After the age of 40 years, most women will experience changes in the body associated with the alterations in the female hormones (estrogen and progesterone). Before menopause sets in, there are intermediate or transition stages which may present with some of the same symptoms as menopause.
What is perimenopause?
Perimenopause is the period of time before menopause sets in. It is a natural transition phase which signals the impending start of menopause.This transition before menopause can last anywhere between a few months to as long as a decade. However, perimenopause lasts around 4 years for most women. It is a gradual shift from the menstruating years to the non-menstruating stage of life.
Another term that is used synonymously with perimenopause is ‘climacteric‘. This is the transition from the reproductive to the non-reproductive years starts before the phase classified as perimenopause. However, a woman may continue having periods even without ovulating. These anovulatory periods can continue for long periods before menopause sets in or before perimenopausal symptoms arise.
Although menopause is defined as the cessation of periods for 12 consecutive months, it is important to understand that the transition is not always as clearly defined biologically. In other words climacteric, perimenopause and menopause overlap. Premenopause is a term that is mistaken for perimenopause but premenopause refers to the reproductive years. It is therefore not associated with menopause in any way like perimenopause.
Causes and Hormone Changes
Menopause, and therefore perimenopause, is a natural phase in a woman’s life. Perimenopause usually starts in the forties but can occur earlier. Some of the following factors may increase the risk of early menopause and therefore earlier perimenopause:
- Family history
- Cigarette smoking
- Hysterectomy (even without ovary removal)
- Cancer treatments
What happens in perimenopause?
Within the reproductive years, hormones secreted by the pituitary gland – follicle-stimulating hormone (FSH) and luteinizing hormone (LH) – stimulate the ovaries to release an egg cell. Estrogen and progesterone are secreted by the ovarian follicles. If pregnancy does not occur then there inner lining of the uterus along with the egg cells is flushed out of the uterus. This is known as menstruation, or is commonly referred to as periods. The entire process repeats over a 28 day duration and is referred to as the menstrual cycle.
Read more on female hormones.
With advancing age, the ovarian follicles also reduce in quality and quantity. The ovaries become less responsive to FSH and LH. As a result, the level of ovarian hormones, particularly estrogen, dimnishes over time. It is around this time that perimenopause commences. Menstration may still occur although there may be no ovulation (anovulatory cycle). The periods may also become irregular and eventually cease. Only if this cessation persists for more than 12 months can it be considered as the start of menopause.
Signs and Symptoms
The development of perimenopause symptoms arise gradually and may be mild to moderate. Some women may experience severe symptoms. Many of these symptoms of perimenopause are also seen during menopause. It may be more intense, frequent and/or persistent during menopause than in perimenopause.
Read more on signs of menopause.
The most noticeable of perimenopause symptoms is the irregular bleeding. Initially the menstrual cycle may extend by a few days Eventually some periods will be missed entirely. For example a woman may find that she misses one or two consecutive periods only for menstruation to return thereafter. The menstrual flow can be heavy or light and periods may be longer or shorter than normal.
Hot flashes is another characteristic symptoms of perimenopause and menopause. It is a sudden feeling of heat that may be accompanied by facial redness and sweating. Hot flashes vary in intensity and duration. Sometimes it can be very intense while at other times in may be mild. The hot flash may last for a few seconds to even several minutes. Over time, these hot flashes become more frequent. It may be accompanied by night sweats when sleeping.
Mood swings are another common symptom of perimenopause. Perimenopausal women may experience a sudden change of mood and often become irritable over trivial matters. Anxiety disorders and depression may also arise in some women. Although hormonal changes may account for the change in emotional state, it is also possible that these mood swings are not due to perimenopause.
Many perimenopausal women experience sleep problems, ranging from difficulty falling asleep to difficulty maintaning sleep for sufficient hours. It may be persistent or occur for short periods as occasional episodes. This may be due to hot flashes, night sweats, sleep cycle disturbances due to the same hormonal effects that cause mood changes or even due to other causes that are not related to perimenopause.
Fatigue and Low Libido
Unexplained fatigue is another common symptom of perimenopause. Many women report low energy levels and being easily tired even with mild to moderate activity. There is also often a drop in libido as a result of the hormonal changes. Poor sleep patterns, anxiety and irritability as well fatigue may also contribute to the decrease in libido. However, this change in libido may not affect every woman in perimenopause although it does become prominent in menopause.
A host of other symptoms also occur in perimenopause. However, it is always important to consider whether these symptoms are due to the changes in perimenopause or related to other conditions that may arise.
- Frequent urination
- Constant urge to urinate
- Urinary incontinence
- Vaginal dryness
- Moderate weight gain
There may also be elevation in blood cholesterol levels and a decline in bone mass density due to the hormonal changes of perimenopause.
Does Perimenopause Need Treatment?
Mild perimenopause symptoms may not require treatment if it is bearable and does not significantly affect daily functioning. This is a decision that should be made by the patient after proper advice from a doctor. However, moderate to severe symptoms should be medically treated to improve quality of life and minimize the possibility of complications like osteoporosis.
- Hormone replacement therapy (HRT) to raise estrogen levels.
- Low dose birth control pills also raise estrogen levels.
- Antidepressants for mood swings, anxiety and depression.
- Anti-seizure drugs like gabapentin for hot flashed.
Read more on hormone replacement therapy.