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. 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.

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• HotFlash News
• Interview 1
  • Estrogen Dominance
  • Estrogen vs. Progesterone
  • Replacement vs. Substitution
  • Perimenopause Diagnosis
  • Menstrual Calendar
  • What are SERM's
  • Future of Ultrasonography
• go to interview 2
• Ask Dr. Goldstein

newly revised for 2000!
Could It Be...Perimenopause?
by Steven R. Goldstein, Laurie Ashner

see the interview with Dr Goldstein
In clear, supportive prose, Goldstein offers no-baloney advice. "Today's perimenopausal women has neither the time nor the patience to go through four to fifteen years of symptoms without relief," he says. He fully delineates the roles of various hormones, how to determine if you're in perimenopause or not, as well as how to treat the various symptoms to gain control over your life.

The Estrogen Alternative:
What Every Woman Needs to Know About Hormone Replacement Therapy and Serms, the New Estrogen Substitutes
click here to find out more
by Steven R. Goldstein, Laurie Ashner
Most women know the benefits of estrogen replacement after menopause: It reduces the risk of osteoporosis, heart disease, even Alzheimer's disease. Many are still reluctant to take it, because it increases the incidence of breast and uterine cancer. Find out more.