Perimenopause and the Biological Clock

  

Dr Steven R. Goldstein is a Perimenopause Specialist NYC who has helped thousands of women navigate Perimenopause, the transitional phase to Menopause. From the late thirties to the late forties, women may enter Perimenopause, which is a preparatory stage for menopause, both biologically and symptomatically.

 

Women in their late thirties or forties who are not yet married often ask about the “Biological clock”.  The term "biological clock" is more than just a phrase—it refers to the natural, age-related decline in fertility that women experience over time.

 

From a medical standpoint, a woman is born with all the eggs she will ever have—around 1 to 2 million at birth. By puberty, that number drops to about 300,000. With each menstrual cycle, a group of eggs begins to mature, but typically only one reaches ovulation. Over time, both the quantity and quality of these eggs diminish.

 

This decline becomes more noticeable in a woman’s mid-30s, and by the time she reaches her early 40s, fertility has significantly decreased. It's not just about getting pregnant—it's also about a higher risk of miscarriage, chromosomal abnormalities like Down syndrome, and complications during pregnancy. The "biological clock" isn’t meant to pressure or scare—it’s simply a biological reality.

 

Dr Steven R. Goldstein, a Perimenopause Specialist NYC says that a woman’s chance of conceiving naturally within a year over the age of forty is 25 to 30 percent. Still, midlife motherhood is definitely on the rise. Dr Goldstein has had patients in their late thirties and early forties who conceived the first time they had unprotected sex, merely by carefully charting their menstrual cycles and copulating on the appropriate days. However, it’s estimated that 75 percent of women over forty will need some help from technology to conceive.

 

What makes it so difficult to have a baby during Perimenopause? First and foremost, you may not ovulate every month, giving you fewer chances to become pregnant. Next, women simply have fewer and older, less viable eggs. By the time of Perimenopause, it is estimated that she has about ten thousand left. Less viable eggs are those that are harder for sperm to penetrate.

 

Some women have scar tissue that comes from the ovary having to repair itself after each ovulatory cycle. The more difficult a time the egg has navigating thru this scar tissue to the place where it can be released, the more difficult conception becomes. Scarring can also come from pelvic inflammatory disease, caused by sexually transmitted disease such as chlamydia. If it goes untreated for long, it can cause enough scarring to block the fallopian tubes or damage the ovaries. The fallopian tubes, which link the ovaries to the uterus, must be unobstructed for pregnancy to occur.

 

The cervix can also cause problems. If it is scarred from previous childbirths or narrowed for any reason, it can block the sperm from reaching the egg. In rare cases, a woman’s cervical mucosa contains substances that immobilize sperm.

 

Many women of Perimenopausal age have had gynecological surgery. If you’ve had a fibroid or some other benign growth removed, there may be scar tissue as a result.

 

Your body is probably still making estrogen in perimenopause – and progesterone when you ovulate. But how high are those levels? It’s not uncommon for women to find that they don’t secrete enough progesterone to prepare the endometrium for the fertilized egg. The egg can’t embed itself, and therefore no pregnancy ensues. This condition is sometimes called “luteal phase deficiency”.

 

If you are perimenopausal and the state of your fertility is important for you to know, the use of follicle stimulating hormone (FSH) measurements on day three of your cycle is the trick of the reproductive endocrinologist. It has been noted that if FSH on day three of the cycle is already climbing (20 or greater), then the patient’s chances of conceiving naturally are not very good.

 

If you are thirty five plus, have decided you want to pursue pregnancy, and you know that you are not ovulating regularly, see a specialist as soon as you can if you fail to get pregnant after six months of having intercourse the time of ovulation. You will need to pursue a structured plan to overcome fertility problems.

 

If you are perimenopausal and considering pregnancy, then perhaps a consultation with Dr Steven R. Goldstein, a Perimenopause Specialist NYC  may be in order. Dr Goldstein is a past President of The Menopause Society and the International Menopause Society. He is also a Certified Menopause Practitioner and considered one of America’s top gynecologists.

 

LIBIDO IN THE PERIMENOPAUSE

 

 

Dr Steven R. Goldstein is a Perimenopause Specialist NYC in private practice for over thirty five years. He has helped many women through the Perimenopause and Menopause stages of life.

