Definition

Perimenopause, or the ‘transition period to menopause,’ is the time when your body undergoes a natural transition to menopause. This period marks the end of the reproductive years. Perimenopause can occur for 4–10 years before menopause.

Women begin perimenopause at different ages. You may start noticing signs of the transition towards menopause, such as irregular periods, around your 40s. However, some women experience changes as early as their 30s.

When you have gone 12 consecutive months without a period, you have reached menopause, and the perimenopause period is over.

Read more about Menopause

Causes

As you go through the perimenopause period, the production of estrogen and progesterone in your body fluctuates. Many changes you experience during perimenopause are caused by a decrease in estrogen.

Risk Factor

Menopause is a normal phase of life. However, it can occur earlier in some women than others. While the exact cause is not known, several factors can accelerate the onset of perimenopause, including:

• Smoking: Menopause starts 1 to 2 years earlier in women who smoke compared to those who don’t.
• Family history: Women with a family history of early menopause may also experience early menopause.
• Cancer treatment: Chemotherapy or pelvic radiation therapy for cancer is associated with early menopause.
• Hysterectomy: A hysterectomy is the surgical removal of the uterus but not the ovaries, and usually does not cause menopause.

Symptoms

During perimenopause, some obvious or subtle changes in your body can occur. You may experience several symptoms, such as:

• Irregular menstrual cycles: If your period lasts 7 days or more consistently, you may be in early perimenopause. If your menstrual cycle interval is 60 days, you are likely in late perimenopause
• Hot flashes and sleep disturbances: Sleep problems often occur due to hot flashes or cold sweats but can sometimes happen without these symptoms
• Mood changes
• Vaginal and bladder problems: Low estrogen levels can make you more prone to urinary tract or vaginal infections. Loss of tissue tone can contribute to urinary incontinence (loss of bladder control)
• Infertility: If you want to avoid pregnancy, use contraceptive pills until you have been period-free for 12 months
• Sexual function changes
• Bone density loss: This occurs due to a decrease in estrogen levels
• Cholesterol level changes: Lower estrogen levels can cause unfavorable changes in your blood cholesterol levels, including an increase in LDL (low-density lipoprotein), the ‘bad’ cholesterol, which can increase the risk of heart disease. At the same time, HDL (high-density lipoprotein), the ‘good’ cholesterol, decreases in many women with age, also increasing the risk of heart disease.

Diagnosis

Perimenopause is a gradual transition process. There is no specific test or sign to determine that you have entered perimenopause. Doctors will consider many factors, especially your age, menstrual history, and symptoms or changes in your body.

Doctors may perform tests to assess your hormone levels, such as thyroid hormones, which can affect estrogen levels. However, aside from that, hormone testing is rarely needed or useful for evaluating perimenopause.

Management

Medications are often used to manage perimenopause symptoms. Some of these treatments include:

• Hormone therapy: Estrogen therapy in the form of pills, skin patches, sprays, gels, or creams remains the most effective treatment for managing hot flashes and cold sweats during perimenopause and menopause.
• Vaginal estrogen: Estrogen can be directly inserted into the vagina using vaginal tablets, rings, or creams. This therapy provides a small amount of estrogen absorbed by the vaginal tissues. It can treat vaginal dryness, discomfort during intercourse, and some urinary symptoms.
• Antidepressants: Some antidepressants in the selective serotonin reuptake inhibitor (SSRI) class can reduce hot flashes during menopause.
• Gabapentin: Gabapentin is a medication used to treat seizures but has been shown to help reduce hot flashes. This drug is also useful for women who cannot use estrogen therapy for health reasons and for those who suffer from migraines.

Before deciding on any therapy, consult your doctor about your options as well as the risks and benefits.

Complications

There are health risks associated with menopause, which occurs right after perimenopause.

Estrogen plays an important role in maintaining bone health; when levels decrease, the risk of osteoporosis increases. Osteoporosis is a condition where bones become more fragile, increasing your risk of fractures.

People who experience menopause also have an increased risk of heart and blood vessel disease.

Prevention

Perimenopause is a natural part of a woman’s life cycle. You cannot prevent menopause, but you can control its symptoms and prevent potential complications. It is important to adopt a healthy lifestyle, which includes:

• A healthy diet
• Regular exercise
• Adequate sleep and rest
• Maintaining bone strength
• Controlling blood pressure

When to See a Doctor?

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

Irregular periods are a hallmark of perimenopause. Most of the time, this is normal and not something to worry about. However, you should consult a doctor if:

• Bleeding is so heavy that you need to change pads every one to two hours for 2 hours or more
• Bleeding lasts more than 7 days
• Bleeding occurs between menstrual cycles
• The interval between menstrual cycles is less than 21 days

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