Monthly Archives: February 2010

Irregular Periods During Perimenopause

Wendy Klein MD150One of the first symptoms you may notice during perimenopause is irregular periods.

I was on birth control pills so I did not experience irregular periods. But for those of you not on birth control pills, noticing a change in your period may be an indication you are perimenopausal.


Interview with Dr. Wendy Klein, leading menopause expert and co-author of The Menopause Makeover

Staness: What is one of the first symptoms of perimenopause?

Dr. Klein: The hallmark of perimenopause, which is the phase prior to menopause, is irregularity. We all grow up thinking that when you enter the change of life and become menopausal, your periods just stop. That is not the case.

What happens is your periods start to become irregular. You can have too many periods, you can have too few, you may skip a period and then get regular again, and you may skip a few periods. You may think, “oh my, I am in menopause,” and suddenly your period comes back again.

Staness: Why does this happen?

Dr. Klein: Prior to menopause your periods are usually very regular. The amount of hormone that you are producing is very regular and predictable. However, as you approach menopause, entering the perimenopausal phase, the ovaries are unpredictable. You will have months when you don’t ovulate, and that causes irregular bleeding.

Staness: How long does period irregularity last?

Dr. Klein: How long that lasts is highly individual. Could be a year, could be two years, could be three years and that is all normal variation. I like to say that the ovaries are stuttering. You don’t always ovulate and your previous hormonal milieu begins to change.

Eventually you will experience fewer periods and finally your periods will stop. You are not officially in menopause until you have skipped 12 consecutive periods.

Staness: How does a woman know her periods are irregular?

Dr. Klein: You may get too many periods. You may get too few. You may skip them. The bleeding may become heavier, or it can become lighter.

Staness: What should a perimenopausal woman with irregular periods do?

Dr. Klein: Well the easiest thing to do is keep track of your periods. Write them down in the your calendar and track them. Keep a record of when you are having your periods and what your symptoms are, so when you visit your clinician you can discuss the changes using actual dates.

If you are troubled by irregular periods, you can discuss the option of low dose birth control pills. This can help with regulation, with excessive flow, and also with contraception.

One of the issues of which you should be aware is that even in perimenopause you can still become pregnant and since your periods are not regular you have an increased risk of unintended pregnancy. Birth control is still necessary as long as you continue to ovulate, even if you are irregular.


Menopause is a normal and natural part of a woman’s life. Arm yourself with knowledge, build a strong relationship with your clinician and manage your menopause empowered.

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Posted in hormones, ask the expert

Finding balance — your secret weapon to good health and happiness

Businesswoman jugglingConstantly Cranky in North Carolina

Dear Crabby,

I had a total hysterectomy April 2008 at the age of 30 for endometriosis and a tumor on my right ovary. I was put on birth control pills, but decided I didn’t like the side effects and got off November 2009. After stopping the birth control pill I tried to go on my own, however I found myself hysterical. I was having so many emotions that I really thought I was having a mental breakdown. I was forced into seeing a therapist from my employer because they thought I was “stressed.” I don’t think that fits. I think psychotic fit’s better.

I am now on estrogen therapy (Premarin 0.625mg). After two weeks of being on this, I was forced to take a two-week stress-free vacation, I am actually feeling somewhat better.

I’m not married and therefore the lack of sexual desire doesn’t really bother me but the mood swings do. I feel like a 50 year-old in a 32 year-old body that is 5’2” at 186 pounds. How do I get past the happy one-minute and foaming at the mouth the next? I’m tired all the time and working 40 to 50 hours per week that makes me want to sleep all weekend. It’s a good thing I’m not married and have no children, because at the end of the day I’m exhausted.

Constantly Cranky in North Carolina

Dear Constantly Cranky,

You have a reoccurring theme in your quest for answers – the need for balance. As a busy woman, balance can be hard to find. Balance with your body, mind and spirit is a necessary step to being happy.

Step #1: Body, discuss your ET dose with your doctor

Per Dr. Klein, leading menopause expert and co-author of The Menopause Makeover, “after abrupt surgical menopause, it is generally necessary to start with a higher dose of HT, and taper down as tolerated.” Estrogen alone is prescribed for postmenopausal women who have had a total hysterectomy. This is because, without a uterus, the risk of uterine cancer is essentially absent, so there is no need for the uterine protection of progesterone.

Based on this information, I am not surprised you did not like the effects of being on the birth control pill that usually has progesterone and estrogen. Going off the birth control pill no doubt sent your hormones into chaos possibly contributing to feeling “hysterical.” Now that you feel better being on estrogen therapy (ET), you may wish to discuss your dose with your healthcare provider.

The hormone ups and downs you have experienced may be contributing to other imbalances, including moodiness.

Once you and your doctor manage hormone levels you will start to feel better.

Step #2: Make a commitment to lose weight

Being 5’2” at 186 pounds puts you in an unhealthy category according to the BMI chart. Your BMI is 34, anything over 30 is considered obese.

It is time to make a commitment to your health with weight loss being a major focus. Carrying extra weight can put you at risk of type 2 diabetes and heart disease.

Start eating five to six mini-meals a day to jumpstart your metabolism and reduce those blood sugar crashes that may be contributing to mood swings. Include lean proteins, low glycemic carbohydrates and healthy fats. Reduce your calorie intake. Use the calculators on the homepage. Take the full body analysis to determine your calorie intake for your ideal weight.

Start exercising at least 30 minutes four to five days a week. Forcing yourself to find time for exercise will help you find balance with work. Pamper yourself.

Join a dance class. Start moving for FUN. You will meet great people, and socializing will help you find balance too.

Step #3: Mind and spirit, find balance in your life

You are working long hours, and you wonder why you are tired on the weekend? You are living a stressful lifestyle that is not helping your health situation. It is time to also find balance in your LIFE. Making time for exercise and fun activities can help bring balance.

I invite you to join the Menopause Makeover online community at It is a group of supportive women who will cheer you on, share recipes and ideas. You are not alone.

Finding balance is your secret weapon to good health and happiness

A balanced Dear Crabby

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Posted in ask the expert