The perimenopause: a critical time in a woman's life

The interval from the initiation of declining estrogen levels to final ovarian failure usually encompasses many years. The age of onset and duration of this perimenopausal time can vary greatly. While many patients may have minimal to no symptoms as estrogen levels first begin to decrease, most patients will eventually develop symptoms and sequelae as they approach ovarian failure. The consequences of this decline in ovarian function are numerous, and include vasomotor symptoms, declining bone mass, urogenital changes, infertility, irregular uterine bleeding, and psychosexual dysfunction. The women of today entering the perimenopausal period are unique because of their vast numbers, a consequence of the aging of the "baby boomers." Their reproductive history is also different from that of their ancestors in that many have chosen to delay childbearing into their thirties and even forties, and many have elected not to have children. Because of the unique characteristics of this extremely large population of women that are approaching or currently in the perimenopausal period, it is vital that healthcare providers fully understand the variability, consequences, and treatment modalities of this time of declining ovarian function. Risk factors for such common health problems as osteoporosis, heart disease, and cancers must be assessed and managed appropriately. Screening tests including mammography and cholesterol profiles should be offered along with dietary and exercise recommendations. Low-dose oral contraceptive pills and hormone replacement therapy are often effective in preventing and treating many of the common problems encountered during the perimenopausal period.