Our Crazy Complicated Bodies - Perimenopause and Hormone Imbalances

For most women, the symptoms of perimenopause can come as a surprise and without warning because most of you have experienced regular periods for many years. Then, suddenly your cycles shorten and periods start coming twice a month…..and then you may skip a month or two.  Without warning, the amount of blood flow changes, and periods that once lasted 4-5 days with moderate flow and mere spotting at the end have become heavy bleeding and blood clots for 8-10 days. 

Sound familiar?  “But wait!” you say, “I'm only 28 years old [or maybe 34…].  Aren't I way too young to be experiencing all of this?”  Well, yes & no. 

Perimenopause usually starts sometime in the 40's, so perimenopause may not be the reason you are having irregular periods.  There are many other hormonal abnormalities that can mimic these symptoms and bring on irregular periods in the teens or early 20's.  Why is this? 

It is because perimenopause is a time of extreme hormone imbalances, and many young woman have never known what hormone balance feels like, and rarely experience a normal menstrual cycle with regular blood flow.

Hormone disorders can occur in a woman's body starting in the teen years, with wide and varied fluctuations.  As hormone levels go down and at times 'pop' back up, periods can become irregular and harder to predict.  Since ovulation allows the body to maintain an adequate supply of progesterone, anovulation (loss of ovulation) is a condition in which a woman's hormonal balance is tipped toward too much estrogen and not enough progesterone. The excess estrogen stimulates the growth of the lining of the uterus.  

PCOs (polycystic ovarian syndrome) is the most common hormone imbalance in young women and is known for interfering with ovulation, causing it to mimic perimenopause or premature ovarian failure.  PCOs causes anovulation, and that stimulates the uterine lining to thicken.  When this happens, we see uncontrollable, prolonged periods for 2-3 months, skipped periods for 5-6 months,  uncontrollable weight gain, abnormal hair growth in a male pattern (facial, chin, chest, nipple, belly & belly button hair, and thick pubic hair on buttocks and upper thighs), facial outbreaks and hot flushes.  This creates a domino effect so profound that it pushes many into emotional extremes.  It is this hormone imbalance that we see in women of all ages with irregular periods.  

Other factors involved in hormone imbalances are premenstrual hormone lows, stress, extreme diet & weight changes, pregnancy, childbirth and even some medications.  These imbalances can go undiagnosed for years, which can make it difficult to conceive a child.  This, in turn, places a woman in a masked state of infertility until the underlying cause is corrected . This could take years, therefore delaying her chances of giving birth before age 35 - when a woman is considered to be of an Advanced Maternal Age (AMA). 

Many other factors can come into play that could interfere with conception, pregnancy and childbirth.  Chronic medical illnesses can cause significant emotional stress.  The hypothalamus is a special part of the brain that controls our thyroid gland, ovaries and adrenal glands.  If these malfunction, it can cause oligomenorrhea (fewer periods than 12 a year).  Our bodies will express that by menstrual irregularities, ovulation, weight gain and other irregularities.   Also women suffering from eating disorders like anorexia nervosa or bulimia, and even excessive exercise resulting in loss of body fat can interfere with how the hypothalamus functions.

Anytime there is a change in menstrual patterns you should make an appointment with your doctor.  If you have not had a regular check-up or pap smear in the past year, that should be taken care of at the visit.  Vaginal inspection will detect any polyps or infections that could be contributing to the irregular bleeding. It is important to get blood drawn to check for hormone imbalances, thyroid disease, & pregnancy in premenopausal women.  A CBC should be checked to make sure you are not anemic from the bleeding and any other lab tests that could help evaluate your health.  Other tests that might be helpful would be a pelvic ultrasound or EMB (endometrial biopsy), to evaluated the inside of the uterus.

Treatment for irregular vaginal bleeding always depends on the underlying cause. Once the cause is known, you and your doctor can decide what treatment, if any, you would like to correct the problem. If the bleeding is not adversely affecting your health or interfering with work and personal relationships, then it may be your choice have no treatment for now.  When lab results from blood tests of the thyroid, liver, kidney, or blood clotting disorders are discovered, treatment is directed toward improving these conditions.       

If the cause of the bleeding is lack of ovulation, progesterone can help.   If taken at regular intervals, an oral contraceptive which contains progesterone, can help achieve a proper hormonal balance. Such treatment dramatically decreases the risk of uterine cancer in women who do not ovulate.  Uterine cancer and osteoporosis are two very serious complications of this type of hormone imbalance. Of course if the cause is from an infection and chronic cervicitis, then antibiotics should be given as soon as it is known.

Sometimes surgery is required to remove polyps, or hysteroscopy with D & C can help evaluate and remove the excess lining responsible for all the bleeding.  A procedure that cauterizes the lining of the uterus with either hot water or electro-cautery is a good option for women who do not wish to have more children.  It basically removes the uterine lining for a period of time, and this decreases bleeding significantly from zero periods to a few days of spotting.  The ovaries are untouched so a woman will continue to cycle and ovulate if she was doing so prior to the procedure, there will just be no bleeding.  The ultimate treatment is a hysterectomy if the bleeding is severe and there is no other alternative.  Although most women can avoid this if desired.