Perimenopause, which means "around menopause," refers to the time when your body naturally transitions to menopause, signaling the end of your reproductive years. The menopausal transition is another name for perimenopause.
Women enter perimenopause at various ages. In your 40s, you may begin to notice indicators of menopause, such as irregular menstruation. Some women, however, experience changes as early as their mid-30s.
During perimenopause, the level of estrogen, the major female hormone, in your body fluctuates. Your menstrual cycles may become longer or shorter, and you may begin to have menstrual cycles in which your ovaries do not release an egg (ovulate). Menopause-like symptoms, such as hot flashes, sleep issues, and vaginal dryness, may also occur. There are treatments available to assist alleviate these symptoms.
When you go 12 months without having a monthly period, you've officially achieved menopause, and the perimenopause stage is finished.
WHAT ARE THE SYMPTOMS OF PERIMENOPAUSE?
During the menopausal transition, your body may undergo subtle — and not-so-subtle — changes. You may encounter:
- Periods that are irregular: As ovulation becomes more unpredictable, the duration between periods may get longer or shorter, your flow may vary from light to heavy, and you may miss some periods. If the length of your menstrual cycle changes for seven days or more, you may be in early perimenopause. If you get a period every 60 days or more, you are likely in late perimenopause.
- Hot flashes and sleep issues: Perimenopausal hot flashes are prevalent. The intensity, duration, and frequency all vary. Sleep issues are frequently caused by hot flashes or night sweats, but sleep can also become irregular without them.
- Mood swings: Mood swings, impatience, and an increased risk of depression are all possible during perimenopause. These symptoms could be caused by sleep interruption caused by hot flashes. Mood swings can also be induced by factors unrelated to perimenopausal hormone changes.
- Vaginal and bladder issues: When estrogen levels fall, your vaginal tissues may lose lubrication and suppleness, making sexual contact painful. Low estrogen levels may also make you more prone to urinary or vaginal infections. Tissue tone loss may contribute to urine incontinence.
- Bone loss: When estrogen levels fall, you begin to lose bone faster than you replace it, increasing your risk of osteoporosis, a disease that causes weak bones.
- Changing cholesterol levels: Declining estrogen levels can cause adverse changes in your blood cholesterol levels, such as an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which increases your risk of heart disease. Simultaneously, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — falls in many women as they age, increasing the risk of heart disease.
- Decreasing fertility: Your ability to conceive reduces as ovulation gets irregular. However, pregnancy is still possible as long as you have periods. If you want to avoid pregnancy, utilize birth control for the first 12 months.
- Sexual function changes: Sexual arousal and desire may fluctuate during perimenopause. However, if you experienced satisfying sexual intimacy prior to menopause, this will most certainly continue throughout perimenopause and beyond.
WHAT ARE THE CAUSES OF PERIMENOPAUSE?
During perimenopause, your body's production of estrogen and progesterone, two crucial female hormones, fluctuates. Many of the changes you experience during perimenopause are caused by low estrogen levels.
WHAT ARE THE RISK FACTORS FOR PERIMENOPAUSE?
Menopause is a natural part of life. However, it may develop sooner in some women than others. Although not always conclusive, some evidence suggests that several variables may increase your chances of entering perimenopause at a younger age, including:
- Smoking: Women who smoke experience menopause 1 to 2 years earlier than women who do not smoke.
- Family history: Women who have a family history of early menopause may experience it themselves.
- Cancer therapy: Chemotherapy or pelvic radiation therapy for cancer has been associated to early menopause.
- Hysterectomy: Menopause is usually not caused by a hysterectomy that removes your uterus but not your ovaries. Even if you no longer have periods, your ovaries continue to generate estrogen. However, such surgery may cause menopause to occur sooner than usual. Furthermore, if one ovary is removed, the remaining ovary may quit operating sooner than predicted.
WHAT ARE THE COMPLICATIONS OF PERIMENOPAUSE?
Perimenopause is characterized by irregular periods. Most of the time, this is normal and causes no concern. However, if you experience any of the following symptoms, consult your doctor:
- Bleeding is intense – you have to change tampons or pads every hour or two for two or more hours.
- Bleeding continues for more than seven days.
- Bleeding happens between menstruation.
- Periods are frequently shorter than 21 days apart.
These symptoms may indicate an issue with your reproductive system that requires evaluation and treatment.
HOW IS PERIMENOPAUSE DIAGNOSED?
Perimenopause is a process characterized by a gradual transition. There is no single test or indication that will tell you if you are in perimenopause. Many factors are considered by your doctor, including your age, menstruation history, and the symptoms or body changes you're experiencing.
Some doctors may order hormone tests to evaluate your levels. Hormone testing, aside from examining thyroid function, which might alter hormone levels, is rarely essential or beneficial in assessing perimenopause.
WHAT ARE THE TREATMENTS FOR PERIMENOPAUSE?
Perimenopausal symptoms are frequently treated with medications.
