What is perimenopause?
Perimenopause, or “around menopause,” is when a woman’s body transitions to menopause. Women often show one or more menopause-related symptoms during this time, usually beginning in your 40s, but can begin earlier.
It’s sometimes difficult to tell whether your symptoms are related to menopause or something else, so it’s important to let your primary care provider know.
Signs
When you reach perimenopause, changes may occur in your menstrual flow and regularity. You might stop menstruating suddenly and never have another period; however, about 90% of women experience four to eight years of menstrual cycle changes, which is the average length of perimenopause. These irregular periods are caused by an erratic production of hormones. Every woman’s cycle is different, but you know your body well enough to recognize something’s changed.
Your provider can test your follicle-stimulating hormone (FSH) level to see if you have entered menopause. FSH is a hormone your pituitary gland produces, which stimulates the ovaries to release an egg during ovulation. When the level of FSH is consistently high, it indicates you are reaching menopause. It’s important to note that hormone tests aren't all that helpful to determine your menopause status, because hormone levels can swing high and low throughout perimenopause.
Monitoring your symptoms and menstrual cycle are most important as you transition to menopause. Once you haven’t menstruated for a full year, you’ve reached menopause; let your provider know when you have not menstruated for a full year. If you experience bleeding after this time, your provider should perform tests to see if there’s a medical issue to address, such as infection, fibroids, blood clotting disorders, polyps or cancer.
Symptoms
Hot flashes
Hot flashes are the most common menopause related symptom. As many as 75% of North American women will have hot flashes during perimenopause according to Johns Hopkins Medicine. Blood vessels near the surface of the skin dilate to allow more blood flow which gives off body heat. This can produce a red, flushed look on the face and neck and may cause sweating to help cool down the body. A cold chill usually follows a hot flash. Hot flashes and sweating may occur at night, disturbing a woman’s sleep cycle and potentially causing fatigue and irritability.
Vaginal health
At least one in three women will experience symptoms in the vulva and vaginal area or the urinary tract. These symptoms can include vaginal discharge, irritation, burning, dryness, itchiness, pain with and without sexual activity and urinary incontinence. Decreasing estrogen causes the surface of the vulva and vagina to become thin, dry and less elastic. There are treatments to keep the vagina healthy, including nonprescription options and vaginal estrogens.
Changes in mental health
Menopausal women sometimes report tearfulness, mood swings, lack of energy, anxiety, panic attacks and feeling blue or discouraged. They may also notice memory and other cognitive changes (“brain fog”) which can seem like they are developing dementia. Sometimes coping skills and lifestyle changes aren’t enough to relieve the symptoms, so treatment options including hormone therapy or prescription medicine may be necessary.
Weight gain
As your hormones shift, your metabolism slows down. During perimenopause, it's common for women to gain weight as estrogen starts to decline. Exercising regularly and eating healthy can help ward off extra weight gain as you transition to menopause.
Libido
Women frequently experience a decline in their libido or other sexual dysfunction. This can be due to multiple factors, but there are options out there to help women. Ask your provider about treatment options.
Are there treatments for perimenopause?
There is no treatment to avoid perimenopause, as it's a natural part of a woman’s life and ends when you reach menopause. Your provider may recommend treatments for your symptoms, including:
- Antidepressants for mood swings.
- Birth control pills to regulate periods.
- Hormone replacement therapy
- Vaginal estrogen
- Other non-hormonal medications for relief of hot flashes
Lifestyle changes are also important and may include:
- Performing more weightbearing exercises, such as weight training, walking and hiking.
- Making sure your diet includes more vegetables, fruits, whole grains, healthy fats and protein while limiting alcohol and caffeine.
- Improving your sleep by avoiding TV, computer and phone screens an hour before bedtime to ensure better rest.
- Practicing meditation and breathing techniques for stress management.
- Quitting smoking and other tobacco products.
Transitioning from perimenopause to menopause can be a tiresome journey, but there are ways to manage your symptoms while you are going through it. Talk to your provider today about what options might work best for you.
This blog was medically reviewed by a MercyOne provider.
