WOMEN’S HEALTH
Dr. Sally Sange
During perimenopause, a woman makes peace, or not, with a new hormonal milieu.
EXPLAINING TO MY linguistically fastidious friend about the perimenopause, I realized why so many conceive of “menopause” as something that comes to an end, a stage before and after which the “perimenopause” might reasonably be expected to occur.
Menopause, by definition, arrives on the day of a woman’s final episode of vaginal bleeding and never goes away. That woman is forever in menopause. So the perimenopause describes the hormonally turbulent years leading up to that event, the last hurrah of fertile womanhood. “Women of a certain age seem to do nothing but complain about the temperature. I have a friend at work whose wife is in menopause, and her personality changes are more than he can handle. He just seems to be holding his breath until she gets through it.”
“But she is never through it,” I explain again, and begin to get the sense that I’m the one—though I long ago passed the mark—out of touch with what “menopause” means in the sitcom culture we inhabit. “She wraps it around herself,” I say, “and gets on with it, conducts the rest of her life in its embrace.”
Yin Meets Yang
Squarely on the other side, I muse on menopause, a place where yin meets yang and women incorporate a new (more masculine?) force into their lives. No wonder a man could be frightened by its power. And no wonder many of us, male and female alike, discover (if we look) big holes in our understanding of what, for a woman of 45, 46, 47, is normal.
During the perimenopause, a woman makes peace, or not, with a new hormonal milieu. Physical changes result, most obvious of which is adjustment in the intervals, duration, and flow of menstruation. A period may be skipped; that’s normal. Breasts could be tender; that makes sense to one who knows the science behind the change. But extremely heavy bleeding, bleeding between periods, whole cycles that start and finish in less than three weeks, or bleeding that lasts for days on end are all off the grid and cause for an unhurried call to your gynecologist.
Easy to Measure, Hard to Pin Down
In my practice, some of those calls are queries into the value of hormone testing. Surprisingly, such tests are of no help. Mercurial hormones like estrogen are easy to measure but hard to pin down. This morning’s level doesn’t shed much light on the reason you bled last week like a stuck pig. An understanding of the reproductive organs comes from looking at them (usually through the lens of ultrasonography) and sampling cells from inside the uterus.
WOMEN MAY HAVE different signs or symptoms at menopause. That’s because estrogen is used by many parts of your body. So, changes in how much estrogen you have can cause assorted symptoms. But, that doesn’t mean you will have all, or even most, of them. In fact, some of the signs that happen around the time of menopause may really be a result of growing older, not changes in estrogen.
If you harbor no abnormal cells, no atypical ovarian cysts, and the shaking up of the bleeding pattern is solely due to hormones, your new best friend may be—hold on to your hat–a low dose oral contraceptive you can take all the way to menopause. Maybe the same pill your daughter takes.
There are exceptions: Smoking while taking birth control pills past age 35 is a veiled request for a stroke or heart attack. Better to suffer hot flashes, mood swings, and lack of restorative sleep. But, if you are healthy, a low dose pill will regulate your cycles, possibly even saving you from going under the knife. While it brings back predictability in bleeding, mood, and sleep, it also keeps you from losing bone. Taken over a period of several years, it guards against cancers of the ovaries and the uterus.
I’ve heard perimenopausal women say The Pill seems better suited for younger women. Why not start grownup hormone replacement pills if hormones are what is needed? But estrogen and progesterones, in the doses given to menopausal women, are not helpful during the perimenopause and may even aggravate unpredictable bleeding. They aren’t strong enough to stop ovulation, and they certainly don’t protect against a pregnancy.
Less Likely to Conceive
During perimenopause, you are less likely to conceive because you ovulate erratically. But it isn’t as if your eggs are all used up. And men, ever intelligently designed, persist in making sperm long after retirement. While new parenthood may be just the thing for certain couples entering their fifties, a number of us are ready for a break. Unintended pregnancy in perimenopause is second in frequency only to unplanned pregnancy in adolescence.
I would never push a birth control pill on a woman simply to smooth things out. You can expect a little turmoil as powerful change takes place. But the safety of using the pill right up to the onset of menopause is tried, and the benefits for women at risk for certain female cancers are true. If perimenopausal symptoms become truly disruptive, why not give it a shot?
As for the peanut gallery, they will take their cue from you. When you find peace inside your transition, they have little to complain about. When you assure them there’s continuity between the former you and the better menopausal you, they admire your fortitude. For the record, even the less fair sex are said to pass through a “viropause,” with the occasional mood winsomely described as “grumpy.”
Sally Sange, M.D. has been practicing medicine in Brevard County, Florida for 25 years. Dr. Sange received her M.D. from Georgetown University and is a Fellow of the American College of Obstetricians and Gynecologists. She is Board Certified in Obstetrics & Gynecology and was the Chief of Medicine at Cape Canaveral Hospital, 1998-99. For more information log on to DrSange.com
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