Perimenopause is as Different from Menopause as Chalk from Cheese

by Jerilynn C. Prior
Dr Jerilynn Prior comments on a new menopause site in this Globe & Mail article from October 16, 2009.

Last Thursday I learned from Carly Weeks of The Globe and Mail that a new website by the 14-member strong Canadian Menopause Coalition was just unveiled. I quickly went to www.menopauseandu.ca and found that “menopause” was mixed with perimenopause. Most importantly, accurate and helpful information about the higher estrogen levels in perimenopause was absent.

“Leading up to menopause and after, the estrogen levels in a woman’s body decrease.” Sounds straightforward. However—“leading up to menopause”—is Perimenopause with higher estrogens! During perimenopause estrogen levels are higher than in young women (http://www.cemcor.ubc.ca/help_yourself/articles/perimenopause_ovarys_gra...).

I know the difference between perimenopause and menopause first hand. I had a miserable 10-year stint in perimenopause suffering with flooding, weight gain, perpetually bigger and sorer breasts—my experiences forced me to do the research that proves the higher perimenopausal estrogen levels (1). I have since learned that about 20% of perimenopausal women, like me, are miserable because of extremely high estrogen levels. The majority, however, sail through provided they find accurate information and make some sensible life style adjustments.

Perimenopause can be confused with menopause (one year without flow) because they both bring hot flushes and night sweats. Unfortunately we (wrongly) think of hot flushes as meaning low estrogen. But in perimenopause hot flushes seem to be caused by the sky dive that estrogen intermittently takes, especially before flow.

I’m now happy and well in menopause—the weight has gradually decreased (mind you, with eating less and lots of walking), my night sweats have gone away and my breasts are now comfortable.

Perimenopause has unique symptoms that women need to know. These are not mentioned because Gynecology (the surgical specialty focusing on women’s pelvic organs) and the institutions associated with it, and its pharmaceutical supporters, do not admit that estrogen levels are higher in perimenopause. Most sensible women can figure out that heavy flow, increased cramps, migraine headaches and sore breasts are not caused by low or dropping estrogen! I could find none of these symptoms on this website. At least one in three perimenopausal women will have flooding periods—heavy flow is strongly associated with higher estradiol levels and lower progesterone (2).

This Coalition creates confusion and misinformation rather than the collaborative clarity that it was (surely) intended to provide.

Reference List

1. Prior JC. Perimenopause: The complex endocrinology of the menopausal transition. Endocr.Rev. 1998;19:397-428.
2. Moen MH, Kahn H, Bjerve KS, Halvorsen TB. Menometrorrhagia in the perimenopause is associated with increased serum estradiol. Maturitas 2004;47(2):151-5.