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A call to recognize ‘reverse puberty’ in women: Why the hormonal shift is no less dramatic in middle age than adolescence

Impact of perimenopause broadly ignored, yet hormonal shift is no less dramatic in middle age than adolescence.

By AOA Media Team


CHICAGO—February 20, 2019—The slow reduction of estrogen and progesterone that leads to the end of menstruation and beginning of menopause marks a significant mental, physical and emotional shift for women.

Perimenopause, which comprises the decline and end of women’s ability to reproduce, may extend for years. The transition often causes irregular cycles, extreme bleeding, vaginal dryness, loss of libido, migraine headaches, brain fog, premenstrual dysphoric disorder (PMDD), night sweats and more.

“I think we downplay how much perimenopause affects women,” says Octavia Cannon, DO, president of the American College of Osteopathic Obstetricians and Gynecologists. “During this reverse puberty stage, women’s bodies are under a profound amount of stress that causes physical, mental and emotional strain—and yet, it’s rarely addressed outside of the doctor’s office.”

Translated as “around menopause,” perimenopause refers to the time when a woman’s body makes the transition to menopause. Women enter this stage 8 to 10 years ahead of menopause, typically during their late 30s or early 40s. And while the duration of perimenopause averages four to five years, it can last anywhere from three to 10.

“Compound this stress with the fact that career and familial responsibilities peak around this time, and you can understand why perimenopause is often associated with a feeling of burnout,” says Betsy Greenleaf, DO, an OB/GYN and urogynecologist. “I’m checking on emotional and mental health as much as physical symptoms during consultations with perimenopausal patients.”

Treatment for perimenopause
Hormone replacement therapy (HRT) was widely prescribed to ease the transition in the past. However, at the start of the century an alarming report surfaced that suggested HRT increased risks of breast cancer, stroke and heart disease in certain women. Despite some newer research discrediting the original report, the current standard of care does not include ongoing HRT treatment, especially for women with a family history of cancer.

“New bio-identical hormones are coming to market that show promise, but it’s a balance between easing symptoms and managing risk,” says Dr. Greenleaf. “Some perimenopause symptoms may mimic more serious health concerns, so I highly encourage women to seek out counsel from a physician during this period in their lives.”

Pharmaceuticals solutions such as paroxetine, which can reduce hot flashes and dually serve as an antidepressant, offer some relief, and surgical interventions can control extreme bleeding. However, drugs designed to enhance female libido are still improving, according to Dr. Cannon, who notes that one of the most popular options requires a daily pill that cannot be taken with alcohol.

“Talk with your friends, family and physician about challenges and treatments that have been effective,” says Dr. Cannon. “It’s temporary, but it’s a challenging period that deserves more recognition.”

Typically between the ages of 45 to 58 years, the ovaries stop responding to stimulus from the brain, and menstruation ends. Once a woman completes a year without a menstrual cycle she moves from perimenopause to menopause, which offers some relief from the worst side effects of perimenopause. This closes the reproductive phase of a woman’s life.

About the AOA
The American Osteopathic Association (AOA) represents more than 145,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools.

To learn more about DOs and the osteopathic philosophy of medicine, visit


Media Contact:

Jessica Bardoulas