Perimenopause– literally “around menopause”– is the transitional period when women begin to experience the natural decline in reproductive hormones prior to menopause. Periods continue to occur during perimenopause, although significant changes can be noticed. The average duration of perimenopause is three to four years, although it can last just a few months in some women or extend as long as a decade.1 Natural menopause is considered to have occurred after 12 consecutive months elapse without a period. The average age of menopause in the US is 51 years of age.2

Perimenopause typically begins in women in their 40s, although some women notice changes as early as their mid–30s. Due to fluctuating levels of estrogen, menstrual cycles may become longer or shorter and the ovaries may or may not release an egg in any given cycle. Although this is a time of natural change, symptoms such as sleep–pattern disruption, temperature dysregulation, urinary issues, vaginal dryness/ fragility, and sexual pain or disinterest may adversely affect the quality of life. Mood instability can occur; feeling “ drained, overwhelmed, or out of control” are common descriptions of the emotional state during this transition.

Although there is no clear line between perimenopausal and menopausal symptoms, many women will begin to notice that some acute perimenopausal symptoms (such as hot flashes and emotional swings) slowly begin to “ ease up” after menopause has occurred. In fact, the postmenopausal years can be a time of energetic renewal for many women as estrogen production stabilizes into a new relationship with other hormones in the body, such as testosterone and adrenal hormones. However, reduced estrogen does have a downside in women; the years after menopause present increased risks for a number of health conditions, particularly those related to bone and cardiovascular health. Vulnerability to vaginal/urinary tract issues can occur and the libido and/or mood may remain low. In addition, hormonally–related changes in weight, skin, and hair also brings particular concerns to many women.

The diagnosis of peri/menopause is a clinical one. The clinician will take a detailed history and may recommend keeping a record of menstrual cycles, along with signs and symptoms. Certain symptoms (periods longer than 7 days, extremely heavy bleeding, or very short cycles <21 days) will be evaluated to rule out conditions that can be associated with other underlying reproductive issues.

The most common conventional laboratory test checks for elevated levels of follicle stimulating hormone (FSH), which is secreted in response to low estrogen levels. However, because FSH levels fluctuate during perimenopause, interpretation of a single hormone level is challenging during the perimenopausal period.3,4 A standard thyroid panel may also be done, since thyroid dysfunction can affect hormone levels and produce similar symptoms.5 Since natural menopause is clinically defined as the final menstrual period, the diagnosis includes the retrospective observation of 12 consecutive months without a period.6

Many women go through perimenopause and achieve menopause without treatment. However, when treatment is required due to severe or persistent symptoms, drug therapy has been the treatment of choice. This has generally involved hormonal therapy, antidepressants, and/or specific neurological medications that have demonstrated effectiveness for hot flashes.7,8 In the last decade, however, large studies 9–12 have created reservations about the safety and efficacy of hormonal therapies and raised concerns for patients about their use.

The scientific literature confirms that the onset of perimenopause, ultimately culminating in menopause and the postmenopausal phase of life, is associated with a continuum of physiological changes that can increase the risk of depressive and other mood disorders,13,14 migraine headaches,15,16 bone loss,17,18 metabolic syndrome,19–21 and conditions related to oxidative stress 22–25 (such as cardiovascular and neurodegenerative diseases).

Health–supporting behaviors are critical during the time of perimenopausal transition and in the years after menopause as the body achieves and adjusts to its “new normal.” Ensuring sufficient levels of nutrients through a balanced diet and judicious supplementation can be a key component of that support. Specialty diagnostic testing offers valuable insight into a person´s nutritional status and provides targeted direction for clinical interventions.

The NutrEval® and ION® profiles provide a comprehensive assessment of essential and other nutrients. Key areas evaluated include:

  • Amino Acids (protein building blocks and critical compounds for neurotransmitter production)
  • Fatty Acids (essential components of cellular membranes; key compounds for maintaining healthy skin and balanced immune/anti–inflammatory performance)
  • Organic Acids (biomarkers of metabolic function, including vitamin-metabolism pathways, cellular–energy pathways, and neurotransmitter–metabolism pathways)
  • Vitamins (adequate Vitamin D is associated with bone health)
  • Minerals (minerals act as essential cofactors)
  • Toxic Elements (levels of several toxic elements, including mercury and lead, which can affect hormonal function)
  • Antioxidant Nutrients (specialty vitamin and mineral nutrients involved in reducing risk for oxidative damage)
  • Oxidative–Stress Biomarkers (biomarkers of oxidative stress in cell membranes and DNA, along with levels of protective compounds, such as glutathione and Coenzyme Q10)

As mentioned, thyroid function is closely tied to sexual–hormone function; as also discussed, peri/menopause has been associated with accelerated bone loss and an increased risk for metabolic syndrome. Therefore, testing of biomarkers in these areas can add complementary clinical utility to the nutritional profile results. These profiles include:

  • Comprehensive Thyroid Assessment – Provides a more complete look at thyroid hormone function than is found in a standard thyroid panel
  • Bone Resorption Assessment–Measures a specific compound in the urine indicating the relative rate of bone loss
  • MetSyn and PreD Guides – Includes an assay of biomarkers associated with the development and progression of metabolic syndrome and Type 2 Diabetes, respectively.

