Most premenopausal women experience changes in their menstrual cycle. When estrogen levels begin to drop, the follicular phase of the cycle may be shortened, and this can shorten the total cycle from 28–30 days to 24–26 days, resulting in more frequent periods. On the other hand, some women begin having longer cycles because they are not ovulating as frequently. These changes can be quite different on an individual basis. Additionally, this declining/fluctuating estrogen level can produce a host of disturbing symptoms: hot flashes, increasing vaginal dryness, sleep problems, mood swings, breast tenderness and many other complications.

Causes

As you go through the menopausal transition, your body's production of estrogen and progestin fluctuates. These hormonal fluctuations are at the root of the changes your body goes through during perimenopause.

In integrative medical circles, there has long been recognition that a transitional period of time exists before menopause, which is different for each woman, when fluctuating hormones may cause her serious distress. Thankfully, conventional medicine has caught up and we now have an official name for this passage in medical textbooks: perimenopause — defined as a transition period that precedes menopause, as in “pre-menopause,” which is symptomatic of hormonal imbalances and fluctuations in a woman’s body.

Symptoms

Some of the symptoms of depression are found in both PMS and perimenopause. Depression is not caused by menopause, but it can run in families. If feelings of depression, loss of appetite, insomnia, and general loss of interest or pleasure in life are at the top of your list you may be suffering from clinical depression. These feelings should be brought to the attention of your health care provider. Depression and PMS can occur together and it's not uncommon for anxiety or depressive disorders to worsen during the week before your period and at menopause.

Some researchers believe it may have more to do with diet than climate. Japanese women eat less animal protein than Western women, consume less fat and eat several servings of soy each day. These foods are rich in compounds called phytoestrogens, which may "fake your body out" by acting biologically like female hormones.

Treatment

Many women experience relief from hot flashes after taking low-dose birth control pills for a short period of time. Other options that may control hot flashes include the birth control skin patch, vaginal ring and progesterone injections. But, certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.

Recent studies have led to a big change in how health professionals use hormone therapy after menopause. For a long time, estrogen-progestin, or hormone replacement therapy (HRT), was thought to protect against heart disease or dementia. But studies now show that HRT use can cause serious health problems in a small number of women. These health problems include dangerous blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia. The heart disease risk does not seem to affect women during their first 10 years after menopause.

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