Perimenopause

DEFINITION

Perimenopause means “around menopause” and refers to the time period during which a woman’s body makes its natural transition toward permanent infertility (menopause). Perimenopause is also called the menopausal transition.

Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.

The level of your estrogen — the main female hormone — rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help ease these symptoms.

Once you’ve gone through 12 consecutive months without a menstrual period, you’ve officially reached menopause, and the perimenopause period is over.

CAUSES

As you go through the menopausal transition, your body’s production of estrogen and progesterone rises and falls. Many of the changes you experience during perimenopause are a result of decreasing estrogen.

SYMPTOMS

During the perimenopausal period some subtle — and some not-so-subtle — changes in your body may occur. Some things you might experience include:

• Menstrual irregularity. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you’re likely in late perimenopause.
• Hot flashes and sleep problems. Many women experience hot flashes during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
• Mood changes. Some women experience mood swings, irritability or increased risk of depression during perimenopause, but the cause of these symptoms may be sleep disruption caused by hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.
• Vaginal and bladder problems. When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen levels may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
• Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you’re having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you’ve had no periods for 12 months.
• Changes in sexual function. During perimenopause, sexual arousal and desire may change. But for most women who had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.
• Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.
• Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the “bad” cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the “good” cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

When to see a doctor

Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don’t experience symptoms severe enough to need attention. Because subtle symptoms may come on gradually, you may not realize at first that they’re all connected to the same thing — rising and falling levels of estrogen and progesterone, another key female hormone.

If you do experience symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your doctor.