Moving Through Perimenopause
The opinions expressed herein are the guest’s alone.
If you have questions about your health, you should consult your personal physician.
This event is meant for informational purposes only.
Irregular periods, breast tenderness, worsening PMS, and diminished libido can all be signs that you’re experiencing perimenopause.
If any or all of these symptoms are a part of your life, read about our discussion with ob-gyn Laura Corio, MD, author of The Change Before the Change.
Moderator: Welcome to WebMD Live. Today our guest is Laura Corio, MD. She’ll answer your questions about perimenopause. Thanks for joining us today!
Dr. Corio, what are symptoms of perimenopause?
Corio: Well, the first sign of perimenopause has to be a change in your menstrual cycle. You cannot consider yourself perimenopausal unless you’ve had a change in your periods. And then along with it, you can have:
Member: I’m only 33 and have all of these symptoms. Am I too young?
Corio: The average age of perimenopause is 46 and the average age of menopause is 51, but that doesn’t mean that a women cannot go through it as early as 35 or as late as 55. I’ve seen patients who have been having infertility problems and find out that they have high FSH [follicle stimulating hormone] and they are in their late 30s and were sure that they could be able to conceive, but couldn’t get pregnant and were clearly in perimenopause. So, you can be in your 30s or you could be even in your later 40s or 50s. Women have to understand that this can happen as early as 35 or even later as 46.
Member: I’m 44 and started menstruating at age 10. Within the past year I’ve started having heavy periods, including one episode of flooding, some night sweats, and PMS that has worsened quite a bit. I get very nauseous right before my period, too. Could this be perimenopause? And what exactly is perimenopause? I’m so miserable. The new man in my life must think I’m absolutely insane!
Corio: It is important to know whether these changes are occurring two weeks prior to your period. Are you clearly having PMS? Or, are there hot flashes and mood swings occurring anytime in your cycle? Women can have PMS and then it goes into perimenopause but if you are only having these symptoms two weeks before your period, it may not be perimenopause.
Member: At what age is a "baseline" check of hormone levels recommended? I am 44 years old, and still having regular (although much lighter) periods. I do experience other perimenopause symptoms. Is it reasonable for me to ask my doctor to check my hormone levels at this time to establish a baseline as I continue on, and eventually into menopause?
Corio: Blood tests and saliva testing are available. They have to be timed accordingly in the cycle. When we do blood tests, we usually do them on the third day of the cycle and we’re looking at levels of FSH, LH [luteinizing hormone], and estradiol hormones. But understand that blood tests are not as accurate as a good history and physical exam.
There’s also saliva testing which can be done through something called a perimenopausal panel with which you can look at your estrogen, your progesterone, your testosterone throughout the cycle and even though it may not be accurate, it can be reassuring to women to look at these hormone levels on the third day of their cycle to just get an idea of what is going on.
Member: Is perimenopause an adjustment period in anticipation of menopause?
Corio: I think it is the normal, natural transition that women go through before menopause. Menopause is defined as a full year without a period. Once a woman goes a full year without a period, she is considered menopausal. So, the perimenopause is so much more critical as a pivotal point in a woman’s life -- the change before the menopause.
Moderator: How good a job do you think doctors are doing in teaching their patients about perimenopause?
Corio: I would say that they are doing better than when I first went out on my book tour. The book came out in November 2000. I went out on a book tour in 2001 and it was very upsetting to me as a physician to realize that women were not being heard. It was part of the reason I wrote the book. The doctors didn’t have time to speak about it. It was a lack of interest on their part. They would put their hands up in the air and say ’I can’t help you.’ But I think that’s getting better.
Member: I just found out a month ago that I was in fact experiencing symptoms of perimenopause. My doctor has given me progesterone cream to use, and so far, it’s helped. I do however want to know a few things.
1. Even though I’m 36 years old, would this condition prevent me from having a baby in two to three years?
2. Are there any over-the-counter drugs that one could use to help with hot flashes, frequent urinating, and fatigue?
3. When will it be over? Is this just a cycle or will it last until I’m actually going through menopause?
Corio:
1. I would recommend highly that you do not put off the pregnancy for two to three years. If you are experiencing perimenopausal symptoms, definitely have your third day bloods done so that you can see where your FHS is and I would definitely encourage you to conceive now rather than later, because perimenopausal women may not be as fertile as younger women.
