- The Washington Times - Monday, March 13, 2006

weating in meetings and at night was something Mary Patton endured for about two years as she went through perimenopause.

“The night sweats, that symptom is the worst. You wake up, and your entire bed is drenched,” the Clarksville, Md., resident says about having to get up, change the sheets and try to go back to sleep.

Ms. Patton experienced four years of perimenopausal symptoms in her early 50s — starting with irregular menses and followed by night sweats and hot flashes — before she entered menopause.

“All of a sudden, you would have sweat pouring off of you as if you ran a marathon,” says Ms. Patton, who is 59.

She is among the majority of women who experience symptoms of perimenopause, the time of transition from the childbearing years to menopause. “Peri” refers to the time “around” menopause, while premenopause extends from the onset of menses to menopause.

“It’s a normal, natural transition in a woman’s life,” says Dr. Asha Thomas, an endocrinologist and clinical investigator for the MedStar Research Institute in Southeast.

Perimenopause typically begins when a woman is in her 40s but can begin as early as the mid-30s, Dr. Thomas says. The average age of menopause for American women is 51 years, she says. A woman can begin showing symptoms two to eight years, four to eight years and five to 15 years before menopause. Perimenopause also may or may not be said to include the year after menses ceases.

Perimenopause is defined differently for various research studies on a woman’s middle years, says Sherri Sherman, program director for clinical aging and reproductive hormone research at the National Institute on Aging in Bethesda.

“Nobody knows what perimenopause is,” Ms. Sherman says. “The symptoms are not necessarily attributed to low levels of estrogen. It’s a much more complicated story.”

Perimenopause, however, is characterized by a change in menses, she says.

Menstrual cycles can be prolonged, occur more or less frequently, or have a heavier or lighter flow than normal, says Dr. Phyllis Campbell, gynecologist and chairwoman of the obstetrics and gynecology department at Howard County General Hospital in Columbia, Md.

“The ovaries become less responsive to signals from the brain that normally would cause ovulation to occur,” Dr. Campbell says.

The pituitary gland, located at the base of the brain, releases follicle-stimulating and luteinizing hormones that increase and decrease throughout the cycle to regulate it, Dr. Thomas says. During perimenopause, the hormones’ signals become irregular, she adds.

The ovaries respond by decreasing production of estrogen, which thickens the lining of the uterus to receive a fertilized egg, Dr. Campbell says. Progesterone, the hormone that signals the uterus to release the lining when pregnancy does not occur, also is decreased, she says.

In perimenopause, the lining can build up and thicken, then shed in pieces, resulting in irregular cycles and an increased risk for uterine cancer, Dr. Campbell says. During this time, women also are at risk for developing osteoposis because estrogen activates cells that build bone, she says.

“Lower estrogen makes it more difficult to absorb calcium, so the bones end up more brittle and fragile,” says Maureen Edwards, professor and coordinator of the health education and gerontology programs at Montgomery College in Rockville.

The loss of estrogen, responsible for giving skin a smooth, youthful appearance, can cause skin to wrinkle, says Mrs. Edwards, who holds a doctorate in health education.

Other symptoms associated with perimenopause include vaginal dryness, sleeplessness, dry skin, hair loss, rapid heartbeat, mood swings, depression and loss of libido, as listed on www.americanmenopause.org. It is the Web site for the American Menopause Foundation Inc., a national nonprofit organization in New York City that provides support and assistance on issues concerning menopause.

“It’s not going to be the same for every woman,” says Marie Lugano, the foundation’s president and founder. “What women have to do is begin to educate themselves with the correct information.”

The National Institutes of Health, the Centers for Disease Control and Prevention in Atlanta and foundations are good sources of information, along with a woman’s family history, Ms. Lugano says.

“You have to take charge of your health and what you’re going to do with your life as you change,” she says.

The symptoms of perimenopause can be treated individually, such as with vaginal creams that help with vaginal discomfort, and medications that lower blood pressure and treat hot flashes, insomnia and mood symptoms. The symptoms can be treated generally with oral contraceptives or hormone replacement therapy (HRT). HRT provides higher doses of estrogen and/or progesterone than birth-control pills to prevent thickening of the endometrium, the lining of the uterus.

Dr. Judith Hsia recommends HRT be used only for severe perimenopausal symptoms because estrogen and progesterone therapy can increase the risk of stroke, blood clots in the legs and dementia, while estrogen alone can increase the risk of heart attack and breast cancer, she says.

High cholesterol is a risk during perimenopause, caused by a reduction in estrogen production, says Dr. Hsia, a cardiologist and professor of medicine at the George Washington University Medical Center in Northwest. Weight gain and high blood pressure also are risks, though it is not known if the symptoms are directly related to perimenopause, she says.

“[Women] should take the opportunity to reassess their lifestyle for its implications and their cardiovascular risk and remedy situations that aren’t optimal,” she says.

If women know what is happening to their bodies, they are less likely to be concerned about a normal process and better able to identify coping strategies, says Dr. Marcie Richardson, director of the Harvard Vanguard Menopause Consultation Service, a multispecialty medical group in Boston. She also is a member of the board of directors for the North American Menopause Society, a scientific organization in Cleveland that provides menopause-related information.

“The idea of menopause and perimenopause does sound like a pathological condition. It isn’t, and it’s a reality, and we all are going to age,” she says.

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