There was a huge snowstorm raging outside, and we'd been receiving cancellation calls all day. So I was surprised to open the door to one of our examining rooms and find Marian perched on the end of the table. Marian started seeing me twelve years ago, when she was single and living in the city. A husband and two children later, she now lived in the suburbs but still remained a loyal patient.
"Why didn't you reschedule?" I asked. "You took your life in your hands driving all the way in from Long Island."
"I couldn't wait another day, Dr. Corio," she replied.
"What isn't? I feel like my whole body is falling apart--in fact, it doesn't even feel like my own body anymore!" Marian went on to list a host of symptoms: migraines, hot flashes, insomnia, dry itchy skin, urinary tract infections, irregular periods, and decreased libido. "Poor Skip," she continued, referring to her sweetheart of a husband. "My moods have been all over the place and I haven't let him touch me in weeks. He's been really understanding, but I know that for both our sakes I can't put off dealing with this any longer."
"Well, Marian--how old are you now?" I glanced down at her chart. "Forty-three? It sounds to me as if you may be in peri-menopause."
"You're kidding!" she responded. "But my mother didn't go through menopause until she was 50."
"And you may not, either. Perimenopause can begin up to a decade before menopause," I reminded her. "When was your last period?"
"About three weeks ago."
"And how was it? Longer or shorter than usual? Heavier or lighter?"
"A little heavier and longer than normal. And I had wicked PMS--my breasts were killing me and I had really bad cramps. I told Skip he should buy some stock in Motrin! It was like being a teenager all over again."
"Funny you should say that," I said, "because in some ways peri-menopause is the mirror image of puberty. One of the reasons you're experiencing irregular periods, mood swings, and PMS is that after twenty years of relative stability, your hormones are beginning to fluctuate all over the place. In your case, it's because your body is winding down its reproductive life; in a teenager's, it's because her body is winding up."
"Lovely," Marian said, rolling her eyes. "But if I'm reliving those happy teenage years, how come I have no sex drive?"
"Because perimenopause is like puberty in reverse. Although your estrogen levels are bouncing around, they're basically on their way down, whereas a teenager's are basically on their way up. Your skin is getting drier; a teenager's gets oilier."
"So is there anything I can do to feel like a human being again, or do I just have to wait this out?"
"Of course there are things you can. do--why should you suffer?" We went on to discuss a myriad of options, from vitamin and mineral supplements to herbs and foods she could try to relieve her various symptoms. "Before you leave today I'd like to write you a prescription for saliva testing to check your estrogen, progesterone, and testosterone levels," I added. "This is the perfect time because you're in the middle of the second half of your cycle. If these levels are no longer in the normal range and your symptoms aren't improving with just the complementary treatments, we can talk about the possibility of adding a low dose of hormones."
"I can't tell you how relieved I am to know I'm not completely falling apart!" Marian sighed as she leaned back on the table so I could begin her physical examination. "It was definitely worth braving the hazards of the Long Island Expressway to see you today."
Checklist of Perimenopausal Symptoms
Every woman experiences perimenopause differently. Some have virtually no symptoms; others have every one in the book. Because the range of symptoms is so diverse, many women don't make the connection with perimenopause and either suffer in silence or run from one specialist to another looking for cures. If you are experiencing any of the following, ask your gynecologist if he or she thinks you may be in perimenopause.
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