The rocky road to menopause

Many women dread the eventuality of menopause - while others welcome it with open arms. In either case, the process of reaching the "end of monthly cycles" can be a rocky road. The timeframe directly before a woman starts menopause is called peri-menopause; which literally means "around menopause".

The storm before the quiet

This phase can start 2-10 years prior to actual menopause and occurs generally in women ages 35-55. The most common sign of peri-menopause is an irregular menstrual cycle. The timing and length of periods usually become erratic and unpredictable. Menstrual bleeding often becomes lighter, but sometimes - perhaps ironically - heavier and more frequent before stopping altogether.

Many women in peri-menopause also experience hot flashes, difficulty sleeping, mood swings and other unpleasantries. Alterations in hormone levels are largely to blame for these menopausal-type symptoms.

To test or not to test?

Diagnosing menopause and peri-menopause can typically be done with just a good health history and physical exam. However, a variety of medical conditions can have similar symptoms. Sometimes medical testing is needed to rule out any "other" suspected conditions.

Lab testing directly for "menopause" or "peri-menopause"  can be tricky and has many caveats. We know that post-menopausal women have very low levels of estrogen and high levels of Follicle Stimulating Hormone (FSH). Prior to several years past menopause, estrogen levels vary widely among different women (regardless of age) and even within the same woman depending on day and time - so it is generally not the best test to confirm menopausal issues.

A consistently "elevated" FSH is the most reliable lab marker of ovarian failure, the underlying cause of menopause. However, the FSH test is not without it's limitations. The timing of the FSH rise can be variable with respect to menopause; sometimes occurring years before or just around menopause in others. Also, FSH levels can vary widely within a single woman (even at the same time in a cycle), so they need to be repeated several times for confirmation.

Predicting menopause

For a variety of reasons, many women want to know when they are likely to start menopause. Family history of menopause (particularly first-degree relatives) is probably the best predictor currently available - especially if it occurs at a young age. Also, smokers tend to enter into menopause a few years earlier than their counterparts. Some health conditions and medications may also speed up the process.

In recent years there have been a few breakthroughs on using laboratory markers to predict the onset of menopause. The most recent advancement is a lab test called Anti-Mullearian Hormone. Several media reports have touted it as a predictor of menopause and for good reason. This test has been used for many years in fertility concerns, but just recently studied with respect to menopause. It has been found that a "low" AMH is a very good predictor of menopause occurring "in the next 5 years".

Medical management

Most women can progress through peri-menopause without any type of medical intervention. If symptoms become severe, bleeding becomes heavy or other conditions are suspected, a visit with the doctor is warranted to discuss diagnostic testing and possible treatment. Sometimes supplements or medications may be helpful or warranted to ease the transition into menopause.