I am 41 and have been having a period every 14 days for the last six weeks. I think I have had some hot flashes. I also have symptoms that seem like a vaginal yeast infection just before and during my period. Is this normal? Is this menopause? Will using a natural progesterone cream help?

Rhonda

Recent findings in large-scale research studies suggest that HRT may increase a woman's risk of breast cancer, heart disease and stroke. In addition, when estrogen is prescribed alone, it may increase the risk of ovarian cancer. Consult a physician before starting any medication regimen.

These symptoms are not unusual for a woman in her 40s and entering menopause. Before we actually become menopausal (defined as a lack of menses for one year), we go through a transition stage -- puberty in reverse! This transition stage is called perimenopause. Hormone levels begin to change, ovulation does not happen every month like clockwork, hot flashes and night sweats may occur occasionally, and cycles become irregular. The average age of menopause in the United States is 51, but it occurs earlier in smokers and in women living at high altitude. It may be influenced by genetics; if you can, ask your mother when she went through menopause. The average length of perimenopause is four years.

The perimenopausal changes in bleeding patterns may be due to a relative lack of progesterone in relationship to estrogen; therefore, progesterone supplementation may help. Progesterone is absorbed easily through the skin, but beware of progesterone creams found in health food stores; one study showed that 50 percent of them didn't contain any measurable progesterone! Progest is one brand that is reliable, and some compounding pharmacies can make progesterone creams for you at your doctor's request.

However, other conditions, such as thyroid dysfunction, may mimic perimenopausal changes. More serious causes of increased bleeding -- such as abnormal uterine lining cells, fibroids or polyps -- should be ruled out by biopsy or ultrasound. You should schedule an appointment with your gynecologist for a complete evaluation. Perimenopause is a good time to reevaluate your lifestyle, make sure you are exercising and eating properly, ensure adequate calcium intake, and reassess contraceptive needs and options.