PERIMENOPAUSE AND THE PERIOD THAT DISAPPEARS FOR MONTHS

 

 

 

Have you noticed that you are waking up perspiring heavily during the night? Are you enduring profuse sweating, weakness, or faintness during the day? These are signs of estrogen depletion. However, a woman’s period can be quite erratic when she is still making estrogen, and not nearly as close to menopause as she thinks.

 

Dr Steven R. Goldstein, a Perimenopause Specialist in NYC says that nine times out of ten, if you are between the ages of thirty five and fifty, the answer to your missing period is PERIMENOPAUSE. Perimenopause is when a woman’s body begins to slow the production of hormones and is the transitional phase into Menopause. Symptoms are irregular periods, free floating anxiety, mood swings, inability to concentrate, memory lapses, sleep disturbances and a period that disappears for one or more months.

 

A missing period for several months could be signalling menopause. An FSH test and a test for estrogen will give you the answer whether it is perimenopause.

 

However, this is not the only cause of missing periods. Disorders of the pituitary gland are a common reason for a periods that disappears for months for women who are not in menopause. An underactive or overactive thyroid gland, known respectively as hypothyroidism and hyperthyroidism can be the culprit. A simple blood test can tell if you are suffering from either of these.

 

Also, excess prolactin, a pituitary hormone that stimulates breast milk production, can cause lack of periods. This is often associated with discharge from the nipple. Dilatation and Curettage (D&C) that hasn’t healed properly and left scar tissue can also cause a loss of your period. A pelvic exam can rule out ovarian cysts or other growths that can cause you to skip your period.

 

There are other, less frequent reasons women can stop having their menstrual cycles. Very heavy drinkers can develop cirrhosis of liver, and their menstrual cycles will stop. Generally, this will not be the first sign of such a disorder. You will have experienced jaundice, gastrointestinal problems, a distended stomach from fluid retention, and an all-over ill feeling.

 

Dr Steven R. Goldstein is a Perimenopause Specialist in NYC who has worked with numerous women to help them cope with the symptoms of Perimenopause for his over 30 years in private practice. Perimenopause is a transitionary phase to menopause which can begin as early as the late thirties and as late as up to the late forties.

 

A past president of the International Menopause Society, a Certified Menopause Practitioner and co author of the book “Could it be….Perimenopause?”, Dr Goldstein is available for consultation at his office in Manhattan.

 

ESTROGEN DEFICIENCY AND SLEEP

 

 

Doctor Steven R. Goldstein MD is a Certified Menopause Practitioner and a Menopause Specialist in NYC in private practice. He has helped thousands of women cope with menopausal symptoms over his 25 plus years in private practice.

When women reach menopause, they often don’t sleep as well as they once did because of the estrogen deficiency. Two very common problems are having trouble falling asleep and waking up in the middle of the night and being unable to fall back to sleep sometimes for an hour or two.

It's true that women who take estrogen often report that they sleep better. Here are three things women can do to improve their chances of getting a good night’s rest. There will be a second part to this article with more points.

1. Wake up at the same time every day. If that doesn’t help, wake up half an hour earlier. This is easier said than done. You’ve tossed and turned, perhaps because of night sweats or tension and ended up watching the 4 am movie. Just as the alarm goes off, you finally feel sleepy. Forget thinking that you need those eight hours of sleep and deciding to crawl back into bed. You will do more damage to your body clock and eventual body well being by over sleeping. For many women, the key to not being able to fall asleep is getting up even earlier. Force yourself to keep a regular schedule, and you’ll reap the benefits of deeper sleep.

2. Beware of hidden caffeine. Chocolate is one source of caffeine that can keep you awake. Excedrin before bedtime keeps some women up for hours. And read the ingredients of cold medicines. The over the counter lose-weight-quick pills of too many names and varieties to list are also full of caffeine.

3. Make your largest meal lunch. Why add major digestion to your night time list of things your body needs to do to finally settle down and relax enough to sleep. The full stomach that makes you nod off in front of the TV at seven at night has a habit of waking you up just when you gather yourself up off the couch and head for bed.

If you are menopausal and need help coping with its symptoms, an appointment with Dr Steven R. Goldstein MD, a doctor for Menopause in NYC. He is a past President of the North American Menopause Society and a past President of the International Menopause Society. He has also coauthored several books on hormone replacement therapy such as “The Estrogen Alternative”.

Dr Goldstein also specializes in hormone replacement therapy (HRT) to help women with the symptoms of menopause. His practice offers individualized patient care and Dr Goldstein will personally see you from the beginning to the end of your visit.

 

IS IT POLYCYSTIC OVARIAN SYNDROME?

 

Dr Steven R. Goldstein is an Obgyn in Manhattan that has seen very young patients come in with their mothers and present with a diagnosis of Polycystic Ovarian Syndrome (PCOS). They are requesting a second opinion. If you have been told you have PCOS, then there is some information you should know.

 

PCOS affects roughly five to fifteen percent of women of reproductive age but many of the cases go undiagnosed. Many of those diagnosed are in their twenties or thirties. Here’s a bit of history on PCOS.

 

In 2003 there was The Rotterdam Criteria for the Diagnosis of PCOS, at that time the consensus was if a women had two of the following three characteristics she could be labeled as having PCOS. They were 1) irregular menses, 2) increased androgens (either in their blood or clinical manifestations), and 3) more than twelve follicles in their ovary on ultrasound.

 

Today, as the resolution of transvaginal ultrasound has increased, as many as 50% of women will have more than twelve follicles in their ovary! And many young women will be having slight irregularity to their menses as their cycle “matures.” Their menstrual cycle is still slightly irregular because of the fact that the hypothalamic-pituitary-ovarian axis has not yet matured. And if patients are extremely young, they may have what Dr Goldstein refers to as “multicystic ovaries” instead of polycystic ovaries.

 

Typically, the women who were thought to have PCOS would be obese, have male pattern hair growth (especially on the chin), and bloodwork showed increased androgens (testosterone and an entity know as DHEA-S). These recent patients seen by Dr Goldstein who were diagnosed by other physicians to have PCOS were 1) not obese, 2) had no evidence of increased androgens, either clinically or in their blood, and 3) were extremely healthy.

 

It has been Dr Goldstein’s experience that the overwhelming majority of such patients, as they get into their mid- and later twenties, ultimately have very normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes. 

 

Upon examination, none of these recent cases truly had PCOS itself. What they had was not unusual for late adolescence (women in their teens and even early twenties).  The problem is someone performed an ultrasound and they had multiple small follicles in their ovary, and thus, were told they had polycystic ovarian syndrome. 

 

In the opinion of Dr Goldstein, a Gynecologist in Manhattan, it is important as to how the follicles are arranged in the ovary. In the original description of polycystic ovarian syndrome, the follicles were all very peripheral and often were referred to as a “string of pearls,” the appearance of small follicles around the edge of an ovary.  This is what points to Polycystic Ovarian Syndrome (PCOS).

 

Women cannot be diagnosed as having PCOS with just an increased randomly distributed number of follicles. There must be the string of pearls pattern.

 

If you have been told that you have Polycystic Ovarian Syndrome (PCOS) and would like a second opinion, schedule a consultation with Dr Steven R. Goldstein MD, a leading Manhattan Obgyn