Menopause & perimenopause
Perimenopause — References & further reading
1 Clayton, A., & Ninan, P. 2010. Depression or menopause? Presentation
and management of major depressive disorder in perimenopausal and postmenopausal
women. Prim. Care Companion J. Clin. Psychiatry, 12 (1), PCC.08r00747.
URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/20582297 (accessed 07.08.2010).
“The median age at onset of the perimenopause in the United States is 47.5 years of age, the median age at menopause is approximately 51.3 years….”
2 Clayton, A., & Ninan, P. 2010.
3 Clayton, A., & Ninan, P. 2010.
Burger, H., et al. 2007. A review of hormonal changes during the menopausal
transition: Focus on findings from the Melbourne Women’s Midlife Health Project. Hum. Reprod. Update, 13 (6), 559–565. URL: http://humupd.oxfordjournals.org/cgi/content/full/13/6/559?view=long&pmid=17630397
(accessed 07.08.2010).
4 Clayton, A., & Ninan, P. 2010.
“The menopausal transition begins with changes in the hypothalamic–pituitary–gonadal axis, which typically coincide with observable alterations in the menstrual cycle. However, hormonal fluctuations may occur without associated changes in the menstrual cycle; it is thus important to recognize that menopausal symptoms may precede noticeable menstrual cycle changes in midlife women.”
Woods, N., & Mitchel, E. 2005. Symptoms during the perimenopause:
Prevalence, severity, trajectory, and significance in women’s lives. Am. J. Med.,
118 (Suppl. 12B), 14–24. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/16414323
(accessed 07.08.2010).
Greendale, G., et al. 2010. Menopause-associated symptoms and cognitive
performance: Results from the study of women’s health across the nation. Am. J.
Epidem., 171 (11), 1214–1224. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/20442205
(accessed 07.08.2010).
5Clayton, A., & Ninan, P. 2010.
6 Former Women to Women practitioner and functional medical colleague Bethany Hays, M.D. writes:
“When adrenaline is continuously elevated, the body tries to balance these actions by lowering estrogen and thyroid.”
Hays, B. 2005. Chapter 19. Hormonal imbalances: Female hormones: The
dance of the hormones. Pt. I, 215–234. In Textbook of Functional Medicine. Gig
Harbor, WA: Institute for Functional Medicine.
Thus, chronic stress can have exaggerated effects during perimenopause, as the ovaries are handing the baton over to the adrenals as primary site of estrogen and progesterone production. Healthy adrenal glands are ready to take on this increased workload at menopause. From the standpoint of the functional medicine model, and as borne out by Women to Women’s clinical experience, it is unremittant stress and anxiety that are probably the most widespread, problematic, and recalcitrant cause of hormonal imbalance and its symptoms, such as irritability, depressed mood, and hot flashes, versus estrogen “deficiency,” as received wisdom might have it.
7 Hassan, I., et al. 2004. PMS in the perimenopause. J. Br. Menopause Soc., 10 (4), 151–156. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/15667751 (accessed 06.22.2011).
References for definition of perimenopause
Clayton, A., & Ninan, P. 2010.
Burger, H., et al. 2007. A review of hormonal changes during the menopausal transition: Focus on findings from the Melbourne Women’s Midlife Health Project. Hum. Reprod. Update, 13 (6), 559–565. URL: http://humupd.oxfordjournals.org/cgi/content/full/13/6/559?view=long&pmid=17630397 (accessed 07.08.2010).
References for symptoms common in perimenopause
1 Clayton, A., & Ninan, P. 2010.
2 Born L., et al. 2008. A new, female-specific irritability rating scale. J. Psychiatry Neurosci., 33 (4), 344–354. URL (PDF): http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-33/issue-4/pdf/pg344.pdf (accessed 06.23.2011).
Freeman, E., et al. 2008. Symptoms in the menopausal transition: Hormone and behavioral correlates. Obstet. Gynecol., 111 (1), 127–136. URL: http://www.ncbi.nlm.nih.gov/pubmed/18165401 (accessed 06.22.2011).
“Irritability is the primary mood complaint for up to 70% of women during the perimenopause, a phenomenon that has been observed cross-culturally.”
3 Freeman, E., et al. 2006. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch. Gen. Psychiatry, 63 (4), 375–382. URL: http://archpsyc.ama-assn.org/cgi/content/full/63/4/375 (accessed 06.22.2011).< /p>
“High CES-D scores … were more than 4 times more likely to occur during a woman’s menopausal transition compared with when she was premenopausal …. Within-woman change in menopausal status, increased levels of follicle-stimulating hormone and luteinizing hormone, and increased variability of estradiol, follicle-stimulating hormone, and luteinizing hormone around the woman’s own mean levels were each significantly associated with high CES-D scores after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment, and marital status. A diagnosis of depressive disorder was 2½ times more likely to occur in the menopausal transition compared with when the woman was premenopausal… the hormone measures were also significantly associated with this outcome.”
Nappi, R., et al. 2010. Hormonal and psycho-relational aspects of sexual function during menopausal transition and at early menopause. Maturitas, 67 (1), 78–83. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/20554405 (accessed 07.08.2010).
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Perimenopause — a time of change
Last Modified Date: 07/26/2011