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56 Current Topics in Menopause Prior et al.
occur prior to the onset of irregular cycles and may be a result of higher rather
than lower levels of estrogen [6]. In addition, some women report difficulty with
hot flushes and night sweats (vasomotor symptoms, VMS) before the onset of
irregular cycles in the menopause transition, indicating that there is more to
perimenopausal VMS than simply low estrogen levels.
For the purposes of this chapter, we propose that women in their mid-30s to midor-late
40s with regular menstrual cycles, who begin experiencing a characteristic
collection of changes such as new night sweats, new or increased breast
tenderness or increased menstrual flow be referred to as “perimenopausal” (Table
1). After starting with the background to current terminology about women’s
midlife reproductive transition, we will explore the endocrine, bone and other
changes that occur during the perimenopause and the menopause transition
Table 1: Midlife women with regular menstrual cycles may be considered to be in perimenopause if
they experience any three of the following experience changes (reprinted with permission from [18]):
1.
2.
3.
4.
5.
6.
7.
8.
9.
New onset heavy and/or longer flow
Shorter menstrual cycles (