Menopause literally means cessation of menses or the stopping of periods. A woman’s menopause is an event , not a time period, and is defined as not having a period for a year. Actually, a woman reaches menopause a year prior to it being defined as such. The average age for menopause in American women is 51 and 95% of women will be menopausal between the ages of 40 & 58.

The perimenopause is really what most women think of as “going through the menopause” or “going through the change (of life).” It is defined as the period prior to menopause and the first year after menopause when endocrinologic, biologic, and chemical features of approaching menopause commence. The average age for onset of perimenopause is 47, and for most women it lasts approximately four years. Only about 10% of women cease menstruating abruptly and have no menstrual irregularity characteristic of the perimenopause .

During the perimenopause, the endocrinologic or hormonal changes are quite varied and can lead to many different clinical syndromes. The clinical presentations generally involve some, if not all, of the following:

• Irregular menses- less or more frequent, heavier or lighter, longer or shorter
• Mood changes
• Weight gain or changes in weight distribution
• Vasomotor syptoms - hot flashes, night sweats
• Sleep disturbance
• Vaginal dryness
• Urinary incontinence, frequency, & urgency
• Urinary tract infection
• Depression & anxiety
• Decreased cognitive function- memory, concentration
• Decreased libido
• Skin & hair changes

All of these symptoms, to some degree, are related to changes in hormone effect brought about by a gradual decline in ovarian function. Estrogen, progesterone and testosterone are the primary ovarian hormones, which are in various stages of decline, and the relative lack of these hormones brings about the symptoms above.

In essence the normal balance or interaction of ovarian hormones, which has existed for 20+ years, is disturbed. Generally speaking, in the perimenopause there is often a wide fluctuation in estrogen levels-sometimes low, often high or normal; the point is that there is frequent change as opposed to more stable levels. Progesterone is usually low, and this is belioeved by some to be the key common denominator in the perimenopause. Testosterone levels are usually declining or low, and may have been on a downward trend for many years prior to the perimenopause.

At the menopause, ovarian failure results in the decline of estrogen and progesterone and usually also testosterone. A lack or imbalance in these hormones results in an increased risk of the symptoms enumerated above as well as the following :

• Heart disease
• Osteoporosis
• Colon cancer
• Alzheimer’s disease
• Urogenital atrophy

It is because of these symptoms and increase in the diseases of aging that we advocate bioidentical hormone replacement therapy (BHRT) for most women. (For more on BHRT, refer the section on Hormone Replacement Therapy)