Perimenopause, also called the menopausal transition is a vaguely defined phase when
a woman’s body progresses from previous predictable cycles of ovulation
and resulting menstruation that concludes with menopause—the complete
absence of menstrual bleeding for 12 consecutive months.
While the average age of menopause is approximately 51, it can occur anytime
in your 40’s and up to age 55. Likewise women start perimenopause
months to years beforehand. Irregular periods are a hallmark of perimenopause,
reflecting your ovaries waning ability to produce female hormones in an
orderly sequence. Most of the time, this is normal and nothing to be concerned
about. However you should see your doctor if
bleeding is too heavy, too often, or too prolonged.
Women may also begin to experience menopause-like symptoms, such as hot
flashes, sleep disturbances, and vaginal dryness. Inconsistent hormonal
fluctuations of estrogen and progesterone are responsible for the changes
Menstrual irregularity: As ovulation becomes more erratic, the intervals between your periods
may vary longer or shorter, flow may be scanty to profuse, and you may
skip periods. Early perimenopause is defined as a change in menstrual
cycle length of more than 7 days. Late perimenopause is characterized
by two or more missed periods and longer intervals between periods.
Hot flashes and sleep problems: About 75% of women experience
hot flashes, most commonly during late perimenopause. The intensity, duration and
frequency vary. Sleep problems are often due to hot flashes or night sweats,
but sometimes sleep becomes erratic even without them.
Mood changes: Some women experience mood swings, irritability or increased risk of depression
during perimenopause. Sleep disruption from hot flashes may contribute
to these symptoms. Conversely, persistent daily mood changes may also
be caused by factors unrelated to the hormonal changes.
Vaginal and bladder problems: When estrogen levels diminish, vaginal tissues may lose lubrication, elasticity,
and thickness making intercourse painful. Initially vaginal lubricants
should be tried for sex, but if discomfort persists then vaginally applied
estrogen can be restorative. Low estrogen levels may also increase vulnerability
to bladder infections. Loss of
bladder control may become more prevalent and can be successfully treated.
Decreasing fertility: As ovulation becomes irregular, the ability to conceive decreases. However,
as long as you are having periods, pregnancy remains a possibility. So
to be safe contraception should be utilized until you have gone 12 months
without a period.
Changes in sexual function: During perimenopause, sexual arousal and desire may diminish. But for
most women who had satisfactory sexual intimacy before menopause, this
will continue through perimenopause and beyond.
Some women seek medical attention for their perimenopausal symptoms. Possible
Oral contraceptives: Birth control pills are often the most effective treatment to relieve
perimenopausal symptoms because they use female hormones to create regularity—even
if a women does not need them for birth control. Ultra low-dose pills
can regulate periods, reduce hot flashes and vaginal dryness without weight gain.
Progesterone therapy: If a women has irregular periods, but cannot use oral contraceptives,
then cyclic progesterone therapy (10 to 14 days each month) usually regulates
periods that occur afterwards. Some women with heavy bleeding during perimenopause
prefer the convenience of a progesterone containing intrauterine device—Mirena® IUD—which lasts 5 years.
Endometrial ablation provides permanent relief from persistent heavy bleeding some women experience
during perimenopause. During the procedure, the inside lining of the uterus
is removed using a device that cauterizes it. It takes 90 seconds and
can be conveniently performed during an office visit. It effectively reduces
menstrual flow or ends it in over 90% of patients.
Finally, making healthy lifestyle choices may help ease some of the symptoms
of perimenopause as well as promote good health as you age. These choices include:
Good nutrition: Because the risk of osteoporosis and heart disease increase at this time,
a healthy diet is more important than ever. In addition, remember to consume
calcium-rich foods or take a calcium supplement (1200mg) that also supplies
vitamin D (600 units). Be mindful that alcohol and caffeine may trigger
Regular exercise: Regular physical activity helps prevent weight gain, improves sleep, strengthens
bones, and elevates mood. Exercise for 30 minutes or more on most days
of the week.
Stress reduction: Practiced regularly, stress-reduction techniques, such as meditation or
yoga, can be particularly helpful during the menopausal transition.
Many women find the perimenopause perplexing. Hopefully a little
information goes a long way helping you understand and navigate this transition.