PERIMENOPAUSE AND YOUR CYCLES

Perimenopause and Your Cycles

Doctor Steven R. Goldstein MD is a leading Perimenopause Specialist in NYC. He is the coauthor of the book “Could it be…..Perimenopause?”. Dr Goldstein is a past President of the International Menopause Society and a Certified Menopause Practitioner.

Perimenopause is a period in which fluctuating levels of estrogen can cause a woman to experience anxiety, memory lapses and other unpleasant conditions, and particularly worrisome to many women – IRREGULAR PERIODS. Perimenopause typically begins around the mid forties, but can be earlier in some women.

Doctor Steven R. Goldstein MD

SYMPTOMS OF PERIMENOPAUSE

WHY IRREGULAR PERIODS OR SPOTTING DURING PERIMENOPAUSE?

During Perimenopause, the ovaries gradually stop working, so ovulation becomes irregular and regular ovulatory cycles are less likely. When a woman does not ovulate, but is still making estrogen, when and how much she bleeds is related to the stability of the estrogen levels without progesterone. When there is fluctuation, this “hormone imbalance” destabilizes the uterine lining, and it can be shed, causing bleeding.

The hallmark of cycles without ovulation is being potentially “all over the map.” They can be heavy, they can be light, they can be continuous or intermittent. As they are in perimenopause.

In a large study conducted by us more than twenty years ago, 79% of women over the age of thirty-five who had any irregularity to their bleeding cycle had no anatomic reason such as polyps, fibroids, pre-cancers, and even occasional cancers. Thus, these 79% had irregular bleeding or spotting due to “hormone imbalance,” what doctors tell patients when they are not ovulating and thus not making progesterone on a regular basis.

WHAT CAN A WOMAN DO ABOUT IRREGULAR PERIODS DURING PERIMENOPAUSE?

HAVE THE UTERINE LINING EVALUATED - The guidelines state that any women over forty who are having any irregular, abnormal bleeding or staining or spotting needs to have her uterine lining (endometrium) evaluated to rule out structural, anatomic reasons for the bleeding.

Whereas, years ago the primary diagnostic procedure was a D&C (dilatation and curettage also known as “scraping”) today we use transvaginal ultrasound and, when necessary, saline infusion into the uterine cavity to better delineate the presence or absence of any anatomic abnormality. If the bleeding is “hormone imbalance,” then such patients can be reassured and almost always treated hormonally.

Dr Goldstein will also discuss treatment options with you. If you have the aforementioned symptoms or have been told you have Perimenopause, then schedule an appointment with Dr Steven R. Goldstein, a top Perimenopause Doctor in NYC.