A woman is officially “menopausal” when she has not had a menstrual period for 12 months. However, the “peri-menopausal era” is a very ill-defined time frame from about age 40 until a woman has had no periods for 12 months. What does peri-menopause mean? Sometimes when women have a bad day, co-workers tell them that they need help, husbands or partners tell them to call their doctor to see what’s wrong, or they yell at their children for no reason and then start crying, they think that they are going through “the change.” There are several stages of menopause/peri-menopause. The first stage starts around the age of 40, and is due to poor functioning of the ovaries; our estrogen and progesterone production decreases. That’s why it may be difficult to get pregnant after 40 years of age. The menstrual cycle stops being regular and can go from 21 to 40+ days. Instead of a normal menstrual flow, there can be the passage of large blood clots and/or bleeding through clothing. Emotional changes may occur such as anger, rage, crying, excessive worrying, or anxiety. This is generally not a great time for husbands or intimate partners. Women understand that if they have not had a baby by age 40, the chances of conceiving are fairly low. The bleeding can be horrendous at the beginning of peri-menopause. The second stage of menopause is the peri-menopause and also starts in the mid-forties. It results in even less ovarian estrogen function and a complete disruption of the estrogen and progesterone environment. A patient may have menstrual cycles every couple of months, and they can be intermixed with periods of very heavy bleeding and clotting. This is when hot flashes may start. Usually, they start at night (night flushes), and may cause you to wake up soaked and hot. Then you may promptly become freezing cold. The hot flashes may start happening during the day, and your scalp and head drip sweat at the most inopportune times. This stage ends 12 months after the last menstrual period (at which time you are officially menopausal).
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I have spent a lot of time on the phone recently with several patients trying to explain a new law that went into effect in Georgia on July 1, 2019 that requires mammography providers to tell their patients about their breast density.
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