Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-02T19:03:02.422Z Has data issue: false hasContentIssue false

8 - Physical changes in menopause and perimenopause

from Part II - Hormonal changes

Published online by Cambridge University Press:  21 August 2009

Margaret Gradison
Affiliation:
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
Jo Ann Rosenfeld
Affiliation:
The Johns Hopkins University
Get access

Summary

Case: S. J. is a 47-year-old woman who presents with abnormal uterine bleeding. She had regular periods until two years ago, at which time her periods became unpredictable. Her current menses started three weeks ago; she says it alternates between needing to change pads hourly to requiring only a daily panty liner. Ms J. is obese and smokes a pack of cigarettes a day. Her only medication is thyroid supplements. Her obstetrical history is gravida three para two spontaneous abortion one (G3P2 AB 1). She uses condoms intermittently for contraception, and her first pregnancy was at age 29.

Perimenopause and menopause

Perimenopause is the time in a woman's life when she begins to experience the changes that lead to menopause. The World Health Organization (WHO) defines this as a “period immediately prior to menopause (when the endocrinological, biological, and clinical features of approaching menopause commence) and the first year after menopause.”1

This transition is caused by a decrease in gonadotropin and ovarian hormones. The ovaries produce decreasing amounts of estrogen and the target organs become less sensitive. Some women experience significant symptomatology during this time, which leads them to seek medical assistance. Menstrual changes, hot flushes, and other signs of estrogen deficiency, such as vaginal dryness, may be the first symptoms that a woman experiences. Perimenopause is a transition phase that usually lasts four to six years. This is the time when women move from a state of fertility and potential childbearing to infertility and permanent amenorrhea.

Type
Chapter
Information
Women's Health in Mid-Life
A Primary Care Guide
, pp. 125 - 136
Publisher: Cambridge University Press
Print publication year: 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization. World Health Report, 1998. Geneva: World Health Organization; 1998. http://www.who.int/whr2001/2001/archives/1998/index.htm. Accessed March 13, 2003
Harlow, B. L. and Signorello, L. B.Factors associated with early menopause. Maturitas 2002; 42 (supp 1): S87–93Google Scholar
Obermeyer, C. M.Menopause across cultures: a review of the evidence. Menopause 2000; 7:184–92CrossRefGoogle Scholar
Valleur, J.Counseling the perimenopausal woman. Obstet. Gynecol. Clin. 2002; 29:541–53CrossRefGoogle ScholarPubMed
Bachmann, G. A. and Nevadunsky, N. S.Diagnosis and treatment of atrophic vaginitis. Am. Fam. Physician 2000; 61:3090–96Google ScholarPubMed
Cutson, T. M. and Meuleman, E.Managing menopause. Am. Fam. Physician 2000; 61:1391–400, 1405–6Google ScholarPubMed
Kaunitz, A.Gynecologic problems of the perimenopause: evaluation and treatment. Obstet. Gynecol. Clin. North Am. 2002; 29;455–73CrossRefGoogle ScholarPubMed
Rymer, J. Menopausal symptoms. In BMJ. Clinical Evidence. London. BMJ; 2000. pp. 1516–19
Leonetti, H. B., Longo, S. and Anasti, J. N.Transdermal progesterone cream for vasomotor symptoms and post menopausal bone loss. Obstet. Gynecol. 1999; 94:225–8Google Scholar
Upmalis, D. H., Lobo, R., Bradley, L., et al.Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Menopause 2000; 7:236–42CrossRefGoogle ScholarPubMed
Faure, E. D., Chantre, P. and Mares, P.Effects of a standardized soy extract on hot flushes: a multicenter, double-blind, randomized, placebo-controlled study. Menopause 2002; 9:329–34CrossRefGoogle ScholarPubMed
Ewies, A.Phytoestrogens in the management of the menopause: up-to-date. Obstet. Gynecol. Surv. 2002; 57:306–13CrossRefGoogle ScholarPubMed
Dog, T. L., Riley, D. and Carter, T.An integrative approach to menopause. Altern. Ther. Health Med. 2001; 7:45–55Google Scholar
Rosenfeld, J. A. and Speedie, A. Patterns in the perimenopausal period. A survey. J. Fam. Pract., submitted
Morelli, V. and Naquin, C.Alternate therapies for traditional disease states: menopause. Am. Fam. Physician 2002; 66:129–34Google Scholar
Rosenfeld, J. A. and Speedie, A. Patterns in the perimenopausal period: a survey. Maturitas, submitted
Davis, P. C., O'Neill, M. J., Yoder, I. C., Lee, S. I. and Mueller, P. R.Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics 2002; 22:803–16CrossRefGoogle ScholarPubMed
Briley, M. and Lindsell, D. R.The role of transvaginal ultrasound in the investigation of women with post-menopausal bleeding. Clin. Radiol. 1998; 53:502–5CrossRefGoogle ScholarPubMed
O'Connell, L. P., Fries, M. H., Zeringue, E. and Brehm, W.Triage of abnormal postmenopausal bleeding: a comparison of endometrial biopsy and transvaginal sonohysterography versus fractional curettage with hysteroscopy. Am. J. Obstet. Gynecol. 1998; 178:956–61CrossRefGoogle ScholarPubMed
Lethaby, A., Augood, C. and Duckitt, K. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst. Rev. 2002; issue 4
Beaumont, H., Augood, C., Duckitt, K. and Lethaby, A. Danazol for heavy menstrual bleeding. Cochrane Database Syst. Rev. 2002; issue 4
Jensen, J. T. and Speroff, L.Health benefits of oral contraceptives. Obstet. Gynecol. Clin. North Am. 2000; 27:705–21CrossRefGoogle ScholarPubMed
Luukkainen, T.The levonorgestrel intrauterine system: therapeutic aspects. Steroids 2000; 65:699–702CrossRefGoogle ScholarPubMed
Lethaby, A. and Hickey, M. Endometrial destruction techniques for heavy menstrual bleeding. Cochrane Database Syst. Rev. 2002; issue 4.

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×