2. One of my favorite over-the-counter drugs is Remifemin, which is black cohosh. It relieves hot flashes, raises the mood, and takes about six weeks to work.
3. It will come and go, but it will last as long as it takes to reach menopause. Some women tell me that for a few months they will have hot flashes and then they will go away, they will feel fine for a few months and then it can come back again. So it comes and goes, sometimes it comes and stays but will continue until menopause and sometimes even after menopause. That’s why it is called perimenopause.
Member: How can I overcome the total lack of libido that I am experiencing? This is the one symptom that I am having the most trouble overcoming.
Member: I am 46 and in good health. Of all the symptoms of perimenopause that I have recently started to experience, the most troubling is the loss of libido. Not only that, but almost all sexual sensitivity has diminished as well. Until now, my husband and I have enjoyed a healthy sex life. Will this come back, and what can I do or take (naturally) to help? I do believe in herbs and vitamins.
Corio: There are separate issues here. Clearly when one goes through perimenopause there is a drop in the hormones -- your estrogen, progesterone, and testosterone call all be affected. One of the first things that can happen in perimenopause is vaginal dryness. Forty percent of women experience vaginal dryness and with that, women can have difficulty with reaching orgasm, decreased sensitivity in their vaginal area, and painful intercourse. A lot of that can be helped with some local estrogen cream.
As far as the libido and the lack of interest in sex, my patients describe it as "I couldn’t care less." I do test testosterone levels. The best time to test testosterone levels in a woman who is still menstruating is the middle of her cycle in the middle of the morning. I test testosterone and free testosterone and if the values come up in the lower one-fourth of normal, those patients would benefit from testosterone. My patients have had wonderful responses with compounding natural estrogen, progesterone, and testosterone to raise libido. I have not found any great vitamins to raise libido.
Member: Can you address the issue of memory loss? What can be done?
Corio: I find that vitamins help a lot. Something called "Memory Enhancer" or "Memory Booster" has phosphatidyl serine (PS), acetyl-l-carnitine (ALC), and ginkgo and those three combined, as well as the B vitamins, have helped memory. And I also find that if women are really having a hard time with memory, taking estrogen or phytoestrogens like soy or flax seed have strong beneficial effects on the brain. Also, powerful antioxidants such as vitamins E and C and beta-carotene also help with memory.
Member: I am almost 40 and all of a sudden I am experiencing all of the symptoms. My period has gone from three to four days to seven or eight, and has become heavy and painful. My doctor says it’s normal. Normal for what?
Corio: I think you should believe that this is not normal. My rule of thumb is any woman over the age of 35 who has any change in her bleeding pattern -- starts bleeding heavier or longer or less than three weeks apart -- I always do a biopsy of the uterus to rule out any problems such as precancer of the uterus. You may need some progesterone because your periods are heavier, crampier, and longer. This may be a lack of progesterone.
Member: I’m 44 and have been using oral birth control since I was 18. How would I be able to tell if my periods are different, since the pill regulates this?
Corio: Interestingly enough, my patients who are on birth control pills do get relief of their perimenopausal symptoms and it does help regulate them, so a lot of times they may not be aware that they are going through perimenopause. However, they may start getting symptoms of perimenopause such as hot flashes, or their periods may stop. I test these patients on the week of their placebo pills and see where they are hormonally. I usually try to do a FSH, LH, and estradiol test a day or two before they are going to start their new package of birth control pills -- during the placebo week. And then we can tell where they are hormonally.
Member: Does perimenopause weaken the strength of hair?
Corio: There is some literature that states that the hair becomes duller, less oily, and coarser. There is definitely a change in your hair. It may be dryer and as far as the facial hair, again, in perimenopause some women may have more testosterone and less estrogen and then they can end up with acne and what is called hirsutism or hair growth in unwanted places.
Member: What will the blood test tell us? They said I will take a blood test every year but I am not sure what we will learn from it.
Corio: I wouldn’t take a blood test every year. Blood tests are not the end all and be all of perimenopause. First of all, what we are more interested in are the symptoms and the history and the physical exam. The blood test may lend some information but it may not. And blood tests are for the moment. It shows what’s going at the moment you drew the blood, but if you drew the blood three hours later or another month later, it could be a different blood test. So it’s an additional test to have, but it’s not the definitive test.
Member: Is there a link between increased incidence of depression and perimenopause?
