35 and Counting
with Sandra Gottwald, M.D., obstetrician/gynecologist with Advanced Healthcare
What was once a subject spoken only in whispers is now a topic of choice, catered to by advertisements, and discussed by thirty-something women contemplating what changes to expect as they near their 40s. Menopause and its symptoms are mainstream topics, and perimenopause - the years leading into menopause - has become equally recognizable.
But just what is perimenopause and how much does it really relate to the actual life changes that occur during menopause?
According to Sandra Gottwald, M.D., an obstetrician/gynecologist for Advanced Healthcare, it's a "wastebasket term" for a number of changes that can occur in the thirties.
"People automatically jump to the conclusion that what they are experiencing is related to menopause," she said. "That can't be true if they're still having their period." Gottwald emphasized the fact that menopause means the complete cessation of menstruation, and used to be defined by one complete year with no menstrual flow. While the latter definition is not so widely applied anymore, menopause is diagnosed only in cases where the ovaries have stopped functioning completely.
While women in their late 30s may be noticing changes, they won't find things to be much different in an annual exam unless they are considering child bearing. If so, they qualify for genetic testing, and should be aware of risks like diabetes and hypertension disorders in pregnancy. The rules for mammograms have changed for thirty-somethings over the last couple of years and aren't indicated until the age of 40 unless a first-degree relative has had breast cancer. Gottwald feels the most important things to pay attention to include up-to-date immunizations, like tetanus, and diet and exercise issues.
Early menopause symptoms
Women who skip a month here or there or have irregular or heavy bleeding often worry that it is an early sign of menopause. Gottwald said that's simply not the case. When those symptoms become socially compromising, it's called dysfunctional uterine bleeding and in many cases, she would treat these symptoms medically by prescribing a birth control pill to regulate the cycle. The birth control pill carries three times the amount of hormone that hormone replacement therapy (used for women who are menopausal) does because it is required in order to suppress ovarian function and tricks the brain into not stimulating the ovaries. It is a common and effective way of treating things like irregular bleeding and hot flashes.
Premature menopause is a reality when it occurs for women before the age of 40. A person who is experiencing long periods of time without menstrual flow or who has regular hot flashes, for instance, can be diagnosed through standard lab work. In these cases, a hormone called FSH (Follicle Stimulating Hormone) released from the brain is very high because the ovaries are not functioning.
As for herbal or other supplements that are advertised for perimenopause, Gottwald warns that these are not approved by the Federal Drug Administration. "People are being bombarded with misinformation and it can be very confusing," said Gottwald. "Most women don't need anything like hormone replacement, but just need to be on the birth control pill. Now the pill is the first order of therapy."
