by Dr. Andrea Hilborn, ND All women, given enough time, will go through the transition from reproductive years to postmenopausal years. For most, the transition will go smoothly and will not cause problems. For some, particularly for women who have their ovaries surgically removed, the transition will be accompanied by symptoms ranging from mild to debilitating.

I should distinguish between two different terms that are used: menopause and perimenopause. Menopause is the time that the menstrual cycle stops. This is confirmed after a year has passed without having a period. Perimenopause refers to the years leading up to and after menopause, during which symptoms of fluctuating hormones may be present. After menopause, levels of estrogen and progesterone are lower and do not fluctuate as they did with the menstrual cycle.

Sadly, there is a lack of information about perimenopause and what a woman can expect from it. I would like to share some of the tidbits I learned from Dr. Jerrilyn C. Prior at a recent presentation and through her book, The Estrogen Errors.

Dr. Prior is a rare type of doctor; she is an endocrinologist who specializes in female hormones. She has devoted her career to increasing the understanding of women's hormones. Here is some of what she shared.

The average age of menopause in North America is 51. However, many women begin to have symptoms of perimenopause at a much, much earlier age. These symptoms can begin as early as the mid-thirties. Whereas at menopause, periods become fewer and eventually cease, during the earlier perimenopause, periods can become heavier and more frequent. PMS may begin, seemingly out of nowhere with sore breasts, insomnia and irritability.

These symptoms in the early stages of the transition are not due to a decrease in estrogen. In fact, in the years leading up to menopause, estrogen increases, spiking sporadically and dropping dramatically. At the same time, progesterone decreases. These changes combine to produce a state that is popularly known as estrogen dominance. In addition to the symptoms described above, one might experience decreased sex drive, bloating, headaches, fatigue, foggy thinking and memory loss.

Hot flashes and night sweats occur because of the rapid drops in estrogen levels. The culprit is estrogen withdrawal, rather than lack of estrogen.

We used to, and many still do, think that many diseases that women suffer from were as a result of the drop in estrogen after menopause. Heart disease, osteoporosis and breast cancer were all attributed to the "estrogen deficient" state of being post-menopausal. Through the use of hormone replacement therapy, we have learned that longterm supplementation of estrogen does not prevent heart disease and it increases risk of breast and endometrial cancer.

What are more likely contributors to this disease are 1) age and 2) whether or not you ovulate consistently when you are in your reproductive years.

Women still in their reproductive years can tell if they are ovulating consistently (if they are not on hormonal birth control) by tracking their basal body temperature. When ovulation occurs, you will see a rise in basal body temperature after ovulation and the temperature will remain high until the next period. You should have at least ten days after ovulation before your next period.

The better we understand what happens to us, the better we can determine what, if anything we would like to do about it. As us healthcare people learn more, we can create treatment plans that work better.