Could It Be the Transition to Menopause?

You're 40 and suddenly it seems as if you're falling apart. You wake in the morning soaked in sweat, despite the ceiling fan above. You can't lose those last five pounds no matter how hard you try. Your interest in sex has gone the way of...well it's just gone. And suddenly you're spending more time browsing the face cream aisle than the ice cream aisle.

Could this be the start of menopause?

Before we try to answer that question, let's get the nomenclature right. First, there really is no "start" to menopause. Menopause is actually just one day -- the day on which you've gone twelve consecutive months without menstruating. Normal menopause can occur any time between ages 40 and 58, although the average age is 51.4.

The day after that magical day of menopause, you're considered postmenopausal. The day before: premenopausal. Then there's this other phase called perimenopause. And that, my friend, may be the realm you've entered.

Perimenopause refers to the transitional time before menopause. It can last a few months or, most likely, a few years. It usually starts in your forties, although it can begin earlier in some women. The primary cause is loss of follicles in the ovaries, leading to slowly declining estrogen levels as your ovaries age. This decline isn't consistent, however, which is why your symptoms may come and go as often as your college-aged children.

Tests Not Available

Unfortunately, there is no conclusive test that can tell you that you are, indeed, in the menopausal transition. No, not even those over-the-counter tests that purport to pinpoint your hormone levels. That's because those tests, with names like Estroven, Menocheck and RU25 Plus, are designed to measure levels of a hormone called follicle stimulating hormone, or FSH. Your body releases this hormone when estrogen levels drop, because it signals the ovaries to produce more estrogen. So, the thinking goes, if FSH levels are high, it means estrogen levels are low, ergo you're approaching menopause.

And indeed, for years gynecologists used this hormonal measurement as an indicator of menopause. But it turns out that estrogen levels fluctuate nearly as much as the stock market -- not only day-to-day, but from morning to night. So a single FSH measure, even a couple, is really no indication of menopausal status.

Instead, you're better off evaluating your status by your symptoms. These include:

• Hot flashes and night sweats.
  Called vasomotor symptoms, we're still not sure what causes them. Somehow, it seems, declining estrogen plays havoc with your body's temperature controls, increasing your core temperature and triggering your body's cooling attempt -- sweating. Hot flashes are the second most common menopause-related symptom, affecting about 75 percent of women. It's also one of the most bothersome. The bad news: In some women, they continue even after menopause itself.
• Irregular periods.
  Fluctuating hormone levels mean strange things may be happening to your periods. You may find them coming more often -- every 24 days instead of every 28 days, for example -- or less often. You can even skip several periods in a row only to have them return on a regular basis. You may also find that your periods are considerably heavier or lighter than they used to be, and that they last longer or shorter than they used to.
• Problems sleeping.
  We don't really know if fluctuating hormone levels contribute to the sleep problems women say are so common during this time of life. It could be that the night sweats interfere with sleep, or that the stresses of this time of life, including teenaged children, aging parents and career transitions, keep you awake. Regardless, studies find that more women report insomnia as they move through midlife, primarily the type that involves waking up in the middle of the night.
• Headaches.
  You may find you're having more headaches, particularly around your period. And if you've always been prone to premenstrual headaches, you may find they're more severe and last longer. The good news? Once you reach menopause, you should experience far fewer headaches.
• Mood swings.
  There's good evidence that perimenopausal women experience more irritability, fatigue and "blue moods," during the perimenopausal transition than before. Again, this could be related to shifting hormonal levels, but is more likely related to midlife stressors. If these mood swings become so intense they interfere with your normal life, however, you should seek professional help.
• Vaginal dryness.
  Estrogen plays a key role in maintaining the moistness and flexibility of the vagina. So as levels drop, you may find you feel "drier" down there. You may notice other changes, such as a discharge or odor, and you may even find you have problems with some urine leakage.

Although all the symptoms listed above are representative of perimenopause, they can also be caused by numerous medical issues. So regardless of whether you think your symptoms are from this midlife transition, it's important to see your health care professional for a complete medical and psychological evaluation. He or she can rule out any other medical conditions and confirm whether you are or aren't in the menopausal transition.