Dr. Sima Aidun is a Naturopathic Doctor offering holistic, natural, integrative care to women of all ages. Her Office is located in Scottsdale, Arizona. She also serves Gilbert, Mesa, Tempe, chandler, Cave Creek, Deer Valley, Care free, Fountain hills, and Phoenix area.

Perimenopause

At birth, a female infant has all the eggs she will ever have. (This is in contrast to males, who manufacture new sperm throughout life.) Each egg in the ovary is contained in a structure called a follicle. Female sex hormones, estrogen and progesterone, are produced by the cells of the follicle walls.

As ovulation (egg release) takes place on a monthly basis, follicles gradually diminish in number. This reduction begins to be noticeable after age thirty-five in a measurable decrease in average monthly hormone production. The reduction proceeds over about fifteen years to an eventual point at which not enough hormones are produces to cause menstrual periods; they cease entirely

Contrary to its perceived nature, the onset of menopause actually spans across many years of life. The process or life stage which heralds the onset of menopause is called perimenopause, which usually has its beginnings in the mid-thirties. The gradual reduction in estrogen availability which characterizes perimenopause, has an enormous influence on the body and the way it functions. For example, a woman forty years old may have difficulty becoming pregnant because the eggs her ovaries supply are also forty years old and may have lost some of their reproductive efficacy.

Perimenopausal changes in menstrual cycle can vary tremendously. Cycles may become longer or shorter or fall into a “no pattern” pattern. Menstrual bleeding may be heavier or lighter, more prolonged or shorter, or entirely absent. Variable and declining hormone production is the cause. During perimenopause women also experience:

1. Hot flashes (a sudden warm feeling with blushing)
2. Night sweats
3. Mood swings
4. Vaginal dryness
5. Fluctuations in sexual desire (libido)
6. Forgetfulness
7. Trouble sleeping and fatigue, probably from loss of sleep

Recognizing Perimenopause

Testing hormone levels: Until recently, doctors often tested women for follicle stimulating hormone (FSH) to determine whether their ovaries were producing enough estrogen. FSH testing was based on the knowledge that in menopausal women, the FSH level is high because of low production of estrogen. The pituitary gland is sending out high levels of FSH in an effort to get the failing ovaries to produce more estrogen. The problem with FSH testing in premenopausal women however, is that estrogen production may wax and wanes from one month to the next, therefore consistent results are not possible. For this reason, most doctors no longer rely on FSH blood levels to diagnose perimenopause.

Hormone trial: an option often advocated by leading experts in the field, is to do a clinical test: administer a trial dose of a hormone supplement. If the premenopausal symptoms are improved, then patient and doctor are on the right track. If not, other potential root causes, such as thyroid abnormalities, ovarian disease, or perhaps plain old stressful need to be investigated.

Personally, I prefer to have a complete a work up including female hormonal status as described above to root out the cause before moving on to formulating a proper treatment. A key hormone whose levels should be tested is estradiol, the main estrogen produced by the ovaries. Estradiol levels drop as the function of aging ovaries diminishes. Another hormone besides estrogen that I check is progesterone. A low progesterone level can be a another indication that ovulation has ceased.

The final diagnosis is made by putting together:

1. Physical and psychological symptoms
2. Menstrual cycle change pattern
3. Blood hormone levels

CAUTION! In cases where abnormal uterine bleeding is present, hormone treatment is not recommended unless it is clearly established that no uterine disease exists (see fibroid).