Perimenopause: The Myths and the Facts

Menopause is not an overnight event. It transpires over months and years.

"It takes about 12 years from the time a girl is born until her hormonal system is fully operational. So it's no wonder that it takes about a decade for the system to shut down," says Dr. Michele Curtis.

As a board-certified obstetrician/gynecologist at The University of Texas Medical School at Houston with experience caring for women and speaking nationally on women's health, Dr. Curtis is eager to refute the many misconceptions associated with menopause.

The first is the meaning of "menopause." As Dr. Curtis notes, diagnosis of menopause can appropriately be made only after the fact, since it entails the absence of spontaneous menstrual flow for one full year. The period before that, when a woman's hormonal system is in the process of shutting down, is rightly called "perimenopause." Once that process is complete, a woman can be called menopausal or postmenopausal - the two terms are synonymous.

The symptoms that are reported by perimenopausal women vary widely. Many women notice that whatever premenstrual symptoms they've had in the past are heightened during perimenopause. Some continue to have regular periods but feel hot flashes. Others have heavy periods followed by light ones - or no periods for months followed by a very heavy one.

"The fluctuations that women experience in their menstrual cycles is clear indication that their ovaries are heading toward retirement," says Dr. Curtis. "Many women think that if they are normal, their periods will just gradually taper off, but `normal' isn't nearly so standardized or predictable."

Some women may undervalue the importance of knowing they're perimenopausal. "Perimenopausal, menopausal, or post-menopausal - just tell me when it's over," they might say.

But the reason it's important to know, is that once a woman enters perimenopause, her health risks change and she needs to take steps for her continued health.

"With hormonal changes come increased risk of heart disease, the number one killer of postmenopausal women," explains Dr. Curtis. "So women need to learn about the changes taking place in their bodies, get needed screenings, and take preventive actions."

What are these preventive actions?

Definitely, a first mammogram by age 40, followed by mammograms every two years until age 50 and every year after age 50. Definitely a first rectal exam at age 40, followed by annual exams forever. And certainly a colonoscopy by age 50, and afterwards every three years. In addition, and especially if there's a family history of osteoporosis, a woman needs to discuss with her doctor whether she needs bone density screening.

"Perimenopausal women need to have any symptoms that are bothering them addressed," urges Dr. Curtis. "Irregular periods and hot flashes can be handled in two ways - with low-dose birth control pills or through hormone therapy."

Hormone replacement therapy? That's clearly worth evaluating.

Dr. Curtis says one more myth about hormone therapy needs to be dispelled. Many women think they need to choose "once and for all" what to do, but in fact they can make a decision year by year. However, Dr. Curtis says, women who are absolutely not candidates for hormone replacement therapy include those with undiagnosed abnormal bleeding, suspected uterine or breast malignancy, active gallbladder disease, recent heart attack or diagnosed cardiovascular disease, or history of a clot in a deep vein.

For women with a history of cardiac disease, a careful analysis and discussion of the risks and benefits needs to be done. Women with no gallbladder because they had surgery can have the therapy if they choose.

"A woman with a history of breast cancer will need to discuss what's known, and not known, about the risks and benefits of hormone replacement therapy with her gynecologist and oncologist," says Dr. Curtis. "Ultimately, she will need to decide, as we have no definite answers for this category of women - yet."

Finally, don't be misled into thinking that what you heard from your doctor at your last appointment is the "final word." Medical science is learning a great deal very swiftly in the field of menopause, so it's wise to ask, "What's new?" at every year's well-woman exam.

- Courtesy of The University of Texas Health Leader webzine (http://www.healthleader.uthouston.edu)

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©2006 Texas Medical Center

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