Making Sense of Perimenopause

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 during perimenopause:

• 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 therapies include:

• 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: 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 hot flashes.
• 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.