Understanding Perimenopause and Irregular Bleeding in Women: Insights from Dr. Steven R. Goldstein
Perimenopause is a transitional phase in a woman’s reproductive life that can begin as early as her late thirties and extend into her forties. Despite being a common and natural stage, many women remain unaware of the changes occurring in their bodies during this time—particularly with regard to their menstrual cycles and the onset of irregular bleeding.
Dr. Steven R. Goldstein, a leading gynecologist and Perimenopause Specialist in NYC, is at the forefront of helping women navigate this often confusing phase. Co-author of “Could It Be...Perimenopause?”—one of the first books published on the subject—Dr. Goldstein has played a pivotal role in increasing awareness and understanding of this critical life stage. He is a past President of both the International Menopause Society and the North American Menopause Society, and is a Certified Menopause Practitioner.
The Nature of Perimenopause
Perimenopause refers to the years leading up to menopause, typically
lasting between four to seven years. During this time, a woman’s hormone levels particularly estrogen and progesterone begin to fluctuate unpredictably. Ovulation may become irregular or cease altogether, which can lead to a range of physiological changes and symptoms.
One of the most common and noticeable symptoms is irregular menstrual bleeding. According to Dr. Goldstein, the absence of regular ovulation means that the body may not produce progesterone. Without this crucial hormone to counterbalance estrogen, the endometrial (uterine) lining can become unstable.
“When a woman is making estrogen but not ovulating, the pattern and amount of bleeding she experiences is dictated by the stability—or instability of her estrogen levels,” explains Dr. Goldstein. “This imbalance can cause the uterine lining to shed unpredictably, leading to spotting, heavier bleeding, or even long stretches with no bleeding at all.”
Recognizing the Signs
Unlike the predictable and consistent cycles of premenopausal women who ovulate regularly, perimenopausal cycles are marked by inconsistency. Women may experience:
• Heavier or lighter periods than usual
• Spotting between periods
• Irregular timing of cycles
• Periods that last longer or shorter than normal
• Intermittent episodes of no bleeding for weeks or even months
These irregularities can be disorienting and concerning, especially for women who are unaware that they may be entering perimenopause. Beyond changes in bleeding, the hormonal fluctuations during this time can produce a wide range of symptoms unrelated to the menstrual cycle itself. Dr. Goldstein, a Perimenopause Specialist in NYC notes that constant or unopposed estrogen levels may lead to:
• Salt and fluid retention
• Episodes of low blood sugar
• Increased risk of blood clotting
• Enhancement of fibroid tumors
• Altered thyroid hormone function (potentially causing weight gain or fatigue)
• Increased production of body fat
• General feelings of sluggishness and low energy
These symptoms, especially when occurring together, can signal that a woman is in perimenopause. However, it’s important to recognize that not all symptoms indicate perimenopause on their own. A proper evaluation by a healthcare provider is necessary to determine whether they form a recognizable pattern characteristic of this transition, that is, a “family of symptoms”
When to Seek Help
Women in their thirties or forties who notice unusual or irregular bleeding patterns, particularly when accompanied by other symptoms such as fatigue, fluid retention, or changes in body composition, should consider consulting a specialist. Dr. Goldstein emphasizes that while perimenopause is not always the cause, it should certainly be considered in the diagnostic process.
Healthcare providers will typically look for a “family” of symptoms that occur together in a recognizable pattern before making a preliminary diagnosis. This holistic approach helps distinguish perimenopause from other possible medical issues that could cause similar symptoms.
Expert Support in Navigating Perimenopause
For women seeking clarity and relief, consulting a knowledgeable and experienced specialist can make a significant difference. Dr. Steven R. Goldstein offers comprehensive care to women dealing with perimenopausal symptoms. His deep expertise, backed by decades of research and leadership in the field of menopause care, positions him as a trusted resource for women navigating this complex phase.
If you’ve been told you may be in perimenopause—or if you’re
experiencing irregular bleeding, spotting, or other related symptoms and are late thirties to late forties scheduling a consultation with a qualified physician like Dr. Goldstein, a Perimenopause Specialist in NYC can provide valuable answers and effective solutions tailored to your unique needs.