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What is Perimenopause?

Health & Wellness

By Susan E. Vogler, DO

The natural part of aging that signals the end of your reproductive years is called Perimenopause.  It lasts two to ten years and begins before the cessation of menses (periods) called Menopause.

Perimenopause is characterized by menstrual cycles that become irregular due to the hormones Estrogen and Progesterone rising and falling unevenly.  Some healthcare providers may also call this change ‘abnormal uterine bleeding’ or ‘dysfunctional uterine bleeding’. These changes in your periods most often start in your 40s but some women can experience changes in their late 30s.  Family history is perhaps the best predictor of when you may start to see changes in your menstrual cycle.  If your mother experienced an early menopause the chances are good that you will too. 

In general, menstrual cycles tend to shorten (i.e.: menses get more frequent) as menopause approaches.  This is a slow process occurring over several years.  Periods usually stay regular during this transition – every 23 or 24 days versus every 28-30 days previously.  As the ovaries age and become less efficient, ovulation occurs less frequently.  This is reflected in the menstrual cycle as a more pronounced irregularity; for example, cycles that will vary from 14-40 days or more in length.  These patterns are generally related to hormonal changes and are typically benign. This can result in periods that are not only irregular but also very heavy.  Quality of life can be affected by causing fatigue and limiting activity.  Some women must remain confined to the home or at least within the proximity to a bathroom for days at a time.

In addition to hormonal changes, there are many other potential reasons for a woman to experience changes in menses in the perimenopausal years.  An undiagnosed pregnancy, a thyroid condition, a blood disorder, an anatomical abnormality such as a uterine fibroid or endometrial polyp, or even uterine or cervical cancer are all examples of other possible causes for abnormal uterine bleeding.   However, hormonal change is the most common reason why periods change and become heavy and irregular.

When should you see the doctor?  If you experience symptoms that you cannot tolerate such as heavy, irregular periods that are unpredictable, you should consider making an appointment.  Your doctor may order some basic blood tests, a pelvic ultrasound or perform a biopsy of the inner layer of your uterus called an endometrial biopsy.

There are many medical and surgical options available to help remedy the irregular bleeding pattern, such as, hormone therapy, endometrial ablation and hysterectomy.

Use of the low dose oral contraceptive pill (OCP) or Mirena intrauterine device (IUD) are just a couple examples of medical treatments. The OCP and Mirena IUD help keep the inner lining of the uterus thin so bleeding gets lighter and they provide effective birth control.

The endometrial ablation, on the other hand, is a non-invasive surgical procedure which can quickly and often permanently resolve heavy, irregular periods without the need of having major surgery.  It does not provide any birth control.  The procedure takes just a few minutes and recovery is brief.  The endometrial ablation procedure can be performed in the hospital, an ambulatory surgery center or in your doctor’s office. Most women report their quality of life improves greatly after having this type of procedure.

Hysterectomy is removal of the uterus.  It is considered major surgery and recovery time is often longer.  There are many different surgical techniques to perform a hysterectomy including vaginal, abdominal, laparoscopic and the robotic-assisted.  The recovery time for each of these approaches varies.

If you are concerned about your menstrual flow or would like to learn more about how to make your bleeding pattern lighter and shorter, please call the office to make an appointment.

Susan E. Vogler, DO

Hawthorn Medical Associates Gynecologist Susan E. Vogler, DO, is board certified by the American Board of Obstetrics and Gynecology. She specializes in providing comprehensive, personalized women’s health care that encompasses the special health issues women face from the teenage years to menopause.

A graduate of New England School of Osteopathic Medicine, Dr. Vogler completed an Obstetrics/Gynecology residency at St. Francis Hospital and Medical Center in Hartford, CT.

Dr. Vogler sees patients at 537 Faunce Corner Road in Dartmouth, MA. Her office number is 508-996-3991.


View all articles by Susan E. Vogler, DO



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