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Just as when we started our periods as teenagers, peri-menopause is when the body is not able to have exact hormonal release to cause regular menses as the ovaries start to shut down. This fluctuation causes some women to have changes in their cycles. These changes include irregularity, heavier flow, more cramps or longer cycles. Women can feel "menopausal" symptoms like hot flashes or vaginal dryness months to years before actual menopause occurs. Most women tend to feel or experience some of these changes in their 40's.
Many women can be diagnosed purely from the history that is taken and her age. However, it is important to do an examination, some work-up lab work, and possibly an evaluation of the uterine lining to rule out other causes, depending on the symptoms. Some women may need a pelvic ultrasound and some women will need a sampling done of the lining of the uterus called an endometrial biopsy. It is a quick office procedure that gives us a sampling of the lining so that it can be evaluated.
Depending on the symptoms, there are a variety of different treatments. For a majority of women, reassurance and education may be all is needed. Other women can obtain cycle control with birth control methods or an out-patient surgery. The important thing is to treat the symptoms that are most troublesome and make sure that nothing dangerous is causing the changes when it probably could be easily treated by medications or outpatient surgery.