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Perimenopausal Bleeding: The Roller Coaster of Mid-life

Understand the unpredictable and irregular patterns of bleeding during perimenopause. Learn about the clinical sequelae and the stages of reproductive aging. Expert insights from Dr. Steven R. Goldstein.

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Perimenopausal Bleeding: The Roller Coaster of Mid-life

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  1. Perimenopausal Bleeding: The Roller Coaster of Mid-life Steven R. Goldstein, M.D..FACOG,CCD,NCMP, RCOG(H) Professor of Obstetrics & Gynecology New York University School of Medicine Director of Gynecologic Ultrasound Co-Director of Bone Densitometry New York University Medical Center

  2. PERIMENOPAUSE (DEFINED)Harlow, Siobán D., et al. Executive summary of the Stages of Reproductive Aging Workshop+ 10: addressing the unfinished agenda of staging reproductive aging. Climacteric 2012: 15.2 : 105-114. • The STRAW+10 system for reproductive aging in women defined “perimenopause” as the “early” and “late” menopausal transition.

  3. “Early” menopausal transition: • Variable duration • Cycle length variable “persistent ≥ 7day difference in length of consecutive cycles”. • Lab tests • FSH: variable • AMH (Anti- Mullerian Hormone): low • Inhibin B: low • Antral follicle count: low

  4. “Late” Menopausal Transition • Duration 1-2 years. • Interval of amenorrhea of ≥ 60 days. • Lab tests • FSH: elevated • AMH: low • Inhibin B: low • Vasomotor symptoms “likely”.

  5. PERIMENOPAUSE: CLINICAL SEQUELAE • Some have likened perimenopause as the mirror image of adolescence. • Corollary to this: one is the coming onto the reproductive years, the other the coming off.

  6. PERIMENOPAUSE: CLINICAL SEQUELAE • Characterized by oligoovulation • Hallmark of ovulation: regular cyclic, predictable menses. • Hallmark of anovulation/oligoovulation: irregular timing and length of uterine bleeding.

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