1 Perimenopause: Rocky road to menopause. Harvard Women's Health Watch 2005;–health/Perimenopause_rocky_road_to_menopause.

2 Diseases and Conditions: Menopause. 2015;–conditions/menopause/basics/definition/con–20019726.

3 Arslan AA, Zeleniuch–Jacquotte A, Lukanova A, Rinaldi S, Kaaks R, Toniolo P. Reliability of follicle–stimulating hormone measurements in serum. Reproductive biology and endocrinology : RB&E. Jun 18 2003;1:49.

4 Burger H. The menopausal transition––endocrinology. The journal of sexual medicine. Oct 2008;5(10):2266–2273.

5 Thyroid Disorders in Women.

6 Kahwati LC, Haigler L, Rideout S, Markova T. What is the best way to diagnose menopause? The Journal of family practice. Nov 2005;54(11):1000–1002.

7 Diseases and Conditions: Perimenopause Treatments and drugs. 2013;–conditions/Perimenopause/basics/treatment/con–20029473.

8 Treatment of menopause–associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause (New York, N.Y.). Jan–Feb 2004;11(1):11–33.

9 Anderson GL, Judd HL, Kaunitz AM, et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. JAMA : the journal of the American Medical Association. Oct 1 2003;290(13):1739–1748.

10 Anderson GL, Chlebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow–up of the Women's Health Initiative randomised placebo–controlled trial. The Lancet. Oncology. May 2012;13(5):476–486.

11 Chlebowski RT, Anderson GL, Manson JE, et al. Lung cancer among postmenopausal women treated with estrogen alone in the women's health initiative randomized trial. J Natl Cancer Inst. Sep 22 2010;102(18):1413–1421.

12 Rossouw JE, Manson JE, Kaunitz AM, Anderson GL. Lessons learned from the Women's Health Initiative trials of menopausal hormone therapy. Obstetrics and gynecology. Jan 2013;121(1):172–176.

13 Weber MT, Maki PM, McDermott MP. Cognition and mood in Perimenopause: a systematic review and meta–analysis. The Journal of steroid biochemistry and molecular biology. Jul 2014;142:90–98.

14 Freeman EW. Associations of depression with the transition to menopause. Menopause (New York, N.Y.). Jul 2010;17(4):823–827.

15 Allais G, Chiarle G, Bergandi F, Benedetto C. Migraine in Perimenopausal women. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. May 2015;36 Suppl 1:79–83.

16 Ashkenazi A, Silberstein SD. Hormone–related headache: pathophysiology and treatment. CNS drugs. 2006;20(2):125–141.

17 Lo JC, Burnett–Bowie SA, Finkelstein JS. Bone and the Perimenopause. Obstetrics and gynecology clinics of North America. Sep 2011;38(3):503–517.

18 Finkelstein JS, Brockwell SE, Mehta V, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. The Journal of clinical endocrinology and metabolism. Mar 2008;93(3):861–868.

19 Polotsky HN, Polotsky AJ. Metabolic implications of menopause. Seminars in reproductive medicine. Sep 2010;28(5):426–434.

20 Carr MC. The emergence of the metabolic syndrome with menopause. The Journal of clinical endocrinology and metabolism. Jun 2003;88(6):2404–2411.

21 Janssen I, Powell LH, Crawford S, Lasley B, Sutton–Tyrrell K. Menopause and the metabolic syndrome: the Study of Women's Health Across the Nation. Archives of internal medicine. Jul 28 2008;168(14):1568–1575.

22 Zitnanova I, Rakovan M, Paduchova Z, et al. Oxidative stress in women with Perimenopausal symptoms. Menopause (New York, N.Y.). Nov 2011;18(11):1249–1255.

23 Brinton RD, Yao J, Yin F, Mack WJ, Cadenas E. Perimenopause as a neurological transition state. Nature reviews. Endocrinology. Jul 2015;11(7):393–405.

24 Kolesnikova L, Semenova N, Madaeva I, et al. Antioxidant status in Peri– and postmenopausal women. Maturitas. May 2015;81(1):83–87.

25 Ogunro PS, Bolarinde AA, Owa OO, Salawu AA, Oshodi AA. Antioxidant status and reproductive hormones in women during reproductive, Perimenopausal and postmenopausal phase of life. African journal of medicine and medical sciences. Mar 2014;43(1):49–57.

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