Progesterone therapy

Why Does My Heart Feeling Like it is Doing Hurdles?

Bonnie — Thu, 27 Sep 2012 15:22:00 -0500

Midlife Muddle - Own the Power of Naming

Bonnie — Fri, 25 May 2012 11:01:32 -0500

This article originally appeared as post on the Society for Menstrual Cycle Research re:Cycling blog.

By "midlife muddle" I don't mean the trouble concentrating or remembering names that sometimes occurs for all of us (but more frequently if we've wakened with night sweats and not gotten back to sleep). I mean the condoned and official confusion about naming of women's reproductive aging. Let me show you why I am upset.

STRAW+10 staging system for reproductive aging in women
Stages of Reproductive Aging Workshop (STRAW) held a 10-year anniversary last summer. (As someone frustrated by not being "heard" at the original conference, I still think that the "W" in STRAW should stand for Women!) Despite that, STRAW+10 has made progress because at least some of the classification is now supported by population-based prospective data rather than based on what experts believe. The names that are now politically correct are summarized in the STRAW+10 Executive Summary¹ and the diagram¹ at right.

We in the Society for Menstrual Cycle Research have also had our say about nomenclature: "Naming Women's Midlife Reproductive Transition". I wrote this (with revision and refinement by collective effort of SMCR members) because women keep getting left out of this naming business. For example:

•a regularly menstruating woman with night sweats, heavy flow, and increased cramps could learn to call herself perimenopausal² (not STRAW+10 Late Reproductive Phase -3b?!).
•a woman who just finished her period can say, I'm in late perimenopause and have at least a year without further flow before I'll be menopausal. Based on STRAW+10 she could be told that specific menstruation was her final menstrual period (nickname "FMP") and the next day, according to STRAW+10 be told that she is now "postmenopausal"!!
•a woman with sore breasts, irregular periods, and heavy flow could say, I'm in perimenopause. However, she may instead be told she is in the "Early Menopausal Transition." Because she has heavy flow she is also likely to be prescribed the birth control pill (as is currently and commonly recommended). Usually she will not be told that The Pill will make her perimenopausal irregular flow worse-she may well start spotting in the middle of her cycle.³
This new and improved STRAW+10 still centers all of women's reproduction on that mythical FMP. But to call the FMP "menopause", as many women's health experts do, is just unscientific. It takes at least a year without another menstruation in those of us over age 45 before nine out of ten of us will not get another period4. But one (out of ten) of us will get a further, normal period even though we've been that whole year without any⁴. We can tell that new flow is normal (in other words, does not need investigation for endometrial cancer) if we had cramps or bloating or sore breasts or moodiness-or all of these-that told us our period was coming.

So our new Naming position statement says don't call it "menopause" until you've not had a period for a year. And do call it "perimenopause" if things are variable and changing even if you are still having regular flow².
Three of nine changes can confirm for you that you are perimenopausal even if your flow is still regular:²

1.Shorter cycles (25 days or less);
2.Increased cramps;
3.Heavier flow;
4.Increased trouble sleeping-especially waking up in the middle of sleep;
5.New or increased migraine headaches;
6.Night sweats-especially if they tend to occur before or during flow;
7.An increase in or new premenstrual mood swings;
8.New sore, enlarging or nodular breasts; and
9.Weight gain without changes in what you eat or the exercise you do.

If women can learn to call themselves perimenopausal, they will be saying they know that perimenopause is not the same as menopause-perimenopause is a midlife transition with higher and erratic estrogen levels. Menopause is a fairly stable life phase with normally low estrogen and progesterone levels that begins one year after their last menstrual flow.

Furthermore, by naming themselves accurately they will be able to tell whether a medication that is proposed for them has been tested and proven effective in perimenopausal women. Usually symptomatic women are treated with oral contraceptives (that are proven reasonably safe and useful for premenopausal contraception), or offered hormone therapy that has only been tested and shown effective for hot flushes/flashes in menopausal women.

So. . . I like the word perimenopause and think if women understand and own it they will be on their way out of a midlife muddle.

References

1.Harlow, S. Executive Summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging [pdf]. Fertility Sterility, 2012 doi: 10.1016/j.fertnstert.20012.01.128

2.Prior JC. Clearing confusion about perimenopause. BC Med J 2005; 47(10):534-538.

3.Casper RF, Dodin S, Reid RL, Study Investigators. The effect of 20 ug ethinyl estradiol/1 mg norethindrone acetate (MinestrinTM), a low-dose oral contraceptive, on vaginal bleeding patterns, hot flashes, and quality of life in symptomatic perimenopausal women. Menopause 1997; 4:139-147.

4.Wallace RB, Sherman BM, Bean JA, Treloar AE, Schlabaugh L. Probability of menopause with increasing duration of amenorrhea in middle-aged women. Am J Obstet Gynecol 1979; 135(8):1021-1024.