Corio: Depression per se is not a symptom of perimenopause. Women can have mood changes and feel depressed. But a depression, a clinical depression, is more to do with whatever’s going on in your life or maybe something chemical. What we found when we were doing the research was that if a woman entered perimenopause and was in a good place, she may be unhappy or moody but she wasn’t going to undergo a depression. If a woman entered perimenopause and she was having major [problems] in her life, the hormone change may be enough to make her depressed but I don’t think perimenopause per se causes clinical depression.
If somebody were experiencing mood swings along with hot flashes and other perimenopausal symptoms, I would always recommend low-dose natural bioidentical hormones. If somebody is really in a depression -- she’s not eating, not sleeping, and she’s going through a clinical depression while she’s in perimenopause -- I have had patients take low-dose bioidentical hormones along with antidepressants. I don’t think that the antidepressants should be treating hot flashes unless it’s an unusual situation such as a woman with breast cancer who can’t take hormones.
Member: What kinds of foods/supplements/vitamins would ease the symptoms of perimenopause?
Corio: Throughout my book we talk about vitamins, minerals, phytoestrogens, diet, weight gain, and exercise. This is a critical time in a woman’s life where she needs to make changes and I don’t mean dieting. I mean changing the way she eats, taking her vitamins, and really looking at her exercise regime. Because if she doesn’t, the weight is going to creep up. She’s going to notice that weight gain distribution in the middle of her abdomen and she’s going to lose that waistline and put herself at risk for heart disease, stroke, diabetes, and cancer.
Moderator: Dr. Corio, we are almost out of time. Before we wrap up for today, do you have any final comments for us?
Corio: I think that if women want information, they should get the book. It is filled with so much information and everybody whose read it loves it. They keep it by their bedside and use it as a referral.
Moderator: We are out of time. I’m sorry we couldn’t get to all of your great questions. Thank you Dr. Corio, and thank you members for joining us today. For more information, please read The Change Before The Change: Everything You Need to Know to Stay Healthy in the Decade Before Menopause, by Laura Corio, MD.
Check out our news stories, features, and archived interviews with experts on women’s health -- visit the WebMD Menopause Center. Don’t forget our message boards, Menopause, with Joan Starker, MSW, PhD and Women’s Health: Friends Talking .
If you have questions about your health, you should consult your personal physician.
This event is meant for informational purposes only.
Irregular periods, breast tenderness, worsening PMS, and diminished libido can all be signs that you’re experiencing perimenopause.
If any or all of these symptoms are a part of your life, read about our discussion with ob-gyn Laura Corio, MD, author of The Change Before the Change.
Moderator: Welcome to WebMD Live. Today our guest is Laura Corio, MD. She’ll answer your questions about perimenopause. Thanks for joining us today!
Dr. Corio, what are symptoms of perimenopause?
Corio: Well, the first sign of perimenopause has to be a change in your menstrual cycle. You cannot consider yourself perimenopausal unless you’ve had a change in your periods. And then along with it, you can have:
- Hot flashes
- Mood swings
- Fatigue
- Insomnia
- Joint pain
- Palpitations
- Migraines
- Decreased libido or a lack of interest in sex
- Vaginal dryness
- Memory glitches
- Weight gain
Member: I’m only 33 and have all of these symptoms. Am I too young?
Corio: The average age of perimenopause is 46 and the average age of menopause is 51, but that doesn’t mean that a women cannot go through it as early as 35 or as late as 55. I’ve seen patients who have been having infertility problems and find out that they have high FSH [follicle stimulating hormone] and they are in their late 30s and were sure that they could be able to conceive, but couldn’t get pregnant and were clearly in perimenopause. So, you can be in your 30s or you could be even in your later 40s or 50s. Women have to understand that this can happen as early as 35 or even later as 46.
Member: I’m 44 and started menstruating at age 10. Within the past year I’ve started having heavy periods, including one episode of flooding, some night sweats, and PMS that has worsened quite a bit. I get very nauseous right before my period, too. Could this be perimenopause? And what exactly is perimenopause? I’m so miserable. The new man in my life must think I’m absolutely insane!
Corio: It is important to know whether these changes are occurring two weeks prior to your period. Are you clearly having PMS? Or, are there hot flashes and mood swings occurring anytime in your cycle? Women can have PMS and then it goes into perimenopause but if you are only having these symptoms two weeks before your period, it may not be perimenopause.
Member: At what age is a "baseline" check of hormone levels recommended? I am 44 years old, and still having regular (although much lighter) periods. I do experience other perimenopause symptoms. Is it reasonable for me to ask my doctor to check my hormone levels at this time to establish a baseline as I continue on, and eventually into menopause?
