Peri-menopause is the time leading up to your last period. It usually starts for women in their mid-40s and lasts, on average, four years, but 8-10 years is not uncommon. One year after a women's final period, she is considered to be menopausal. During peri-menopause, sex hormone (estrogen and progesterone) levels change erratically, resulting in hot flashes, brain fog, trouble sleeping, mood changes, and vaginal dryness and pain. Periods become irregular because ovulation does not happen every month. Because hormone levels are fluctuating instead of following a predictable course, periods may be heavier or lighter, shorter or longer, and happen more frequently or less frequently.
Doctors typically do not test for peri-menopause because it is difficult to get reliable results when hormone levels are fluctuating so dramatically. Additionally, hormone tests are expensive, and diagnosis and treatment are based on symptoms not a test result. The exception is for women under 40 experiencing symptoms of peri-menopause. Doctors sometimes test those women for follicle stimulating hormone (FSH), which is a hormone produced in the pituitary gland that prompts eggs to grow and be released from the ovaries (ovulation). When eggs are not being released normally, FSH rises in an attempt to compensate. The rule of thumb is that women with FSH levels greater than 30mlU/ml and no period for one year are in menopause. The FDA also has approved tests for anti-Mullerian hormone (AMH), a hormone produced by the ovaries, as a determinant for menopausal status. According to the American College of Obstetricians and Gynecologists (ACOG), the production of AMH is reflective of a woman's ovarian reserve. Studies have shown that women with AMH levels less than 10pg/ml likely will have their final period within one year. In summary, hormone testing is rarely necessary or useful to diagnose or treat peri-menopause, and if you doctor says it is and you're over 40, you should get a second opinion.
Although ovulation occurs irregularly during peri-menopause, it remains possible to get pregnant. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Once you are fully into menopause and can no longer get pregnant, you can still get a sexually transmitted infection (STI) so you should use barrier protection (condoms and dental dams) for vaginal, oral, and anal sex unless you are in a monogamous relationship. In fact, the vaginal dryness and irritation of peri-menopause and menopause may put you at higher risk for an STI since you are more likely to experience small cuts and tears during sex.
Symptoms of peri-menopause can be uncomfortable and, in some cases, life-altering. But there are treatments for many of the symptoms, and more research is being done every day to develop new therapies. Before deciding on a treatment, talk with your doctor about your options and the risks and benefits involved. She may recommend hormone therapy, vaginal estrogen, anti-depressants, or other drugs. She also may suggest interventions like acupuncture, laser treatments, or psychotherapy, as well as lifestyle changes such as exercise, nutrition, stress reduction, and better sleep hygiene. Review your options yearly with your doctor since your needs and available treatment options may change.
If you have symptoms that interfere with your life or well-being, such as hot flashes, mood swings, or changes in sexual function, make an appointment to talk to your doctor. If you have unusually heavy vaginal bleeding or thoughts of harming yourself or others, see your doctor immediately.
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