Perimenopause... What is it?

“Perimenopause” is a commonly used word these days, and seems to carry a dreaded connotation, at least among many women. Most of the time it doesn’t mean anything much except that menopause itself can be anticipated in a few years.  “Menopause” means ceasing of menses but it is the decline and ceasing of ovarian function that is the prime mover of symptoms.

Ovarian function begins to decline before menopause itself comes at the average age of 51. This fact is of little significance for most women, but can cause conception to become difficult.  The decline comes to women in their 30’s, but, at least initially causes few symptoms.  By the time women are in their 40’s, symptoms of ovarian dysfunction become common and are usually in the form of abnormal bleeding.  This era from about age 45 until menopause is the time most appropriately referred to as “Perimenopause.”  Women in this age group are not ill and experience little or none of the problems that can arise during menopause itself.  They do however have problems with cycles that become abnormally frequent or too seldom or too heavy.  This can be a minor, self-limited problem or can make women clinically ill with pain or even anemia from blood loss.

When women have abnormal bleeding in the 40’s, it is most often from the phenomenon usually referred to by doctors as “Dysfunctional Uterine Bleeding”. Other possibilities exist however, because the problem could come from disease and not just “dysfunction”.  These include polyps inside the uterus, overgrowth in the uterine lining, or even cancer of the uterine lining. Because of these possibilities, the doctor needs to demonstrate that these problems are not present  before proceeding to treat the dysfunction, rather than assume that there is no disease present.  Ultrasound of the uterus and biopsy of the uterine lining are the procedures most commonly used for that purpose.  And these are most often done in the doctor’s office. More extensive evaluations such as dilation and curettage (D&C) are sometimes done in operating rooms because they might require anesthesia.