Is It All in Your Head?
Not to be confused with menopause, a distinct stage in a woman's life where she has stopped producing estrogen, , and no longer menstruates, or even early menopause defined by the cessation of a menstrual period for more than 12 consecutive months before age 45, perimenopause is a transitional phase—occurring up to a decade before menopause—defined by fluctuating hormone levels. With little or no progesterone (due to a non-ovulating cycle, or anovulation) to balance the effect, unopposed estrogen—up one day, down the next—causes many women to experience a myriad of symptoms from irregular menstrual cycles to changes in memory and mood.
The biggest misconception about perimenopause is that what women are experiencing is all in their heads. Because in fact, it's not, says Steven R. Goldstein, professor at New York University School of Medicine, and author of Could It Be...Perimenopause?: How Women 35-50 Can Overcome Forgetfulness, Mood Swings, Insomnia, Weight Gain, Sexual Dysfunction, and Other Telltale Signs of Hormonal Imbalance. Perimenopause, he says, is one of today's most misdiagnosed conditions. "For a lot of women there's a huge hormonal component to how they feel which has been blown off in the past by many physicians. But we've begun to realize that there is a definable entity prior to the onset of menopause. It needs some distinct attention."
Since these perimenopause symptoms can subtly (or not so subtly) show up a decade before the onset of menopause, Dr. Goldstein stresses the importance of knowing the difference between the two. "The immediate forerunner of menopause is a set of symptoms that are not usually subtle, such as a dry vagina and hot flashes. These symptoms are caused by very low levels of estrogen as well as rising levels of FSH (follicle stimulating hormone)," he writes. Women entering perimenopause, on the other hand, are still making estrogen, although the levels may fluctuate from day to day. "If a doctor misreads the signs and gives estrogen supplements to a woman whose problems are caused by unopposed estrogen, the symptoms may be compounded."