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Please know that our general columns cannot take the place of a visit to a qualified professional who can determine your exact situation and needs.
Archived Questions and Answers from
Debra L. Hill-Busselle, MD
On Women's Health Issues
Questions & Answers
Dear Dr. Deb,
I’ve been having hot flashes and night sweats. My cycles are changing, I don’t sleep as well as I used to and I can be pretty moody at times. I am 46 years old and think I am too young to be in menopause. My friend, who is 39 years old, just stopped taking birth control pills three months ago. She is having hot flashes daily and has not had a period yet. She told me her mom went through menopause in her early 40s. Is she in menopause? Am I? ~Confused
Dear Confused,
Let’s start by defining menopause. Menopause is actually the 13th month without menstruation, so the determination can only be made in hindsight after no menses for a year. The average age is 50-52 years.
The state called perimenopause begins 6-12 years before menopause. During this time, the ovaries begin to age and work less regularly. Periods can get closer together and heavier, or further apart and lighter. Women can skip months, then start having monthly menses again. “Expect the unexpected” during the perimenopause. This is a time when the abnormal or the unexpected can be normal!
We used to think that the perimenopause was a time of a gradual decrease in the level of hormones, primarily estrogen and progesterone. We now know that it is a time of drastic hormone fluctuations. You may ovulate (release an egg) some months and your ovary will make both estrogen and progesterone. In other months, you won’t ovulate and the ovary makes only estrogen. Some months you have fairly high levels of estrogen and progesterone and other months lower levels.
If adolescence is climbing a staircase, perimenopause is descending the same stairs. No wonder you can feel so out of sorts!
There is no specific blood test that can tell a woman that she is definitely in menopause. Often, doctors check levels of two hormones (FSH and LH). If both are greater than 40, there is a good likelihood you are in perimenopause. Hormone levels can also vary from month to month, though, so they cannot be used to tell when your periods are going to stop. You need to go a year without a period AND have elevated FSH and LH levels to be considered menopausal.
If your mother went through menopause before age 50-52 years, there is a good chance you too will have an earlier-than-average menopause. Smoking also causes menopause to come earlier.
Treating Perimenopausal Symptoms
If your perimenopausal symptoms really bother you, the treatment of choice is a low-dose oral contraceptive pill. For some women this is the best way to control the hormonal fluctuations, irregular periods, heavy flow, hot flashes and other symptoms. The steady dose of estrogen and progesterone in the birth control pills controls the widely fluctuating ovarian hormone levels and supplies a steady dose of estrogen and progesterone on a daily basis. Your friend who began having perimenopausal symptoms when she stopped taking birth control pills might want to talk to her doctor about restarting her birth control pills or one of the other options listed below.
A healthy woman can safely take oral contraceptive pills until age 50- 55 years if she is of normal weight and does not smoke. However, many women should not take birth control pills. If you have hypertension, diabetes, migraines with aura, obesity, history of blood clots (deep venous thrombosis) or if you smoke, you should not take estrogen/progesterone birth control pills. Your doctor may be able to suggest a progesterone-only oral contraceptive or a lower dose of hormones (menopausal doses). If the doctor thinks your symptoms are due to an absence of ovulation and a lack of progesterone production, she may even prescribe a cyclic monthly dose of progesterone.
What other things can you do to control Perimenopausal symptoms?
Lifestyle modifications can help. Certain foods and beverages can trigger hot flashes, so experiment with avoiding spicy foods, hot beverages, alcohol, and caffeine. Certain medications, especially decongestants and some anti-depressants, can also trigger hot flashes. Stress can increase them, too.
Many studies have shown that regular exercise can decrease hot flashes, and some research suggests the herb Black Cohosh may also be beneficial. Studies have shown inconsistent results for soy, which may or may not decrease hot flashes.
One class of antidepressants–the SSRI’s (selective serotonin reuptake inhibitors)–has been shown to decrease hot flashes very effectively. Usually hot flashes can be reduced with a lower dose than is needed to treat depression. Relief from hot flashes is usually seen within 7-14 days.
To recap: 6-12 years before you stop menstruating is the PERIMENOPAUSE. During this time, menses become variable and symptoms can vary from month to month. Hot flashes, sleep disturbances, mood changes, and cycle irregularity are common. You are MENOPAUSAL once you have not had a period for 12 months.
There is no ‘one size fits all’ solution for the perimenopause. Notify your doctor if you experience heavy, abnormal or prolonged bleeding! And be sure to talk to your doctor about your options and to try some of the lifestyle modifications.
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