Corio: Blood tests and saliva testing are available. They have to be timed accordingly in the cycle. When we do blood tests, we usually do them on the third day of the cycle and we’re looking at levels of FSH, LH [luteinizing hormone], and estradiol hormones. But understand that blood tests are not as accurate as a good history and physical exam.
There’s also saliva testing which can be done through something called a perimenopausal panel with which you can look at your estrogen, your progesterone, your testosterone throughout the cycle and even though it may not be accurate, it can be reassuring to women to look at these hormone levels on the third day of their cycle to just get an idea of what is going on.
Member: Is perimenopause an adjustment period in anticipation of menopause?
Corio: I think it is the normal, natural transition that women go through before menopause. Menopause is defined as a full year without a period. Once a woman goes a full year without a period, she is considered menopausal. So, the perimenopause is so much more critical as a pivotal point in a woman’s life -- the change before the menopause.
Moderator: How good a job do you think doctors are doing in teaching their patients about perimenopause?
Corio: I would say that they are doing better than when I first went out on my book tour. The book came out in November 2000. I went out on a book tour in 2001 and it was very upsetting to me as a physician to realize that women were not being heard. It was part of the reason I wrote the book. The doctors didn’t have time to speak about it. It was a lack of interest on their part. They would put their hands up in the air and say ’I can’t help you.’ But I think that’s getting better.
Member: I just found out a month ago that I was in fact experiencing symptoms of perimenopause. My doctor has given me progesterone cream to use, and so far, it’s helped. I do however want to know a few things.
1. Even though I’m 36 years old, would this condition prevent me from having a baby in two to three years?
2. Are there any over-the-counter drugs that one could use to help with hot flashes, frequent urinating, and fatigue?
3. When will it be over? Is this just a cycle or will it last until I’m actually going through menopause?
Corio:
1. I would recommend highly that you do not put off the pregnancy for two to three years. If you are experiencing perimenopausal symptoms, definitely have your third day bloods done so that you can see where your FHS is and I would definitely encourage you to conceive now rather than later, because perimenopausal women may not be as fertile as younger women.
2. One of my favorite over-the-counter drugs is Remifemin, which is black cohosh. It relieves hot flashes, raises the mood, and takes about six weeks to work.
3. It will come and go, but it will last as long as it takes to reach menopause. Some women tell me that for a few months they will have hot flashes and then they will go away, they will feel fine for a few months and then it can come back again. So it comes and goes, sometimes it comes and stays but will continue until menopause and sometimes even after menopause. That’s why it is called perimenopause.
Member: How can I overcome the total lack of libido that I am experiencing? This is the one symptom that I am having the most trouble overcoming.
Member: I am 46 and in good health. Of all the symptoms of perimenopause that I have recently started to experience, the most troubling is the loss of libido. Not only that, but almost all sexual sensitivity has diminished as well. Until now, my husband and I have enjoyed a healthy sex life. Will this come back, and what can I do or take (naturally) to help? I do believe in herbs and vitamins.
Corio: There are separate issues here. Clearly when one goes through perimenopause there is a drop in the hormones -- your estrogen, progesterone, and testosterone call all be affected. One of the first things that can happen in perimenopause is vaginal dryness. Forty percent of women experience vaginal dryness and with that, women can have difficulty with reaching orgasm, decreased sensitivity in their vaginal area, and painful intercourse. A lot of that can be helped with some local estrogen cream.
As far as the libido and the lack of interest in sex, my patients describe it as "I couldn’t care less." I do test testosterone levels. The best time to test testosterone levels in a woman who is still menstruating is the middle of her cycle in the middle of the morning. I test testosterone and free testosterone and if the values come up in the lower one-fourth of normal, those patients would benefit from testosterone. My patients have had wonderful responses with compounding natural estrogen, progesterone, and testosterone to raise libido. I have not found any great vitamins to raise libido.
Member: Can you address the issue of memory loss? What can be done?
Corio: I find that vitamins help a lot. Something called "Memory Enhancer" or "Memory Booster" has phosphatidyl serine (PS), acetyl-l-carnitine (ALC), and ginkgo and those three combined, as well as the B vitamins, have helped memory. And I also find that if women are really having a hard time with memory, taking estrogen or phytoestrogens like soy or flax seed have strong beneficial effects on the brain. Also, powerful antioxidants such as vitamins E and C and beta-carotene also help with memory.
