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Perimenopause: Hormone ups and downs can last years

By Amy Burkholder
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(CNN) -- What shapes a woman's reality -- how she sees the world, how she relates to the people in her life, and how she feels about herself?

Ask neuropsychiatrist Louann Brizendine and she'll say it depends on her age and what hormones her brain is steeped in at the time.

And, contrary to what you may think, the rockiest time isn't age 12, with the flood of hormones associated with the beginning of menstruation, or age 51, the average age of menopause, according to Brizendine. It's those years before a woman enters menopause.

"The biggest time for changes for women in terms of behavior and symptoms is in the perimenopause, when estrogen and progesterone fluctuate the most in the female brain," says Brizendine, founder of the Women's Mood and Hormone Clinic at the University of California, San Francisco. "This is when the dialogue between the brain and ovaries begins to run out of fuel, and that may change our reality as we are going through our cycle."

It may surprise many women to learn that "menopause" actually lasts one day. It's defined as the single day 12 months after a woman's last menstrual period. The changes over time that are often described as "menopause" are really perimenopause.

Years of ups and downs

Perimenopause can begin as long as 10 years earlier, but women often fail to connect irksome symptoms to the beginning of "the change." For example, an important first clue may be sleep difficulties, which affect about 30 percent of women. Other symptoms may be more familiar, such as intense irritability, decreased libido and mood fluctuations, often for women who've never experienced moodiness before.

Pat Dodson of San Francisco was a politically connected working mom, when at age 47 she started feeling "brittle as glass," yet had no idea she was in the throes of perimenopause. "I was feeling angry. I was feeling like I should get a divorce. I can't ever remember feeling like that at any other time in my life," says Dodson.

Hormonal changes certainly lead to behavioral changes, Brizendine says, offering a fascinating statistic: Contrary to conventional wisdom that men often dump their menopausal wives, government statistics show that after age 50, 65 percent of divorces are initiated by women. It may be bold, even reckless to reason that seismic hormonal shifts are breaking up marriages, but Brizendine suggests that as a woman's brain chemistry changes, she may, too -- and some of that has to do with oxytocin, that feel-good hormone women get from sex or a massage, cuddling a baby or simply hugging someone for a good 20 seconds. When her estrogen levels naturally decrease over time, so does a woman's oxytocin, and she may become less "we" focused and more "me" focused as a result.

"The estrogen and oxytocin that have been pumping through her brain for years have quieted down. Women just don't feel as much stimulation in their brain with their hormones to do the caretaking anymore."

So how do you know if you're just in a bad mood, or experiencing perimenopause?

For most women, perimenopause happens after age 40, and can last anywhere from two to 10 years. While a shorter menstrual cycle is a reliable tipoff, shortening from an average of 28 days to 24 days until eventually tampering off altogether, your doctor isn't likely to give you a blood test to tell you -- definitively -- you've reached that point. Your cycle would probably be too erratic to provide an accurate result.

"You could be perfectly fine one day and completely in the perimenopause zone the next day," Brizendine says. "It's a rapidly changing target."

Finding relief

So what can a woman do to feel better as her body and brain are changing?

At the mood and hormone clinic, Brizendine routinely prescribes short courses of hormone therapy, sleep medications if warranted, and small doses of antidepressants. But before rushing off to fill a prescription, experts concede that medicating menopause is something women should consider carefully.

"If it ain't broke, don't fix it," says Dr. Nanette Santoro, a reproductive endocrinologist who co-wrote the American College of Obstetricians and Gynecologists' guidelines on hormone therapy. "All treatments have benefits and risks, and the driver here should be a woman's symptoms. Only a woman can judge."

The national OB-GYN group stresses exercise, particularly weight-bearing exercise, and suggests that a good diet rich in calcium can provide natural relief.

Dodson, who's now 61 and many years through menopause, didn't lose her mind, or her marriage, during those tumultuous years, and credits seeking treatment, which included sleep medication and brief hormone therapy. She says she feels renewed contentment in her life, and counsels women that things really do get better after they're over the hormonal hump.

"My post-menopausal period has been like starting all over again," says Dodson. "It's an opportunity to find your interests and pursue them, and not something to fear."

Brizendine couldn't agree more. She believes hormonal changes in the brain can make the late perimenopausal and menopausal years a very liberating time indeed, giving women the zest to focus on their own projects.

"I think our culture is so much of a youth culture we think, after age 50 it's all over. But if you actually talk with menopausal women, you find many are having the best time of their lives."


Pat Dodson says she felt "brittle as glass" during her perimenopause years, but things are much better now.


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