Sue:
There are women who are prescribed HRT (hormone replacement therapy) when in perimenopause to “smooth out” their severe symptoms.  Other women are prescribed birth control pills. What have you found is the most effective therapy for a perimenopausal woman?  What would be your rationale for your choice?

Dr. Goldstein
I have outlined this in my answer to question #1.  The basic message and it needs to be made often and loudly is that there is a difference between replacement when menopausal patients who make virtually no estrogen need it replaced and the concept of "turn off and substitute" which is what the perimenopausal patient with fluctuating levels of unopposed estrogen will require for improvement.  Many physicians and patients do not understand the difference. (see Loestrin)

Blood tests for perimenopause and menopause

I believe there is much
confusion in the use of blood tests.

Invariably perimenopausal patients will have levels of estradiol which will be reported as "premenopausal." Thus estradiol levels are of very little value in patients who are having even irregular bleeding.  The use of FSH (follicle stimulating hormone) has been greatly misunderstood.  FSH on day 3 of the cycle has been used in assisted reproductive technologies (ART) to predict which patients will and will not benefit from ART. If the FSH on day three is already elevated (greater than 20–30) studies show that in these patients although spontaneous pregnancies can occur, they will have no better outcome from various assisted reproductive technologies.

This is not the same as using FSH to diagnose perimenopause.  It has been my experience that there is a paradox in blood tests often in perimenopausal patients. What I mean by that is as follows: FSH seems to rise before estradiol falls. There are many women in relatively late perimenopause who are bleeding irregularly and may be quite symptomatic who will have estradiol levels that are "premenopausal" but FSH levels that are "postmenopausal".  Thus if one only looked at one of these two values, one would be misled as to whether this patient were pre or postmenopausal.  I call this the "paradox of transition." What that signifies to me is that there is some "light at the end of the tunnel" and often within 6, 12, or 18 months the patient will indeed become frankly menopausal.

How can birth control pills
help symptoms of perimenopause?
There is a whole new group of BCPs like Loestrin that were created especially for women over 35 years of age.  Not only do they function to help with the often disruptive symptoms of perimenopause, they work as an effective means of birth control.  They contain just enough estrogen and progesterone to prevent pregnancies and help with perimenopause. Find out more.

Selecting Over-the-Counter Products
Dr Carolle Jean-Murat, author of Menopause Made Easy comments on selecting over-the-counter medications and supplements and says, "There are many brands of herbal medications on the market. Because they are classified as a food, they are not regulated. Over-the-counter herbs and supplements lack quality control of content. There is usually a batch-to-batch variation."
Here are my recommendations

Could It Be...Perimenopause?
The Estrogen Alternative
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Dr. Steve Goldstein
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Healthy Living Books
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Linda Ojeda
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