Perimenopause

Perimenopause is the time leading up to menopause, when a woman's body naturally transitions to the end of her reproductive years. It's also sometimes called the menopausal transition. Think of it as the period around menopause.

Women experience perimenopause at different ages. Some notice changes in their menstrual cycles, like irregular periods, as early as their 30s, while others don't experience these signs until their 40s.

During perimenopause, the level of estrogen, a key female hormone, fluctuates. This means your menstrual cycles can become unpredictable – sometimes longer, sometimes shorter, and sometimes your ovaries might not release an egg (ovulate) during a cycle. You might also experience symptoms like hot flashes, trouble sleeping, and vaginal dryness, similar to those experienced during menopause. Good news: there are treatments available to help manage these symptoms.

Menopause itself happens when you haven't had a menstrual period for 12 consecutive months. At that point, perimenopause is over.

The Menopausal Transition: Understanding Your Body's Changes

As you move through the menopausal transition, your body may undergo several changes, both subtle and noticeable. These shifts are due to a gradual decrease in estrogen levels. Let's look at some common experiences:

Menstrual Changes: Your periods may become irregular. This means the time between periods might get longer or shorter, and the flow could vary from light to heavy. Sometimes, you might skip periods altogether. If your cycle length changes by seven days or more, you might be in early perimenopause. If you have a gap of two months or more (60 days or longer) between periods, you are likely in late perimenopause.

Hot Flashes and Sleep Disruptions: Hot flashes are very common during perimenopause. They can range in intensity, duration, and how often they occur. These flashes often cause sleep problems, like night sweats. Even without hot flashes, sleep may become disrupted.

Mood Swings: Changes in mood, such as irritability or feelings of sadness, can also happen during perimenopause. These mood swings may be linked to the sleep disruptions caused by hot flashes. However, other factors not related to hormones can also influence your mood.

Vaginal and Bladder Issues: Lower estrogen levels can cause vaginal dryness and decreased elasticity. This can make sexual intercourse uncomfortable. The lack of estrogen can also increase your risk of vaginal or urinary infections. You may also experience urinary incontinence due to the loss of tissue tone.

Decreased Fertility: As ovulation becomes more unpredictable, your chances of getting pregnant decrease. However, as long as you are still having periods, pregnancy is possible. If you want to avoid pregnancy, use birth control until you haven't had a period for 12 months.

Changes in Sexual Function: Your sexual desire and arousal might change during perimenopause. However, if you were happy with your sexual intimacy before menopause, it's likely you'll continue to be satisfied throughout perimenopause and beyond.

Bone Loss: Decreased estrogen levels cause your body to lose bone faster than it replaces it, which increases your risk of osteoporosis (weakened bones).

Changes in Cholesterol: Lower estrogen levels can affect your blood cholesterol. Your levels of LDL ("bad") cholesterol may increase, which raises your risk of heart disease. At the same time, HDL ("good") cholesterol often decreases with age, also increasing heart disease risk.

Seeking Help: Some women experience only mild symptoms, while others have more significant changes that require medical attention. If you notice symptoms that are affecting your daily life, like bothersome hot flashes, mood swings, or changes in your sexual function, talk to your doctor. Remember, these symptoms are often connected to the hormonal fluctuations of the menopausal transition. It's important to understand that these changes are a normal part of life, and there are ways to manage them.

Many women go through perimenopause, the time leading up to menopause. Some women experience noticeable symptoms, and seek medical help. Others either don't have strong symptoms, or they find ways to manage them. It's important to remember that these symptoms can develop slowly and subtly. You might not realize they're all linked to changes in hormone levels during this transition.

If you're experiencing symptoms like hot flashes, shifts in your mood, or changes in your sex drive that are making it hard to live your life comfortably, it's a good idea to talk to your doctor.

During perimenopause, the body's production of estrogen and progesterone, important female hormones, fluctuates. This means their levels go up and down. Many of the symptoms you feel during perimenopause are directly linked to the decrease in estrogen levels.

Menopause is a natural part of a woman's life, marking the end of her reproductive years. However, some women experience menopause earlier than others. While it's not always possible to pinpoint the exact cause, several factors seem to play a role in the timing of perimenopause (the period leading up to menopause).

Several things might increase the chance of early perimenopause.

