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Early or Late Perimenopause?
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Early or Late Perimenopause?

Dear Dr. Seibel,

I am 46 years old, perimenopausal, and have a question about the stages of perimenopause. My history includes regular cycles since age 13 of approx. 28 days length and 5 to 7 days duration with heavy flow and severe uterine cramping; laparoscopy & hysteroscopy 8 years ago for endometriosis, uterine fibroids, and polyps (this temporarily reduced the worst of the heavy flow for 2-3 years); borderline low-normal thyroid function; and no anemia but below-normal mean platelet volume counts. Family history is unknown due to multigenerational hysterectomies for fibroids and heavy flow problems.

For the past several years I have been hot at night one-third of each month; over the past 2 years I have gained 15 pounds despite increased exercise and have had flooding periods lasting 7 to 10 days with large clots the size of raw eggs; and for the past 3 cycles my periods are now coming 18 to 20 days apart with the worst cramping I have ever experienced but thankfully now only lasting 5 days. My emotions range from apathy to jittery anxiety, and I have had dizziness and actual vertigo intermittently for the past 3 months. There is also a history of breast fibroadenomas and multiple surgical biopsies, the last of which for microcalcifications showed precancerous atypical cells, perhaps facilitated by the worsening estrogen/progesterone imbalance.

I read somewhere that once the monthly cycles begin to become irregular, this is a sign that the last period before menopause is only 6 to 12 months away. I know that every woman is different and you have no crystal ball, but in your experience is this true? Do you think that by my description I am in early or late perimenopause? I need some hope that this ongoing torture could be over soon! Thank you very much -- I appreciate your feedback.
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Unfortunately, there is no crystal ball. Even hormone testing is only a rough indicator and you might be different because sometimes endometriosis changes the time frame to menopause because the disease destroys some of the ovarian tissue.

However, once the periods do start to change in a woman who is typically regular, it does suggest that you are on the way to menopause but it could be more than one year away. That is based on the "STRAW" study (STages of Reproductive Aging in Women).

There are a few things I would suggest while you wait. Have some blood testing done for serum iron and iron binding capacity and a vitamin D test.Also, usuallly early on, estrogen levels are normal to high and progesterone levels are low. So adding some progesterone to the second half of the cycle can sometimes help both mood, hot flashes and bleeding. If that is the case, the pattern will change in the months to come because your hormones are changing.
Machelle M. Seibel, MD
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Dear Dr. Seibel,

Thank you for your detailed response and helpful suggestions. The information from the STRAW study is also really helpful, although according to the staging system I am still in the category of "early perimenopause"! So it would appear that unfortunately my uncomfortable symptoms will continue for quite some time.

Do the effects of endometriosis on ovarian tissue typically result in a more rapid menopausal transition, or is this more likely prolong the process? I know that my left ovary is completely taken over by adhesions that are glueing it and my uterus to the left ureter and portions of the bowel, as seen via laparoscope.

For everyone else, here is a Medscape link to the Executive Summary on the Stages of Reproductive Aging Workshop: http://medgenmed.medscape.com/viewarticle/430187

Thank you.
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