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" Right now, some 21 million American women are in perimenopause -- the transitional period, lasting anywhere from 4 to 15 years, that leads up to menopause. And many women are grappling with symptoms that range from mildly annoying to virtually incapacitating. Think hot flashes, irregular periods, vaginal dryness, insomnia, forgetfulness and more. Unfortunately, doctors still don&amp;#039;t fully understand perimenopause. But they know much more than they did when our mothers and grandmothers went through it. Here, answers to common questions about what experts dub &amp;quot;the storm before the calm.&amp;quot;  Your ovaries are aging, but the pituitary gland in your brain, which governs reproduction, is determined to keep you fertile. Every month, your pituitary produces the follicle-stimulating hormone (FSH), which prods your ovaries to produce mature eggs. If an egg isn&amp;#039;t released on schedule, your pituitary churns out more FSH to correct the problem. This may or may not work -- meaning you may or may not ovulate. In any case, your production of estrogen and progesterone becomes erratic. Some months you may skip your period altogether; other times you may experience heavy, unpredictable bleeding.   It could, indirectly. Estrogen nourishes the tissues of the vagina, urethra, bladder and pelvic floor. As perimenopause progresses -- and droughtlike lows in estrogen occur more frequently -- these tissues become thinner, less elastic and more easily irritated. The result: vaginal dryness and irritation, inflammation of the vulva (the outer genital area), painful intercourse and urinary incontinence.  Because of your erratic periods, you may assume you&amp;#039;re no longer fertile. That&amp;#039;s not true. The average woman has a 33 percent chance of becoming pregnant in a given month; after age 40, her chances plummet to 7 percent. However, if you don&amp;#039;t want to get pregnant, you still need to be diligent about birth control. Sometimes when I get my period, I seem to hemorrhage. What&amp;#039;s going on?  Blame it on your fluctuating hormone levels -- in this instance progesterone, which causes you to shed your uterine lining each month during your period. While the average menstrual flow totals a mere two ounces, it can escalate to 10 times that amount during perimenopause. Another reason you may bleed excessively: fibroids. These benign but very common tumors are often fueled by high estrogen levels.  Your brain is dependent upon estrogen to function properly, so when estrogen levels rise and fall unpredictably, moodiness, trouble concentrating and memory problems can occur. In addition, night sweats can disrupt sleep, making symptoms even worse.  Lots of doctors test FSH levels in a woman&amp;#039;s blood. Except for a midcycle spurt when you ovulate, FSH levels stay well below 15 when your ovaries are young; during perimenopause, they may start to rise; after menopause, they can skyrocket to 40 or above. Unfortunately, the FSH test isn&amp;#039;t reliable. Also, because some conditions -- including thyroid disorders -- can cause perimenopause-like complaints, your doctor may need to rule them out first. "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.goodhousekeeping.com/health/wellness/a17218/taming-raging-hormones-jun02/>