- Hormone therapy: The most successful treatment option for perimenopausal and menopausal hot flashes and night sweats is systemic estrogen therapy, which comes in pill, skin patch, spray, gel, or cream form. Depending on your personal and family medical history, your doctor may recommend the lowest possible dose of estrogen to give you with symptom relief. If you still have your uterus, you will need progestin in addition to estrogen. Systemic estrogen can aid in the prevention of bone loss.
- Vaginal estrogen: Estrogen can be delivered vaginally via a vaginal pill, ring, or lotion. This medication only produces a trace amount of estrogen, which is absorbed by vaginal tissue. It can help reduce vaginal dryness, intercourse discomfort, and some urinary symptoms.
- Antidepressants: Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have been shown to lessen menopausal hot flashes. An antidepressant for hot flashes may be beneficial for women who are unable to take estrogen due to medical reasons or for women who require an antidepressant for a mood problem.
- Gabapentin (Neurontin): Gabapentin is licensed for seizure treatment, but it has also been demonstrated to aid with hot flashes. This medication is beneficial for women who are unable to utilize estrogen therapy due to medical reasons, as well as those who suffer from migraines.
Before deciding on a course of therapy, consult your doctor about your options and the risks and benefits of each. Your alternatives should be reviewed yearly because your needs and treatment options may change.
HOME REMEDIES FOR PERIMENOPAUSE
Making the following healthy lifestyle choices may help alleviate some perimenopausal symptoms and promote good health as you age:
- Reduce vaginal discomfort: Use water-based vaginal lubricants (Astroglide, K-Y Liquid, and others) or moisturizers over-the-counter (Replens, Vagisil Prohydrate, others). Choose products free of glycerin, which can cause burning or irritation in women who are sensitive to it. Staying sexually active also aids in blood flow to the vagina.
- Consume nutritious foods: A nutritious diet is more important than ever at this time because your risk of osteoporosis and heart disease increases. Adopt a high-fiber, low-fat diet rich in fruits, vegetables, and whole grains. Consume calcium-rich meals. If alcohol or caffeine appear to cause hot flashes, avoid them. Inquire with your doctor if you should take a calcium supplement, and if so, what type and how much. Also inquire if you require more vitamin D, which aids in calcium absorption.
- Be active: Regular exercise and physical activity helps you lose weight, sleep better, and feel better. Exercise for 30 minutes or more most days of the week, but not right before bed. Regular exercise has been demonstrated to lower the risk of hip fracture in elderly women and to increase bone density.
- Get enough rest: Maintain a steady sleep routine. Avoid caffeine, which can make falling asleep harder, and excessive alcohol consumption, which can interrupt sleep.
- Use stress-reduction methods: Stress-reduction practices such as meditation or yoga, when practiced on a daily basis, can promote relaxation and good health throughout your life, but they may be especially beneficial during the menopausal transition.
Alternative medicine
Many women approaching menopause desire to learn more about complementary and alternative techniques to addressing symptoms, in addition to traditional therapy. Researchers are investigating these medicines to assess their safety and efficacy, although evidence is typically weak.
Among the options studied are:
- Black cohosh: Some women use this herb extract to alleviate hot flashes and other menopausal symptoms. There is insufficient evidence to justify its use. Experts are also unsure about the hazards of using black cohosh. Some research have claimed that black cohosh is toxic to the liver, although other investigations have shown no evidence of this. Researchers also wonder if the plant extract is safe for people who have or are at risk of developing breast cancer.
- Phytoestrogens: These estrogens are naturally present in some meals. Isoflavones and lignans are the two main types of phytoestrogens. Soybeans, other legumes, and red clover contain isoflavones. Flaxseed, whole grains, and some fruits and vegetables contain lignans. Plant-derived substances with estrogen-like characteristics are also available.
Whether phytoestrogens from food or supplements help alleviate menopausal symptoms is the subject of debate. Moreover, studies disagree on whether phytoestrogens have any positive effect on breast cancer risk.
- Bioidentical hormones: The phrase "bioidentical" refers to hormones that are chemically identical to those produced by your body. However, because compounded bioidentical hormones are not regulated by the United States Food and Drug Administration (FDA), quality and hazards may vary. Furthermore, there is no proof that compounded bioidentical hormones are any safer or more successful than traditional hormone therapy.
- Dehydroepiandrosterone (DHEA): This natural steroid produced by your adrenal gland is available as a dietary supplement and has been used by some to relieve pain caused by vaginal atrophy during intercourse. However, the evidence on its usefulness is equivocal, and there are some worries regarding potential side effects.
Before taking any herbal or nutritional supplements for perimenopausal or menopausal symptoms, consult your doctor. The FDA does not regulate herbal products, and some of them can be harmful or interfere with other prescriptions you are taking, putting your health at risk.
Complementary therapies with low risks that may help relieve stress and promote psychological well-being include:
- Acupuncture: Acupuncture research for hot flashes is unclear yet encouraging.
- Techniques for relaxation: Yoga and meditation, for example, can help reduce stress, which may help alleviate menopausal symptoms.