One of the trickiest times for woman is perimenopause.  This stage of life means that ovaries are starting to fail, but not to the point that the woman has a cessation of her menstrual cycles.  As long as the ovaries respond enough to produce an egg monthly, a menstrual cycle will occur.  This period of time is the stage between healthy normal ovarian function and menopause.  It is an important stage because even though it looks as if everything is normal, it is not.  The decrease in estrogen production can cause marked symptoms in women.  The following may occur in perimenopause:

Fatigue

Anxiety

Sleep disorders

Temperature intolerance

Difficulty with memory

Lack of motivation

Other changes may also be occurring, that are not obvious.  These may include:

Bone loss

Raising cholesterol and LDL

Increased blood pressure

When the ovaries start to fail, the production of estrogen can be like a car running out of gas; it surges and drops, back and forth.  Laboratory tests may look great one day, and terrible the next, so diagnosis can be challenging.  Perhaps the most important information is that represented by how the patient feels.

Some practitioners mistakenly give patients progesterone for perimenopause.  If the patient is skipping ovulation, progesterone may help calm anxiety, and may also help with sleep.  About 85% of swallowed progesterone is converted to sedative substances.  It is also, unfortunately, responsible for extra breast stimulation and enlargement, weight gain, constipation, bloating and headaches.  If the woman is ovulating, the resultant release of the egg will stimulate the production of progesterone.  No additional need be added.  The PMS symptoms that drive some women, and their partners crazy, are from progesterone.  In this part of the menstrual cycle, progesterone is high for 14 days before menses until two days before, when the supply of progesterone runs out and there is a sudden crash of little available progesterone and menses occur two days later.  Estrogen, during this time, has peaked midcycle and is decreasing, to some of the lowest levels, especially one week prior to menses.

It is true that progesterone can “prime” estrogen receptors so that the decreased amount of estrogen will be responded to more efficiently, so it may seem that progesterone is helping.  The effects are temporary and usually do not last beyond 6 months.

What helps woman who are noting symptoms in perimenopause is a smaller, supportive dose of estrogen.  Usually within a few days, the distressed woman feels better; less anxious, more energy, and a more positive attitude towards life.

Women in perimenopause deserve to be treated if tools are available to help them feel better, happier, and increase the quality of their life.