. All of the above statements are generalizations but you have to remember that you are a unique individual.
After reviewing your family history for age of menopause and occurrence of PMS and depression, you should complete a symptom diary or calendar. This will be a unique record of your feelings on a daily basis. For three months keep track of your menses along with a daily record of your symptoms. Ideally, you should review your calendar with a health care provider but first there may be a lot you can learn on your own. There are two things you should look for. First look for patterns. In PMS you will generally see an increase in emotional symptoms beginning at mid cycle (around day 14). In the week before your period emotional symptoms will increase and physical symptoms may begin. In the last few days emotional symptoms will peak and then rapidly disappear after your menses start. There are variations of this pattern, but the key is symptoms that increase BEFORE and are relieved AFTER your period. Now that you have your symptoms calendar before you, look for depression that lasts most of the month. This could be a clue that you are depressed and need professional evaluation. If your menses are occurring sooner than 21 days it may be perimenopause or a more serious gynecological condition and you need to be evaluated by your health care provider. Menses occurring later than 45 days is more consistent with menopause or perimenopause. If physical symptoms predominate, especially hot flashes, vaginal dryness and night sweats, and if they last throughout the month unrelated to menses think more about menopause. Remember menopause before the age of 40 is called premature menopause and is rare. However perimenopause can begin before age 40. Surgical removal of the ovaries is the most common cause of premature menopause. Hopefully you know if your ovaries have been removed, but you may not. Years ago doctors routinely removed ovaries in women undergoing a hysterectomy (removal of the uterus). Now many gynecologists do not remove the ovaries.
Until you are firmly in menopause, that is, no periods for one year, you can still get pregnant. If you don't smoke, low dose oral contraceptives can be used right up to menopause. Hopefully your calendar will help you become more familiar with your symptoms. From here you can design a PMS / perimenopause / menopause treatment plan. Future articles in this series will address treatments, including the new prescription drugs SRI's, vitamin and mineral supplements, exercise, relaxation techniques, stress management, and nutrition. THE FOLLOWING HERBS AND VITAMINS MAY BE USEFUL IN PMS PERIMENOPAUSE AND MENOPAUSE. EVENING PRIMROSE (oenothera biennis) Other Names: Primrose Oil General Description: Common in North America where it can be seen growing along road sides. It's a biennial herb. Parts Used: Leaves, stem, flowers and especially the seed oil. Active Ingredients: (GLA) Gammalinolenic acid and Linoleic acid Traditional Uses: Evening Primrose seeds were gathered by Native Americans for food. Current Status: The seed oil is a good source of GLA, an essential fatty acid. An essential fatty acid is a nutrient that the body can't make but is essential to good health. Evening Primrose Oil has been used for premenstrual syndrome ( PMS ) and mastalgia ( sore breasts ) Studies to date have been conflicting, some show a significant reduction in breast pain, while others fail to confirm this.
Precautions: No known contraindications or drug interactions reported. FLAX SEED OIL ( Linum usitatissimum) Other Names: Linseed oil. General Description: A perennial herb growing to 3 ft. with oily brown seeds, native to Europe and Asia. Parts Used: Seeds and seed oil. Active Ingredients: fatty acids, Palmitic, Steric, Oleic, Linoleic and Linolenic. Traditional Uses: In the Middle East Flax has been cultivated for at least 7,000 years. "What department is there to be found in active life in which linseed is not employed? Pliny ( A.D. 23-79 ). Current Status: Flax seed oil is a good source of essential fatty acids. Essential fatty acids must be taken in the diet as the body can not make them. Flax seed oil is rich in (GLA) gamma Linolenic acid used by many for PMS and breast tenderness. Precautions: No reports of toxicity, when used at recommended doses. Vitamin E (d-alpha tocopherol) Food Sources: Polyunsaturated vegetable oil, seeds and nuts. Adult Female ( RDA ): 12 International Units (IU). Types Available: In natural vitamin E the small d in d-alpha tocopherol signifies a natural source which is preferable to synthetic vitamin E signified by the dl in dl-alpha tocopherol. Mixed tocopherols contain d-alpha, beta, delta and gamma tocopherols. Mixed tocopherols offer the greatest benefit. Look for natural mixed tocopherols.
Beneficial Effects: Vitamin E is an antioxidant. Can it prevent hot flashes? There were studies done in the late 1940's showing it to relieve hot flashes and postmenopausal vaginal dryness. More recent studies are lacking. There are other benefits. We know from the Nurses Health Study that women who took vitamin E over a two-year period reduced their risk of fatal heart attacks by 40%. Vitamin E is also being studied for its effect on Alzheimer's disease and cancer. Combining vitamin E with other anti oxidants such as selenium, chromium, beta-carotene, and vitamin C may offer a synergistic effect. That means they work better together than separate. Dosage: 400-1200 IU a day. Precautions: Vitamin E potentiate (cause a greater effect) of anticoagulant drugs such as Coumadin or aspirin. If you are on either of these drugs consult your doctor before starting vitamin E. Vitamin B6 (pyridoxine) Food Sources: whole grains, bananas, potatoes, nuts and seeds, cauliflower. Adult Female ( RDA ): 1.6mg. Types Available: pyridoxine hydrochloride. Beneficial Effects: Pyridoxine is involved in the production of brain hormones (neurotransmitters). More than 50 chemical processes in the body are dependent on pyridoxine. Vitamin B6 levels can be low in depression or in women taking estrogen, in the form of birth control pills or hormone replacement therapy. Pyridoxine, folic acid and vitamin B6 deficiencies have been associated with osteoporosis in postmenopausal women. At least 10 studies have been done on the use of pyridoxine for PMS. Most studies have shown improvement of PMS symptoms with pyridoxine supplementation. Vitamin B6 has now been associated with a decrease in the incidence of heart disease in women see Menopause-Update February 3, 1998 for more information. Dosage: 50mg. Precautions: safe when taken in recommended doses.
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