YOUR CYCLES DURING PERIMENOPAUSE
Dr Steven R. Goldstein is a Perimenopause Specialist in NYC who has written extensively on Perimenopause and treated many patients going through this stage of life. Menopause is defined as when there is no more ovarian function. The ovaries no longer make estrogen, and you no longer ovulate. Pre-Menopause means you are still making estrogen, though you may not be ovulating on a regular basis. Perimenopause is technically the first break in cyclicity. In other words, in the reproductive years most women have very regular cycles, and as you come off the reproductive years into perimenopause, the cycles can become somewhat irregular. To most patients, all the blood that comes out of their vagina is their period, but to Dr Goldstein, a menses is a bleed that is preceded two weeks before by ovulation. And so, if you don’t ovulate, you can still bleed. Those cycles are referred to as anovulatory, the “an” meaning without. You are making estrogen, but not any progesterone. So, Perimenopause is a time of fluctuating estrogen in a woman’s body without ovulation and without progesterone. This can cause some real havoc in the bleeding pattern, cycles, and also some havoc in what we call psychosocial symptoms such as worsening PMS, free floating anxiety, mood swings, inability to concentrate, sleep disturbances, brain fog, and so on, due to fluctuating levels of unopposed estrogen, rather than the absent estrogen of menopause.