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Easing into Menopause

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WebMD Health News

Aug. 30, 2000 -- They are just a bit over age 40, seemingly too young for "the change." But their sleep is fitful. They sometimes wake up in the middle of the night drenched with sweat. During the day, they feel irritable and depressed. And yes, the monthly cycle isn't as predictable as it once was. It's as unnerving as the hormonal changes of adolescence.

Cindy is a classic case. "I was having a period every two weeks," she tells WebMD from her home in Urbana, Ill. "It was like having PMS constantly."

When she found herself crying in a parking lot one day for no apparent reason, she knew something had to be done. "I thought, 'This is nuts.' I'm a pretty sane person, and I just didn't want to put up with this any more." Soon, Cindy began taking low-dose birth control pills, just to keep things regular -- which, finally, they did.

Like many women, she says, "I had no idea anything could be done about it," before she discussed the problem with her doctor.

She's in the midst of what doctors call perimenopause, the decade or so that is a woman's natural period of transition into menopause. As estrogen levels fluctuate dramatically, menstrual periods can become shorter, lighter, and unpredictable. Hot flashes or "flushes" -- the signature of this era -- may come and go. For some women, this transition takes place gradually over a decade. For others, it lasts just a few years. When her period has stopped for a full year, a woman knows she is in menopause.

The study of perimenopause "is a science in its embryonic phases," Cynthia Stuenkel, MD, a gynecologist at the University of California in San Diego, tells WebMD. "We really are struggling to define what's happening, how to measure it, how to get any sense of how long it might last."

"It may be that how you go through your perimenopausal years determines your health for the rest of your life," Nanette Santoro, MD, director of reproductive endocrinology at Albert Einstein College of Medicine in the Bronx, N.Y., tells WebMD. "This transition has simply not been looked at."

Santoro is principle investigator of the Study of Women Across the Nation (SWAN), a five-year, National Institutes of Health-funded study involving 3,200 women ages 42-52 from five ethnic groups (Caucausian, African-American, Japanese, Chinese, and Hispanic).

"There's just a huge gap in knowledge of what makes women stay healthy after menopause," says Santoro. "Is it their level of activity? Is it their ability to resist the weight gain that seems to plague so many women? ... Are there features of their hormone picture during these years that leads to trouble in some women? Do hormones predict symptoms, predict bleeding?"

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