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What Is Peri-Menopause (the Menopause Transition)?


Peri-menopause refers to the period of time when menstrual cycle and hormone changes occur in a woman who still has her ovaries.  Because of the now variable release of estrogen from the ovaries, the length of the menstrual cycle will start to change.  The temperature regulation system in our bodies is somehow tied to this and women may start to experience hot flashes or night flushes. 

I like to explain this to my patients as “puberty in reverse.”  Let me explain it this way.  When girls go through puberty, the hormonal changes start at around age 8.  Prior to this change in hormones, we refer to the child as “pre-pubertal.”  The child doesn’t look any different, but the hormones are increasing constantly.  It takes many years of hormonal stimulation to change the way the girl looks.  These physical characteristics may not start until around the age of 11 to 12 with the onset of menses on average at age 13 or 14.  The onset of the menstrual cycle does not end “puberty.”  The hormonal changes continue until the age of 18 or 20 as observed by the changes in the hips, breasts, and the overall figure of a young woman.  During these later teenage years, the body changes, but the hormones regulate the menstrual period to a predictable interval and duration.  The acne changes and mood swings of puberty normalize because of this hormone stabilization. 

We then have about 15 years of relative hormonal stability.  These 15 years, from age 20 to 35, are the time of optimal ovarian hormone function.  It is the easiest time to conceive a child. 

Then, around age 35 to 40, women instinctively know that their chance to have a baby is dwindling.  Women going through infertility treatments understand that this is the age that your ovaries are not functioning as well as they should and, if you were to get pregnant, you are considered to be of “advanced maternal age.”  The ovaries don’t function in the perfect hormonal harmony that they did for the last 15 years. Now, slowly over the next 15 years, they start to fail. 

A woman may not realize it at the time, but the same things start to happen that they did during puberty. Acne may return with a vengeance.  Even women who did not have a tough time with acne as a teenager may find herself with a terrible case that needs prescribed medication.  I have more women in their 40’s on Accutane than those in their teens. 

They can’t control their emotions:  they are happy one minute and then burst into tears for apparently no reason.  They may have been having a normal conversation, and then explode in a burst of rage…then they cry because they were so mean to someone they love.  Menstrual cycles tend to get very erratic and heavy with the passage of large clots.  This may also come with severe menstrual cramps and worsening PMS.  The menses may start to space out and be several months apart. 

The peri-menopause or the menopausal transition is over when you have not had a menstrual period in 12 months.  Menopause is the term we use to describe the time in your life when you have not had a period in 12 months. You are now “post-menopausal” and will be post-menopausal for the rest of your life.