USA Today, Monday, September 26

Change of life remains hard
Perimenopause symptoms are often difficult to treat
Your health By Kim Painter

Perimenopause — defined roughly as the several years in which a woman's body undergoes the changes that end in menopause — wasn't invented in the mid-1990s. But it sure seemed that way.

Suddenly, magazines and newspapers were full of stories about women shocked to find that they were approaching what their mothers called the “change of life.” The first baby-boomer women to encounter middle age wanted to know — in typical demanding boomer fashion — what the heck was going on with their bodies. Largely because of their persistence, a lot has been learned in the past few years.

But for women who are just entering this phase, much remains murky.

“Women are still being caught off guard by these symptoms,” from their first hot flashes to bouts of insomnia to menstrual bleeding that seems alarmingly frequent or infrequent, heavy, light or just unpredictable, says Karen Giblin, founder of the Prime Plus/Red Hot Mamas support network. A woman of 35, 45 or even 50 today often just can't believe she's old enough to be perimenopausal, Giblin says. That's despite the fact that women in perimenopause (which typically starts in the mid to late 40s) often have more intense symptoms than women who have passed the milestone of the last menstrual period (at an average age of 51).

“It's a time of rapid fluctuations in hormone levels, where one month a woman could think she's menopausal because she has all the symptoms, and suddenly the symptoms disappear and a few weeks later she has a period. It's also a time when a woman may worry that a missed period means she's pregnant. It all can be very disconcerting,” says Isaac Schiff, chief of OB/GYN at Massachusetts General Hospital in Boston.

Doctors can't always give women the answers they seek. Experts convened by the National Institutes of Health this year concluded that estrogen, alone or with progestin, is the most effective treatment for intolerable hot flashes and night sweats; other treatments, though popular, are unproven or less effective.

But we all know estrogen isn't the wonder drug once imagined. Yes, it will stop the hot flashes (though they may return when you stop taking hormones) and is good for your bones (though other drugs will help, too). But it won't prevent heart disease or dementia and could raise the risk of heart attack, stroke and breast cancer — though studies that revealed these risks involved post-menopausal women who, on average, were older than most who seek symptom relief. Risks of short-term use for younger women are unknown, though doctors believe they are lower.

Another wrinkle for women still having periods: Doctors often prefer to offer them low-dose birth control pills, which have higher hormone doses than drugs given to postmenopausal women. The pill more effectively regulates menstruation and offers contraception, too. Risks include blood clots and stroke.

For women who are queasy about hormones, there are the old standbys: Exercise, wear layers of comfortable cotton clothing, cut caffeine and crank up the air conditioning. One recent study found many women who resumed hot flashes after dropping hormone therapy found such basic approaches helpful.