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
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 :
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.