Perimenopause

The perimenopausal years represent transition in a woman’s life. At a time when achievement and comfort can be enjoyed, hormonal changes may begin to affect us resulting in physical or emotional symptoms, and life’s stresses can contribute to hormone imbalance. This is a time to really focus on positive health measures and preventative medicine. Perimenopausal changes may start from the mid thirties, though most women don’t experience changes until their mid forties.

40+ women are innovative, sexy, fertile, talented, successful, and beautiful. Media reporting suggests that women’s concepts of themselves, and society’s concepts of women, are changing, with Hollywood now giving her sexy roles. Pregnancy is up 41% among over 40’s, and the rate of women giving birth over 40 has almost doubled in 10 years. However like all transitional periods it is a time when we may need additional support.

What is perimenopause?

Perimenopause represents the time when pre-menopausal hormone changes first begin to occur, until one year after the last menstrual period. For each woman the changes will be different.

In the early stages hormone levels start to fluctuate more, periods may become irregular or can become heavier or lighter, and you may have some cycles where ovulation doesn’t take place. PMS can become worse, and changes in sleep pattern and mood may develop. Fatigue and irritability may increase, and memory can seem less sharp. It is important to remember that all these changes can be a result of stress, and that stress can often aggravate any hormonal changes already occurring.

As perimenopause progresses hot flushes and night sweats may occur, and some women experience changes in skin quality, hair thickness, abdominal weight gain, vaginal dryness, and libido. Fertility levels begin to decrease as a result of less frequent ovulation and a reduction in the quality of the eggs being produced.

Am I still fertile?

Blood tests to assess fertility during perimenopause include

• Anti-mullerian hormone (AMH) is considered the best blood test to measure ovarian reserve, and is usually performed on Day 3 of your cycle. Ovarian reserve indicates both the number and quality of the ovarian follicles. AMH is produced by antral follicles on the ovaries, and levels relate to the number of antral follicles present. Low AMH levels are seen in low ovarian reserve, but elevated levels may indicate PCOS.
• Follicle stimulating hormone (FSH) which becomes increasingly elevated as menopause approaches, but may also be increased in hormonal imbalance. FSH levels normally show a small peak in each menstrual cycle before ovulation. The test is taken on Day 3 when your FSH levels would normally be low.
  
• Inhibin B this test is taken on Day 3 of your menstrual cycle, and low levels indicate a low ovarian reserve.

This combination of tests is available through the complementary medicine practice and is termed an Ovarian Reserve Profile. It will be taken on Day 3 of your cycle.

Ultrasound scanning can performed to show an Antral Follicle Count. These are the resting follicles that can be seen on the ovary on Day 3 of your cycle. A good count shows good ovarian reserve, but too high a count may indicate PCOS.

The advantage of being tested is that it enables you to make life plans and decisions. Many women are delaying having a baby while busy developing a career, or focussing on other areas of life. Knowing your hormonal status may prompt you to make definite plans, or to make lifestyle changes that help balance hormones.

Am I menopausal?

Blood tests that can be performed to assess menopausal changes include

• Follicle stimulating hormone (FSH) which becomes increasingly and persistently elevated as menopause approaches, but may also be increased in hormonal imbalance
  
• Luteinising hormone (LH) which gradually increases as menopause approaches and remains raised after menopause
  
• Oestradiol 17-beta this is the most common oestrogen in the body and levels diminish at menopause
  
• Thyroid stimulating hormone (TSH) thyroid problems can mimic perimenopausal and menopausal symptoms so it is a good idea to exclude thyroid disease, also some women develop thyroid problems at menopause
  
• Free thyroxine (Free T4) to exclude thyroid problems

This combination of tests is available through the complementary medicine practice and is termed a Menopause Profile.

What can I do if I’m perimenopausal?

The choices here are very individual, and often depend on both the severity of the symptoms, and the changes evident on blood tests.

Acupuncture has a long history of use in regulating the menstrual cycle, relieving hot flushes, assisting fertility, and alleviating stress symptoms. Using a combination of acupuncture and nutrition or herbs, we are able to balance the body’s hormones and energies. Perimenopausal changes, hormone imbalance, infertility, menopausal symptoms, concomitant disease, stress management, and mood changes can be addressed this way. If you are trying to conceive and assisted conception or IVF is indicated then acupuncture, nutrition and herbs can provide effective support.