Premenopause can be a term broadly used to refer to anytime before menopause. It can also mean the time period 5 to 10 years before menopause, when the process of hormone down regulation begins. Symptoms and the amount of time it takes for hormonal axis’ to unravel vary greatly between individuals. For example, one woman might sail through her 30’s and 40’s with no noticeable issues other than heavy periods, then becomes menopausal with those classic symptoms. Another woman might develop bad PMS; extreme emotional lability in her early 30’s which continues. By her mid 30’s she has heavy bleeding that though initially is menstrual becomes longer periods of bleeding by her late 30’s. Her libido is down and she has migraine headaches the last 2 weeks of her cycle. Her quality of life is poor. Her gynecologist started her on a birth control pills, but she felt worse.

In premenopause, the problem is decreased progesterone production. Estrogen deficiency does not happen until later on in this chain of biologic events.  Low levels of progesterone can occur early and is the first hormone to decline – but it is often below the radar . Many times doctors are focused on treating the symptoms resulting from the deficiency, not the deficiency itself- especially in younger women. Doctors may prescribe an antidepressant to treat PMS or PMDD, or write a script for a birth control pill ( a nonbioidentical hormone ). Patients do not improve without real progesterone (bioidentical progesterone).

If a woman is unlucky enough to have low progesterone levels for a long time ( a long premenopause ) and doesn’t receive proper diagnosis and treatment – she will likely have to suffer through her 30’s and 40’s .

  • migraine headaches/ tension headachesPremenopause
  • menstrual cramps
  • depression/irritability
  • out of control moods and severe mood swings
  • fatigue
  • decreased blood glucose
  • dizziness
  • increased susceptibility to infections
  • heavy vaginal bleeding
  • infertility

Treatment can be given as oral or sublingual bioidentical progesterone throughout the cycle or just the last two weeks of the cycle. Progesterone cream may also be prescribed however it is more difficult to attain therapeutic blood levels. Blood levels of progesterone should be monitored carefully as should patients symptoms. Underlying problems such as endometriosis and uterine fibroids should also be considered.  After having a baby, even women under 30 can have transient decline in the production in progesterone.

Forever Health – Bioidentical Hormones and Wellness
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Sue Decotiis, MD | 120 E 46th St., #1201 | New York, NY 10017 | Phone: (212) 685-3640