Volume 1, Number 3: Fall Equinox, 1999

The Puzzle of Perimenopause - an Educational Video - BC Diabetes Foundation

Jerilynn C. Prior MD, FRCPC

A video and personal monitoring system has been launched by Dr. Jerilynn C. Prior, Professor of Endocrinology at the University of British Columbia, Vancouver, Canada. She published a major review, “Perimenopause: the complex endocrinology of the menopausal transition” in Endocrine Reviews (1998;19:397-428). This “meta-analysis” of the published data on estrogen shows that estradiol levels in perimenopausal women are, on average, significantly higher than those in premenopausal women. Therefore, the current concept that declining estrogen levels occur (and cause difficulties) in the time before menopause is incorrect. Some of you may remember that Dr. Prior presented an excellent overview on this subject in the Spring Equinox issue of this Quarterly Newsletter.

The launch was held at the Sassafras Room at Vancouver Hospital on July 29, 1999 and was well attended by the media. The first major coverage was an article in the Vancouver Sun that came out on August 16. I remember well that Monday morning because the foundation phone never stopped ringing and I was deluged by over fifty calls requesting the video. Subsequent articles have appeared in other publications and the orders continue to roll in. The response really has been overwhelming and reaffirms our belief that the video will play a major roll in assisting women and their doctors to understand the complex experiences that can occur at this time in a women’s life. As Dr. Prior said, “I’ve tried for at least five years to teach physicians about this change and have not been very successful. I decided to connect with women instead in hopes that doctors will catch up.”

Dr. Thomas Elliott, president of the B.C. Endocrine Research Foundation, attended the launch and made opening remarks. I had an opportunity to speak with Dr. Elliott afterwards and he had this to say. “I am really excited about the launch of this new video. I feel it will help greatly in the in the dissemination of important information relevant to every woman’s health.”

Dr. Penny Ballem, one of B.C.’s best-known women’s health experts spoke very highly of Dr. Prior’s work. “Jerilynn has slowly and methodically built her scientific evidence base. Changing dogma is difficult, especially for a woman in an area that has been primarily researched by men.”

The Daily Perimenopause Diary, 1990 is included with the video. Given the lack of accurate prospective, women-centred data about what the normal perimenopause is like, women need to be able to make sense of their own experiences. For this reason, Dr. Jerilynn Prior developed this diary as a way in which women can capture the whole range of their experiences: from vaginal bleeding to interest in sex, from breast tenderness to feelings of self worth. A portion of the video is devoted to helping women use this diary to better understand their own experiences.

Along with a better understanding women will also have a very detailed and structured tool for documenting and presenting this information to their doctors. The fact that estrogen levels appear to rise rather than fall during the perimenopause has immense therapeutic implications. It represents a full 180 degree turn in how women and physicians perceive and treat symptoms of the perimenopause. Rather than prescribing estrogen (a common solution in the past) which may simply compound the problems it is necessary to think in terms of the balance between estrogen and progesterone. When estrogen levels are high, cyclic progesterone therapy will bring the balance back to normal.

Although the experiences of perimenopause may be difficult, they will ease. Dr. Prior asserts, “We developed the video and diary to help women survive this confusing but normal stage of life.”

&mdash Dr. Eric Norman PHD

Dr. Norman is the Secretary of the B.C. Endocrine Research Foundation and Editor of the Quarterly Newsletter.

Produced in co-operation with Biomedical Communications, UBC, “The Puzzle of Perimenopause” was funded by the B.C. Centre of Excellence for Women’s Health, which is located at B.C.’s Women’s Hospital and Health Centre. The B.C. Centre of Excellence is one of five Canadian research centres dedicated to improving women’s health.

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