"In my practice, I think women's biggest problems with perimenopause are the mood swings which go along with PMS symptoms -- plus menstrual irregularities. Women do complain more of PMS in their late 30s and early 40s," says Howard County gynecologist Dr. Pamela Kopelove.
"Many of the perimenopausal women who come to me say they feel as if they are in a constant state of PMS," Dr. Damewood agrees.
However, while acknowledging that fluctuating hormones can affect a woman's mood, many physicians and researchers caution that a woman's emotional state during the perimenopausal and menopausal years can be due to many factors.
"Society still has a lot of assumptions, such as equating menopause with a lot of negative attitudes," says Dr. Wulf Utian, chairman of the department of reproductive biology at Case Western Reserve University and founder of the North American Menopause Society. "It can become a self-fulfilling prophecy when you say women are going to fall apart . . . People can misinterpret the socio-cultural issues regarding menopause. If someone feels depressed about being menopausal, you say menopause causes depression."
"Are moods affected by menopause? Nobody really knows," NTC says Dr. Zacur. "If someone is sleep-deprived from hot flashes, that can affect how someone is going to interact with others. It's so easy to attribute "changes in mood" to "changes in hormones" and it may not necessarily be that straightforward or simple.
"Say somebody is having whatever kind of difficulties in her life and is normally able to handle them. If you superimpose these changes, that may make other underlying problems worse."
Dr. Zacur encourages his patients to bring their spouses to discuss the changes and effects of perimenopause and menopause.
"It's a couples problem," he says. "It's important for men to understand the physiology of what's happening and not necessarily rely on old cliches about change of life."
Researchers believe that the experience of perimenopause, like menopause, is very different for each woman. For some, this stage will last several years, for others, much longer. During perimenopause, symptoms of menopause often appear intermittently and vary in intensity.
Women can begin to notice the effects of dwindling supplies of estrogen when they are in their late 30s and early 40s. Some of those changes, according to local physicians, may include the following:
* Hot flashes.
* Irregular menstrual cycles with uncharacteristically heavy or light bleeding.
* An intensification of mood changes often associated with pre-menstrual syndrome.
* Vaginal dryness
* Urinary incontinence and more frequent urinary tract infections.
The National Institute on Aging is seeking volunteers to participate in the Perimenopausal Initiative.
In order to be eligible for the study, women must be between the ages of 45 and 55, be menstruating (or have had a period in the last six months) and have a history of regular periods.
In addition, participants cannot be using hormone therapy, birth control pills or other medications that might affect the study's findings. They must be willing to visit NIA's Gerontology Research Center in East Baltimore once every three months until they have not had a menstrual period for two years. Each visit takes about three hours.
In return, participants will receive free detailed information that will help them and their physicians evaluate their risk for osteoporosis and their need for hormone replacement therapy after menopause.
These women will also become members of the Baltimore Longitudinal Study on Aging, a study which is more than 35 years old. For details, call the Gerontology Research Center, 4940 Eastern Ave., at (410) 558-8139 or (800) 225-2572.