Perimenopause and Menopause
What is Perimenopause?
When I tell my patients “You are in peri-menopause”, they commonly ask in fear “Am I in menopause?”. Perimenopause simply means “a quarter to menopause” in which certain hormonal changes and differentiation occur. In academic point of view in some articles, it is a period of which biochemical basis is formed around 35 even if woman do not understand, but in some cases clinical symptoms may occur even around 38-40.
The most important character of perimenopausal period is that irregular menstruation and problems of high estrogenic activity occur in this period. The cause of this problem lays in basic physiologic information. 🙂
Then let’s talk about these basic information: Basic Pathophysiology Regarding Perimenopause
During the entire lifetime, woman has the highest number of eggs in her mother’s womb. Female fetus has 7 millions of eggs in 16-20th pregnancy weeks. Subsequently, a programmed cellular death begins in ovaries, which is called APOPTOSIS. At birth, there are 1 million of ovum and when menstruation begins there are only 300 thousands of ovum are present. Whether they give birth to 10 children, woman can only use 400-450 of these eggs. This process gets faster especially when the age gets closer to 40. Besides, qualified ova are used in younger ages and old ova which are difficult to provide pregnancy are left behind. Ovulation of these old ova is difficult. They begin to get damaged because they are old. Thus, high estrogen levels occur!
Progesterone cannot be secreted because ovulation does not occur or it is very few. This condition causes excessive effects of estrogen on the endometrium, thus causing excessive activation. Tissue begins to fall off irregularly. That is why irregular and severe bleedings occur in women around the ages 40-45. The reason for women getting surgery due to myomas in this period is also this hormonal environment. Myomas love high estrogen. They grow excessively!
The period in which this hormonal cycle occurs I told about is called “Perimenopausal period”. When hormones are checked, high estrogen and low FSH levels would be determined. IT is also a difficult period for gynecologists who try to solve the problems. Besides, it is a period showing constant hormonal changes.
In treatment of patient’s complaints, especially for treatment of excessive and irregular menstruation, progesterone replacement is applied. Oral drugs can be given as well as intrauterine devices with hormones can be used as local progesterone, which I prefer more, in order to remove the negative effect of high estrogen in the endometrium tissue.
BUT THE MOST IMPORTANT POINT IS THAT A PATIENT WHO HAS INTERMENSTRUAL BLEEDINGS IN THIS PERIOD MUST NOT BE TREATED WITHOUT SAMPLING THE ENDOMETRIUM AND TAKING A BIOPSY. BECAUSE UNDERLYING ENDOMETRIUM CANCER OR PRECANCEROUS FORMATIONS SUCH AS ENDOMETRIAL HYPERPLASIA MAY BE MISSED. BIOPSY MUST BE TAKEN BEFORE TREATMENT.
What is Menopause?
Menopause refers to the end of menstruations. A woman goes through; childhood, adolescence, reproductive age, menopausal period and climacteric period in her life. You can see different definitions of menopause below.
Basically, menopausal period is the period in which ovarian functions of a woman is over after reproductive ages. Ovaries that begin to work with adolescence and secrete hormones basically secrete estrogen, progesterone and testosterone hormones. A major part of production of these hormones in woman occurs in ovaries. In menopausal period, ovarian functions stop and production of these hormones gets reduced. Therefore, a condition comes up that occur with lack of ovarian functions in menopause. This condition is called menopausal syndrome.
Here, you may see a slide showing how and when the symptoms of perimenopausal and postmenopausal period occur.