• Smoking: Women who smoke tend to go through menopause about one to two years earlier than women who don't smoke. This is likely due to the harmful effects of smoking on the body.

• Family history: If your mother, sister, or other close female relatives experienced menopause early, you might be more likely to experience it early too. This suggests a possible genetic link.

• Cancer treatment: Certain cancer treatments, like chemotherapy and radiation therapy focused on the pelvic area, can sometimes lead to premature menopause. The treatments can damage the ovaries, which are crucial for producing hormones like estrogen.

• Surgery: Having a hysterectomy (surgery to remove the uterus) is usually not directly connected to menopause, as long as your ovaries are left intact. The ovaries continue to produce estrogen, which regulates many bodily functions. However, if a hysterectomy does involve removing the ovaries, or if one ovary is removed, it can trigger menopause earlier than expected. The remaining ovary may not function as well as it should, leading to the production of less estrogen and causing menopause to begin sooner.

Changes in menstrual cycles are common during perimenopause. Most of the time, these changes are normal and nothing to worry about. However, you should see your doctor if you notice any of the following:

• Heavy bleeding: If you're needing to change your menstrual products (tampons or pads) every hour or two for more than two hours at a time, this is a sign you should get checked.
• Long periods: If your bleeding lasts longer than seven days, it might be a cause for concern.
• Bleeding between periods: Spotting or bleeding that occurs outside of your usual menstrual cycle could be a sign of something needing attention.
• Periods too close together: If your periods are coming less than 21 days apart, this is also something to discuss with your doctor.

These symptoms could indicate a problem with your reproductive health that requires medical attention and diagnosis. It's important to remember that these are just potential indicators, and not everyone experiencing these symptoms will have a serious issue. Your doctor can help determine the cause and recommend the best course of action.

Perimenopause isn't a single event; it's a period of time, like a gradual shift. There's no single test to say for sure you're in perimenopause. Your doctor will look at several factors to determine if you're experiencing it. These factors include your age, your menstrual history (how your periods have been over time), and any symptoms or changes you're noticing in your body.

Sometimes, your doctor might run some tests, especially to check your hormone levels. However, unless your thyroid function is suspected of being a factor (since thyroid problems can affect hormone levels), hormone tests aren't usually needed or helpful in figuring out if you're going through perimenopause.

If you have concerns about perimenopause, you can find support and information from healthcare professionals at Mayo Clinic. Visit our website or contact us to learn more.

Dealing with Perimenopause Symptoms

Many women experience perimenopause symptoms, which can be managed with various medications. These symptoms often include hot flashes and night sweats.

Hormone Therapy (Estrogen):

Estrogen therapy is often the most effective treatment for perimenopause and menopause symptoms like hot flashes and night sweats. Doctors prescribe the lowest dose of estrogen possible to relieve symptoms. If a woman still has her uterus, she'll also need progestin along with estrogen. Estrogen can help prevent bone loss. There are different ways estrogen can be delivered:

• Systemic Estrogen: This is taken as a pill, patch, spray, gel, or cream. It's absorbed throughout the body.
• Vaginal Estrogen: This is applied directly to the vagina using a tablet, ring, or cream. It releases a small amount of estrogen absorbed by the vaginal tissue, helping with vaginal dryness, discomfort during sex, and some urinary issues.

Other Medications:

• Antidepressants (SSRIs): Some antidepressants can help reduce hot flashes. These might be a good option if estrogen isn't suitable for health reasons, or if a woman needs an antidepressant for another condition.
• Gabapentin (Neurontin): This medication, usually used for seizures, can also help reduce hot flashes. It might be a good choice for women who can't take estrogen or who also experience migraines.
• Fezolinetant (Veozah): This is a hormone-free option for treating hot flashes. It works by affecting the part of the brain that controls body temperature.

Important Considerations:

It's crucial to discuss all treatment options, along with the potential risks and benefits, with your doctor. Your individual needs and suitable treatment options may change over time, so it's important to review your care plan yearly.

Additional Information:

• Mayo Clinic: You can find more information about perimenopause care and other women's health topics on the Mayo Clinic website. They offer resources, expert opinions, and ways to stay up-to-date on women's health.

Important Note: This information is for general knowledge and does not constitute medical advice. Always consult with a healthcare professional for personalized recommendations and treatment plans.