Perimenopause – what are the signs?

Q: I am 42 years old, and my periods have become inconsistent. I often skip a month, then resume for several months, then skip again. I am also noticing more facial fuzz and dark hairs. Is all this normal?

A: There are many causes of irregular periods. It is entirely possible that you are just heading toward menopause. Although the average age at menopause is 51, there are women going through menopause as early as 35, or as late as 59. Unfortunately, menopause is a retrospective diagnosis; if you go a year without a period, I can tell you that you are through menopause.

There is, however, one lab test that might be helpful. When we go through menopause, and our ovaries start pooping out, our pituitary gland sends more of a hormone called FSH, or follicle stimulating hormone, into the blood stream to try to stimulate the ovary. Doctors can measure your FSH, and if it is elevated, that is very suggestive that you are entering menopause.

However, I suspect you might be dealing with a reasonably common condition called polycystic ovary syndrome, known in gynecology as PCO. This condition causes ovaries to churn out more testosterone than is normal. Don’t be alarmed – all premenopausal women make testosterone, it’s just that women with PCO make more. Your extra facial hair may be the result of this. To test for this condition, doctors measure testosterone in the blood stream; elevations of testosterone would help confirm this condition.

If PCO is identified, therapy is readily available. Low-dose birth control pills are very helpful for this condition (they work by shutting down the ovary). When we shut down the ovary’s egg producing capacity, we also shut down its testosterone production, and you will not develop any more hairs. However, hair already present will not disappear, so you might want to think of measures like electrolysis. Of course, low-dose oral contraceptives can be very helpful to control irregular periods in perimenopause, so in either case, pills would be likely to help.

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