Member: I am almost 40 and all of a sudden I am experiencing all of the symptoms. My period has gone from three to four days to seven or eight, and has become heavy and painful. My doctor says it’s normal. Normal for what?
Corio: I think you should believe that this is not normal. My rule of thumb is any woman over the age of 35 who has any change in her bleeding pattern -- starts bleeding heavier or longer or less than three weeks apart -- I always do a biopsy of the uterus to rule out any problems such as precancer of the uterus. You may need some progesterone because your periods are heavier, crampier, and longer. This may be a lack of progesterone.
Member: I’m 44 and have been using oral birth control since I was 18. How would I be able to tell if my periods are different, since the pill regulates this?
Corio: Interestingly enough, my patients who are on birth control pills do get relief of their perimenopausal symptoms and it does help regulate them, so a lot of times they may not be aware that they are going through perimenopause. However, they may start getting symptoms of perimenopause such as hot flashes, or their periods may stop. I test these patients on the week of their placebo pills and see where they are hormonally. I usually try to do a FSH, LH, and estradiol test a day or two before they are going to start their new package of birth control pills -- during the placebo week. And then we can tell where they are hormonally.
Member: Does perimenopause weaken the strength of hair?
Corio: There is some literature that states that the hair becomes duller, less oily, and coarser. There is definitely a change in your hair. It may be dryer and as far as the facial hair, again, in perimenopause some women may have more testosterone and less estrogen and then they can end up with acne and what is called hirsutism or hair growth in unwanted places.
Member: What will the blood test tell us? They said I will take a blood test every year but I am not sure what we will learn from it.
Corio: I wouldn’t take a blood test every year. Blood tests are not the end all and be all of perimenopause. First of all, what we are more interested in are the symptoms and the history and the physical exam. The blood test may lend some information but it may not. And blood tests are for the moment. It shows what’s going at the moment you drew the blood, but if you drew the blood three hours later or another month later, it could be a different blood test. So it’s an additional test to have, but it’s not the definitive test.
Member: Is there a link between increased incidence of depression and perimenopause?
Corio: Depression per se is not a symptom of perimenopause. Women can have mood changes and feel depressed. But a depression, a clinical depression, is more to do with whatever’s going on in your life or maybe something chemical. What we found when we were doing the research was that if a woman entered perimenopause and was in a good place, she may be unhappy or moody but she wasn’t going to undergo a depression. If a woman entered perimenopause and she was having major [problems] in her life, the hormone change may be enough to make her depressed but I don’t think perimenopause per se causes clinical depression.
If somebody were experiencing mood swings along with hot flashes and other perimenopausal symptoms, I would always recommend low-dose natural bioidentical hormones. If somebody is really in a depression -- she’s not eating, not sleeping, and she’s going through a clinical depression while she’s in perimenopause -- I have had patients take low-dose bioidentical hormones along with antidepressants. I don’t think that the antidepressants should be treating hot flashes unless it’s an unusual situation such as a woman with breast cancer who can’t take hormones.
Member: What kinds of foods/supplements/vitamins would ease the symptoms of perimenopause?
Corio: Throughout my book we talk about vitamins, minerals, phytoestrogens, diet, weight gain, and exercise. This is a critical time in a woman’s life where she needs to make changes and I don’t mean dieting. I mean changing the way she eats, taking her vitamins, and really looking at her exercise regime. Because if she doesn’t, the weight is going to creep up. She’s going to notice that weight gain distribution in the middle of her abdomen and she’s going to lose that waistline and put herself at risk for heart disease, stroke, diabetes, and cancer.
Moderator: Dr. Corio, we are almost out of time. Before we wrap up for today, do you have any final comments for us?
Corio: I think that if women want information, they should get the book. It is filled with so much information and everybody whose read it loves it. They keep it by their bedside and use it as a referral.
Moderator: We are out of time. I’m sorry we couldn’t get to all of your great questions. Thank you Dr. Corio, and thank you members for joining us today. For more information, please read The Change Before The Change: Everything You Need to Know to Stay Healthy in the Decade Before Menopause, by Laura Corio, MD.
Check out our news stories, features, and archived interviews with experts on women’s health -- visit the WebMD Menopause Center. Don’t forget our message boards, Menopause, with Joan Starker, MSW, PhD and Women’s Health: Friends Talking .
