Perimenopause

ALEKEL D L, ST GERMAIN A, PERESON C T, HANSON K B, STEWART J W, TODA T (2000) IsoflaVOne-rich soy protein isolate attenuates bone loss in the lumber spine of perimenopausal women. Am J Clin Nutr. 72 844-52. 

Alekel et al., 2000 American perimenopause n = 69 40 g soy protein (containing 80 mg isoflavones/day) over 6 months attenuates bone loss in the lumbar spine... 

Soy isoflavones improve systemic arterial compliance but not plasma lipids in menopausal and perimenopausal women. Arterioscler Thromb Vase Biol. 17 (12) 3392-8. 

WASHBURN s, BURKE G L, MORGAN T and ANTHONY M (1999). Effect of soy protein supplementation on serum hpoproteins, blood pressure and menopausal symptoms in perimenopausal women. Menopause 6 (1) 7-13. 

Physiologic causes Adolescence Perimenopause Immaturity of the hypothalamic-pituitary-ovarian axis no LH surge Declining ovarian function... 

Anovulation may result from a problem at any level of the HPO axis. In addition to various physiologic life stages such as adolescence, perimenopause, pregnancy, and lactation, other causes of anovulation include 11... 

Irregular, heavy, or prolonged vaginal bleeding, perimenopausal symptoms (hot flashes, etc.)... 

The usual transitional period prior to menopause, known as perimenopause or the climacteric, is a period... 

Because the perimenopausal and postmenopausal periods are marked by many biologic and endocrinologic changes, women should inform their health care provider when they experience any signs and symptoms in order to discuss the most appropriate therapeutic approach. 

The pathophysiologic changes that occur during the perimenopausal and menopausal periods are caused by the decrease and eventual loss of ovarian follicular activity. As women age, the number of ovarian follicles decreases, and the remaining follicles require higher levels of FSH for maturation and ovulation. During perimenopause, FSH concentrations... 

Vasomotor symptoms, as well as other menopausal symptoms, occur in over 50% of perimenopausal women and over 80% of menopausal women.5 Menopausal symptoms tend to be more severe in women who undergo surgical menopause compared with natural menopause because of the more rapid decline in estrogen concentrations. Women who seek medical treatment should undergo laboratory evaluation to rule out other conditions that may present with similar symptoms, such as abnormal thyroid function or pituitary adenoma. Once other conditions have been excluded, HRT should be considered. 

Approximately one-third to one-half of osteoporosis cases in men and half of all cases in perimenopausal women are due to secondary causes.4 Common secondary causes in men include hypogonadism, glucocorticoid use, and alcoholism. The most common cause of drug-induced osteoporosis is glucocorticoid use. 

Perimenopause The period of time prior to menopause when hormonal and biological changes and physical symptoms begin to occur and usually lasts for 1 year after the last menstrual period. The perimenopausal period may last for an average of 3 to 5 years. Perimenopause is also known as the climacteric. 

Del Rio, G., Menozzi, R., Zizzo, G., Avogaro, A., Marrano, P. and Velardo, A., Increased cardiovascular response to caffeine in perimenopausal women before and during estrogen therapy. Eur J Endocrinol 135(5), 598-603, 1996. 

Slemenda, C. W., Siu, L. H., Longscope, C., Wellman, H., Johnston, C., Predictors of bone mass in perimenopausal women a prospective study of clinical data using photon absorptiometry, Annals of Internal Medicine, 112, 96, 1990. 

Adolescents, underweight women (<110 lb [50 kg]), women older than 35 years, and those who are perimenopausal may have fewer side effects with OCs containing 20 to 25 meg of EE. However, these low-estrogen OCs are associated with more breakthrough bleeding and an increased risk of contraceptive failure if doses are missed. 

Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. Perimenopause is the period immediately prior to the menopause and the first year after menopause. Indications of postmenopausal hormone therapy include the short-term treatment of menopausal symptoms (i.e., hot flushes, night sweats, and urogenital atrophy). 

Dysfunctional uterine bleeding may occur during perimenopause. 

Menopause is determined retrospectively after 12 consecutive months of amenorrhea. FSH on day 2 or 3 of the menstrual cycle greater than 10 to 12 international units/L suggests presence of perimenopause. 

Endocrine or hormonal dysregulation (Addison s disease, Cushing s disease, hyper- or hypothyroidism, menstrual-related or pregnancy-related or perimenopausal mood disorders)... 

Hormonal changes during the female life cycle can cause dysreguiation of neurotransmitters (e.g., premenstrual, postpartum, and perimenopause). 

Shozu M, Murakami K, Segawa T, Kasai T, Inoue M (2003) Successful treatment of a symptomatic uterine leiomyoma in a perimenopausal woman with a nonsteroidal aromatase inhibitor. Fertil Steril 79 628-631... 

Alekel, D.L., Germain, A.S., Peterson, C.T., Hanson, K.B., Steward, J.W. and Toda, T. (2000). Isoflavone-rich soy protein isolate attenuate bone loss in the lumbar spine of perimenopausal women, Am. J. Clin. Nutr., 72, 844-852. 

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