Could it be...Perimenopause? How Women 35-50 Can Overcome Forgetfulness, Mood Swings, Insomnia, Weight Gain, Sexual Dysfunction, and Other Telltale Signs of Hormonal Imbalance by Steven R. Goldstein, M.D. and Laurie Ashner (Boston: Little, Brown & Company, 1998) ISBN 0-316-31898-1 hb. $32.00

Ah, at last. Or so I thought. A book that would provide the answers to the questions that have been troubling me. Why is it that my PMS seems to have gotten more pronounced in recent years? Why are my breasts that much more tender in the week or so before my period begins? Why is my cycle so short, I'm sure I just finished and now I'm beginning again? I had thought that, after almost 30 years of menstruating, I was finally getting in touch with my body, aware and tuned in to the subtle changes that occur throughout my menstrual cycle. Why, I can even tell when I'm ovulating.

Well, thanks to Dr. Goldstein and Ms. Ashner, I know that's not necessarily the case. Apparently I'm on the threshold of yet another phase of life determined and controlled by hormones. I had thought that after my last child was born, erratic hormonal surges were in abeyance, at least until the onset of menopause, years in the future. It would appear that I am sadly mistaken. Perimenopause, that transitionary time that lasts for roughly a decade before menopause, has now been identified as the culprit behind my capricious cycle. Whew. I thought it was just me.

Goldstein, professor at New York University School of Medicine and past chairman of the American College of Obstetrics and Gynecology, and co-author Ashner, whose work includes When Parents Love Too Much, have identified perimenopause as the transition phase between regular menstrual activity and menopause, one marked by cyclic irregularity and caused by fluctuating hormone levels. We need not read too far into the book to discover Goldstein's preferred cure for the mood swings, bloating, tender breasts and insomnia that mark this time: low-dose birth-control pills (p. 4). And sometimes the message is just a little too insistent. Alternative therapies get short shrift, understandable given Goldstein's unapologetic support of scientific medicine, yet unsatisfying for the reader searching for natural remedies. Much of the message appears straightforward in support of proper diet and regular exercise, certainly no surprise there.

There is much to be commended in this volume. The writing is engaging and accessible, the information clearly presented and supported by case studies and women's own words, with questions accompanying each chapter. I found myself relating to many of the women whose stories appear throughout the book. The mysteries of medical science are uncovered with clarity and I learned a great deal about gynecological examinations and procedures. I am, however, left wanting more. That women's lives are, yet again, subjected to a delineation dependent upon their biology, which is then identified as a problem, angers me, as does the message that there is no effective alternative therapy outside of taking a pill I spent most of my life trying to avoid. I have, though, learned a great deal about perimenopause, a word I first encountered only two months ago, and one which, I am sure, I will hear more of in the years to come.

M.S.