 During the menopause transition, women face significant emotional and physical changes which may impact on their sexual health. For some, irregular bleeding, fatigue, hot flashes, dyspareunia (pain during intercourse), irritability and other perimenopausal symptoms may affect libido. A common cause for sexual dissatisfaction in the maturing woman is lack of a partner, resulting from divorce or death. It is important that the healthcare provider address these and other factors, which may be associated with the woman’s sexual health.

 As a Menopause Specialist NYC, Dr Goldstein has observed that patients often want a pill that will act as a panacea for all their problems, including decreased libido. The media have given much press to the benefits of androgens, and yet hormones may not be causative factors for changes in libido, in some patients.

 Instead for some, night sweats and disturbed sleep may affect a woman’s sense of well being and may deprive her of her perceived sexual drive. These factors must be evaluated before any type of hormonal therapy is begun. A symptom diary may help pinpoint causes for decreased libido for some patients. For example, one patient presented requesting androgens for her decreased libido. On intake history, initially, she vehemently denied that her decreased libido was associated with her spousal relationship. After keeping her diary, she was able to make an association between arguments regarding television and in-laws and successfully adjust her behavior so that she was able to improve her libido without any type of androgen therapy.

 However, for some women, testosterone levels can change during perimenopause, menopause and postmenopause. For patients with low free testosterone levels and severe menopausal symptoms, especially low libido and energy, whose symptoms are not relieved with estrogen or estrogen with progestin, then androgen therapy might be considered.

 Androgens are a group of hormones that play important roles in both men and women. In women, they are involved in reproductive health, bone health, muscle mass and strength, sexual function and their metabolic health. Androgens are most useful for women who have had oophorectomy prior to natural menopause. However, more research is needed regarding the safety of long term androgen use.

 Potential problems associated with androgens include its negative effect on serum lipids, hirsutism, aggressive behavior, and permanent voice deepening. Although androgens can be given alone, doses can be lowered when combined with estrogen and therefore, negative effects may be reduced.

 If you are late thirties to late forties and suspect you may be going through Perimenopause or have questions, a consultation with Dr Goldstein, a Perimenopause Specialist NYC , may be in order.

 Dr Steven R. Goldstein is a past President of the International Menopause Society and is a Certified Menopause Practitioner. He is a leading Menopause Specialist NYC .

 

PERIMENOPAUSE AND INSOMNIA

 

 

Imagine if you are a woman, early forties to late forties or so, and can’t remember the last time you had a good night’s sleep. Dr Steven R. Goldstein, a Perimenopause Specialist NYC has seen women come into his office with a range of symptoms that appear to have nothing to do with their menses or gynecological health. They have been to allergists, psychologists, psychiatrists and other specialists but never thought their issue was related to their gynecological health.

 

Perimenopause is the transition into menopause when a woman begins to slow the production of hormones. Some of the symptoms are irregular periods, hot flashes, and generally one of the least understood and most misdiagnosed stages of a woman’s life. One of the symptoms of Perimenopause is insomnia, the ability to sleep.

 

Insomnia generally gets worse as one gets closer to the last period. This is because night sweats – hot flashes that occur when you are sleeping – trouble many women when their bodies stop making estrogen.

 

While night sweats are a signal that you are close to actual menopause, many women complain about waking up in a sweat years before menopause happens. Or they complain that they wake up for no reason in the middle of the night and can’t go back to sleep.

 

Sleeping poorly is a big complaint for people, regardless of their age. For millions of people, bedtime is an invitation to hours of worry. Small annoyances like a truck driving by or a humidifier turning on interrupts sleep. Then come the worries of the day: Did I pay the gas bill or didn’t I?

 

If this is happening to you and you are a woman late thirties to late forties, then rule out stimulants such as the ones in cold medicines, some of the “natural” health pills, and diet sodas can keep you awake. Alcohol can send you to sleep only to wake up three hours later – for the rest of the night. A sedentary lifestyle and sleeping late can also be culprits.

 

Insomnia alone is not an indicator of Perimenopause. The stress of having subtle symptoms you’ve never experienced before can keep you up at night. Insomnia can exacerbate every other symptom of Perimenopause, so it’s important that if you’re having trouble sleeping, you talk to your doctor about it and formulate a plan for improving your sleep. The quality of your sleep is a major part of your sense of well being.

 

 Dr Steven R. Goldstein is a past president of the International Menopause Society, a Certified Menopause Practitioner and co author of the book “Could it be….Perimenopause?”. If you suspect you have Perimenopause, Dr Goldstein, a Perimenopause doctor in NYC  is available for consultation at his office in Manhattan