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There is concept in the West that menopause and perimenopause are all about dropping and deficient estrogen levels. Regular menstrual cycles are not compatible with low estrogen level. Therefore, midlife women (who may be as young as 35-45) who continue to menstruate regularly but experience new night sweats, sleep problems and PMS are told they are “too young” to be perimenopausal.
This leads to frustration, self-doubt, distrust of health care providers, and “doctor-shopping.” We now know that, by the time night sweats start, women are experiencing the typical hormonal changes of perimenopause—higher and erratic estradiol and stress hormones, and lower progesterone levels.
Plus they are experiencing new symptoms. However, to make the diagnosis of “Very Early Perimenopause,” women need to observe any three of the following typical changes: shorter cycles (usually <25 days), increased cramps, new onset night sweats, heavy flow, mid-sleep awakening, breast tenderness or lumpiness, new or worsened migraine headaches, premenstrual symptoms (especially mood swings) or weight gain without major changes in food or exercise.
Taking oral micronized progesterone 300 mg at bedtime from cycle day 12 until the next flow is very helpful for all except heavy flow that requires daily progesterone for three months.