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The Change Before 'The Change'

Hot Flashes, Infertility, Happen Earlier Than You'd Expect

It's All About Estrogen

Recognizing perimenopause isn't easy for doctors: "Patients will complain of hot flashes, but hormone levels will be normal, so the patient isn't really taken seriously," says Bill Meyer, MD, associate professor of obstetrics and gynecology and a reproductive endocrinologist at the University of North Carolina Hospital in Chapel Hill.

It's not all in your head, he says. "We know that these symptoms do occur," Meyer tells WebMD. "There are some huge and wide fluctuations in estrogen levels that cause these symptoms -- the irregular uterine bleeding, vaginal dryness."

Wild-flying estrogen levels also wreak havoc on your mood. "When estrogen levels are high, more mood-elevating chemicals -- like serotonin, dopamine, norepinephrine, and opiates -- are free to circulate in your bloodstream," writes Corio. "Low levels of these chemicals cause depression."

However, perimenopausal mood swings are often mistaken for depression, says Corio. "A woman suffering insomnia, fatigue, weight gain, problems in concentrating, and loss of interest in sex might be diagnosed as mildly depressive whereas she's in perimenopause."

In other cases, low estrogen levels can make existing depression worse, adds Meyer. Thyroid problems may cause depression-like symptoms as well as irregular bleeding.

That's why it's important that your doctor look at the big picture -- testing your hormone levels rather than just handing you a prescription for an antidepressant, says Corio. Estrogen could help your antidepressants work better, adds McGee.

Taking Stock of Life, Lifestyle

As her estrogen declines, the 40ish woman is at increasingly higher risk of certain health disorders. Her bones, reproductive organs, breasts, and heart all become vulnerable.

"During this period, bones start changing because you're losing estrogen and progesterone," Corio tells WebMD. "Dwindling estrogen puts women at higher risk for uterine cancer, breast cancer, ovarian cancer, heart disease, diabetes."

It's a time to consider your lifestyle -- and your level of stress, says McGee. "Perimenopause is a time of life, not a condition, something to be diagnosed," she tells WebMD. "Women are going through a lot of changes, and some of those are society pressures -- they have parents, grandparents to take care of. Women in their 40s and 50s have a lot of stress."

If you have symptoms, talk to your doctor, someone who takes you seriously, who is sympathetic, says Meyer. "Go to another doctor if that's not happening."

You don't have to put up with the symptoms, says Corio. "There's no need to be a martyr," she writes. "Practically every week new studies are showing that simply incorporating particular vitamins, minerals, herbs, and foods into your diet and making certainly lifestyle adjustments can counter many of the annoying, uncomfortable, and sometimes painful effects of perimenopause."

There are also numerous synthetic and natural "bioidentical" estrogen products to help stabilize your hormone levels, including mini pills and patches, she adds.

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