Can we Prevent Anovulatory Androgen Excess (aka PCOS)?

Bonnie — Fri, 04 May 2012 13:14:38 -0500

Preventive Powers of Ovulation and Progesterone

Bonnie — Wed, 22 Feb 2012 16:41:22 -0600

This series of articles, originally published in the CeMCOR newsletter, illustrate the importance of ovulation throughout women's reproductive life. Scientific evidence shows that ovulation (and therefore an approporiate progesterone level) is necessary for the optimum development and functioning of several physiological systems in women's bodies. The articles explain what ovulation is and address some of the issues and implications of ovulatory disturbances.

Choose from the list below:

Why do I have Osteoporosis? I’m Way too Young!

Bonnie — Tue, 30 Nov 2010 12:03:06 -0600

Do I need an Endometrial Biopsy?

Bonnie — Wed, 15 Sep 2010 12:57:59 -0500

What should I expect after early surgical menopause?

Elyse — Tue, 25 May 2010 12:40:23 -0500

Progesterone Therapy for Night Sweats in Perimenopause

Elyse — Mon, 30 Mar 2009 11:52:56 -0500

Now Available! The Estrogen Errors: Why Progesterone Is Better for Women's Health

Elyse — Tue, 17 Feb 2009 13:31:28 -0600

In this revealing work, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the United States, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking.

Like most women in Europe, Prior's patients find progesterone the key to dealing with a life cycle transition that, contrary to Western medicine, these authors do not see as a disease. Challenging medical orthodoxy, this work presents arguments and evidence both women and doctors will find compelling and useful.

Author Information

Susan Baxter is a medical writer and social scientist with more than 20 years experience writing on controversial medical topics. She teaches part-time at Simon Fraser University. Her articles have appeared in publications including Family Practice, Medical Post, HealthWatch, Lifeline, and Easy Living.

Jerilynn C. Prior, MD is Professor of Medicine, Division of Endocrinology, at the University of British Columbia. She is Founder and Scientific Director of the Centre for Menstrual Cycle and Ovulation Research, and has authored research published in journals including The New England Journal of Medicine and the Journal of the American Medical Association. Prior is a Diplomate of the American Board of Internal Medicine, and a Fellow of the Royal College of Physicians and Surgeons, of Canada. As a clinician and researcher, she has treated thousands of women. Prior has been Visiting Lecturer across Canada and the United States at schools including the New York Academy of Sciences, Harvard School of Public Health, and Albert Einstein Medical School. In 1985, Prior won a Nobel Peace Prize for her work with Physicians for the Prevention of Nuclear War.

What others are saying about The Estrogen Errors

"Jerilynn Prior can always be trusted to go beyond the surface to what is really happening in women's bodies. She is a true champion in women's health. This book will help you finally understand your body and hormones."

-Susan Love MD
President of the Dr Susan Love Research Foundation and author of Dr Susan Love's Breast Book

“In this provocative book, Jerilynn Prior and Susan Baxter raise many key questions that women's health researchers and clinicians have failed to ask or investigate. They are especially effective in deconstructing prevailing myths about "too little estrogen" during the peri-menopause.”

-Judy Norsigian
Executive Director, Our Bodies Ourselves

"Estrogen Errors" is, quite simply, the truth! Jerilynn Prior has done women a huge service by uncovering the real truth about estrogen and the hidden secrets of progesterone! A must read for anyone concerned about women's health."

-Christiane Northrup MD
Author of The Secret Pleasures of Menopause, The Wisdom of Menopause, Women's Bodies, Women's Wisdom, and Mother-Daughter Wisdom.

"Estrogen Errors tells the story of efforts to set the record straight about how healthy ovulatory menstruation - with its ebb and flow of estrogen and progesterone - protects our hearts, breasts and bones and details with sound scientific evidence the implications of this knowledge for women's health. It is also a call to action for women to become body literate. We owe it to ourselves and our daughters to understand and appreciate our bodies if we want to make conscious, informed decisions about our health throughout our reproductive lives - from menarche through to menopause and beyond..."

-Laura Wershler
Executive Director, Sexual Health Access Alberta

Estrogen Errors is now available in hardcover and as an e-book!

You can order your copy at your favourite online retailer, including:

Amazon.com

Amazon.ca

Barnes and Noble.com

Or visit your local bookseller and request a copy using the following ISBN number:

ISBN 0-313-35398-0 or ISBN 978-0-313-35398-7

A portion of all proceeds from the sale of The Estrogen Errors will be donated to the CeMCOR Endowment Fund to ensure that the research and outreach intiatives of the Centre for Menstrual Cycle and Ovulation Research continue well into the future.

Estrogen Errors has its own web page and blog

Follow us online at EstrogenErrors.com

Bewildered by Bio-Identical Hormones

Elyse — Fri, 13 Feb 2009 18:35:26 -0600