DEAR MAYO CLINIC: Is it possible that at age 37 I could be experiencing perimenopause? What are the signs and symptoms? Is there a way to test for it? I have not had children. Does that affect when a woman begins this process?
ANSWER: Menopause before 40 is rare, making perimenopause at age 37 uncommon. But some women do experience perimenopause beginning in their mid-30s. No one test can help a doctor definitively diagnose perimenopause. But you should make an appointment to see your doctor for an evaluation to determine what is causing your symptoms.
Perimenopause is the phase of a woman's life around menopause (the permanent end of menstruation and fertility). The term "perimenopause" is sometimes used interchangeably with "menopause transition," because it is the period of time in which a woman's body begins its transition into menopause.
The most common symptom of perimenopause is variation in the length of a woman's menstrual cycles, but most women have other signs and symptoms, too.
During perimenopause, the body's estrogen level rises and falls unevenly. Menstrual cycles may lengthen or shorten, and women begin having menstrual cycles in which they don't ovulate. Other symptoms of perimenopause caused by hormone fluctuations may include hot flashes, night sweats, sleep problems, mood changes, vaginal dryness and changes in sexual function.
The age range of menopause is typically 40 to 60. Some women have perimenopausal symptoms for an extended duration of four to eight years before they actually reach menopause. For others, perimenopause may last only a year or two. All women are different in the way their bodies experience this transition.
Some factors can predispose women to entering perimenopause at an earlier age. For example, some research has shown that women who have never had a baby may go through menopause earlier than women who have given birth. Family history may play a role, too. Women tend to go through menopause around the same age as their mother and sisters, although that's not always the case. Other factors that can lead to early menopause include smoking, childhood cancer treatment, pelvic radiation therapy and removal of the uterus (hysterectomy).
Even with some of these risk factors, though, if you're having symptoms in your 30s, most physicians wouldn't automatically assume the cause is perimenopause. Tests to rule out underlying medical conditions would be in order first. In particular, thyroid disorders and disorders that affect the production of prolactin often cause irregular menstrual cycles and should be investigated. Prolactin is a hormone released by the pituitary gland that stimulates breast development and milk production in women.
If no other medical condition is found to explain your symptoms, your doctor may perform a blood test to check your body's level of follicle-stimulating hormone (FSH). A woman's FSH level usually increases during perimenopause. So an FSH level, along with an evaluation of symptoms, may help your doctor determine if you are experiencing perimenopause.
Perimenopause is a natural part of the aging of the ovaries. For some women, the transition is easy, while others have significant symptoms that need medical attention. Heavy periods during perimenopause may require evaluation, as they can result in excessive blood loss and anemia. Hot flashes and night sweats may require treatment to improve quality of life. These could be treated with lifestyle modifications and prescription medications. Vaginal dryness usually can be effectively treated with a topical estrogen cream.
If you are experiencing perimenopause, remember that you still need contraception. Many women are surprised by a midlife pregnancy because they think they can't get pregnant during this phase of life. You can. A low-dose birth control pill can be a good option for women in perimenopause because, not only does it prevent pregnancy, but it also helps control hot flashes and mood swings.
I'd recommend you talk with your doctor or see a women's health specialist to have your symptoms evaluated. If you are in perimenopause and want help for your symptoms, a customized treatment plan is the best approach. -- Richa Sood, M.D., Women's Health Clinic, Mayo Clinic, Rochester, Minn.
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