Is It Perimenopause?

Q. I'm 47 years old and I've had changes in my body for the past several years–-changes in the skin on my face, my eyebrows, irregular periods (no period for two months and then two weeks of bleeding). My doctor says I'm experiencing perimenopause, and because of my symptoms, he wants to insert a progesterone IUD. What is perimenopause and what can I expect?

A. Sounds like you're very in tune with your body, and that’s a good thing. It certainly helped your physician determine the cause of your menstrual irregularities, as well as skin and hair concerns. While other health conditions (hypothyroidism, diabetes) may cause similar symptoms, given your age and the body changes you mentioned, it does sound like you are in your perimenopausal years, a time when the production of two major reproductive hormones--estrogen and progesterone--start to decline.

To better understand the changes your body is going through and will continue to experience, I want to turn back time for just a bit. Early on, one of a woman’s most significant body transitions is the hormonal surge of puberty. This typically occurs between the ages of 8 and 18, and propels a girl into her adolescent years. During this time she experiences lots physical changes to her skin, body shape, mood and libido. It is no coincidence that this is also the time when she develops the ability to get pregnant due to the onset of ovulation and her menstrual cycle. Along the way, lots of psychological and social adjustments are made to help cope with these changes.

When a woman reaches perimenopause, her levels of estrogen and progesterone begin to fluctuate in a less predictable pattern. Instead of "revving up" her ability to get pregnant, ovulation becomes irregular, as does the timing, length and predictability of her menstrual cycle, resulting in a decreased ability to conceive. During this period of time, what may bother one woman may not affect another. Some of the symptoms may be subtle, while others are very disturbing. In general, here are some clues you may be experiencing perimenopause:

• Irregular menstrual pattern which may include heavier periods.
• Body and skin changes (increased body fat, decreased muscle mass, thicker waist and dry skin).
• Hot flashes and sleeping difficulties due to hormonal changes and night sweats.
• Vaginal dryness and painful intercourse (decreased lubrication).
• Decreased libido.
• Osteoporosis (decreased estrogen, more potential loss of bone strength).
• Mood changes (depression, anxiety and irritability). These may result from hormonal fluctuations, sleep disturbances or a combination of factors, including life changes with this time of transition.
• Lack of concentration.
• Increased urinary tract infections or urinary incontinence when you cough, laugh or sneeze.

As for the timing of this life transition, it varies. For some, mild changes become noticeable in the mid to late 30s. For others, it could be during the early to mid 40s. Factors that may bring on an earlier perimenopause include:

• Family history of early menopause (before age 48).
• Hysterectomy (even with ovaries left in).
• Cigarettes and tobacco smoking.
• Medical illness (for example, cancer or type 1 diabetes).
• Poor nutrition and being underweight.

To make a diagnosis of perimenopause, your health-care professional will gather a wide range of information including your age, pattern of menstruation and any physical or emotional changes, and will also perform a thorough exam. Your doctor may even order blood work to help confirm the diagnosis.

As for treatment, it all depends upon how bothersome the symptoms are to you. For example, if a woman has a very heavy flow, we need to check her blood count. If this is low, or if the heavy bleeding pattern continues, medication may help to regulate this problem. This may well be the reason your physician recommended the progesterone IUD, as it helps to decrease cramping and bleeding and provides a good birth control option. Oral contraceptives (OCs) are another good option as long as you don’t smoke, have a blood-clotting disorder or a history of breast cancer. To help decrease other potentially bothersome symptoms of perimenopause, here are some suggestions:

• Exercise on a regular basis. This can help to increase the "good feeling" chemicals known as endorphins that your body produces.
• Quit smoking. Besides the benefits of reducing your risk for heart disease and cancer, it can also lessen the severity of your symptoms.
• Eat a healthier diet. This may help to elevate your mood and decrease irritability.
• Keep a social life.
• Lift weights, not to get rippling muscles, but to maintain your strength, decrease your waist size and to increase your libido.
• Speak with your physician regarding any vitamins or herbs that may help to decrease your hot flashes.
• Learn Kegel exercises. These can help to improve or maintain bladder control by strengthening the muscles that control the flow of urine.

Our lives are a series of transitions, and the body changes you are experiencing are a normal part of living. Perimenopause guides the journey into this change of life. Though the sun sets on a woman’s reproductive years upon arrival into menopause, it also rises to shed light on her road ahead.

Read More About Menopause on MSN Health & Fitness:

• Menopause: A Good Excuse
• Weight Gain During Menopause: Is It Inevitable?
• Taming the Flame: Nutrition Approaches That Work for Menopause
• Menopause Message Board

Find all articles by Dr. Rob.

Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.

Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)