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September 22, 2024

Understanding Perimenopause: Symptoms, Stages, and What to Expect

Women’s bodies go through different kinds of transformations at different stages once they attain puberty. Perimenopause is one such change which typically starts in the mid-40s.

Today, let’s discuss this stage in detail to help you navigate your way through it.

What is Perimenopause?

Perimenopause is the transition period of your body to menopause. Perimenopause means “around menopause”. The ovaries start to produce less hormones during this period, resulting in your menstrual cycle becoming irregular or erratic. This indicates the end of your reproductive years.

This time can last anywhere between two to eight years. During this time:

Eggs are released from your body less regularly.
Produces less oestrogen and other hormones.
Fertility decreases.
Has irregular and shorter menstrual cycles.

This is a natural progression; however, it comes with both physical and emotional symptoms. Some of these symptoms can be quite uncomfortable, hindering your day-to-day life. Perimenopause ends in menopause, the stage at which your periods stop. Menopause is when you have no menstrual cycle for 12 months in a row.

Symptoms of Perimenopause

During perimenopause, various subtle and not-so-subtle symptoms may be experienced by you, which include:

Irregular Periods: As ovulation becomes increasingly unpredictable, the time between your periods may become longer and shorter. The flow may also be lighter or heavier. You may skip some periods too. If you have such persistent changes for seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If two periods are 60 days or more apart, then you’re likely to be in late perimenopause.
Hot Flashes: Another common symptom during menopause and perimenopause are hot flashes. The frequency, intensity and length may vary.
Sleep Problems: You may also experience sleep problems, mostly due to hot flashes or night sweats. Sometimes you may have unpredictable sleep without hot flashes as well.
Vaginal or bladder issues: As the oestrogen levels diminish, your vaginal tissues may lose elasticity and lubrication. This can make intercourse painful. Low oestrogen levels make you more vulnerable to vaginal or urinary infections. You will be more susceptible to urinary incontinence too, due to loss of tissue tone.
Mood Swings: Another common symptom of perimenopause is mood change. You may feel irritable or depressed at times. Mood changes are also associated with sleep disruption and hot flashes. Mood changes can also be caused by non-hormonal reasons.
Changes in sexual function: Sexual desires or sexual arousal may change during perimenopause. However, this is not experienced by all women.
Decrease in fertility: During perimenopause, ovulation becomes less regular. Thus, your ability to conceive reduces. However, as long as you are having periods, there remains a chance of getting pregnant.
Changes in cholesterol levels: Reduced oestrogen levels may lead to changes in your blood cholesterol levels. There can be an increase in your LDL (low-density lipoprotein), the “bad” cholesterol. This can increase the risk of heart disease. The “good” cholesterol, i.e. HDL (high-density cholesterol) decreases in many women with age, which also increases the risk of heart disease.
Bone Loss: Declining oestrogen levels lead to quicker bone loss, which increases the risk of osteoporosis.
Anxiety: Many women experience anxiety as a result of perimenopause. The constant worry can interrupt your daily life. Anxiety can lead to other symptoms such as nausea, sweating, muscle tension and others. Anxiety can interrupt sleep making going about your day-to-day routine difficult. Consult a psychological counsellor if you face anxiety during perimenopause. Behaviour therapy or medication can help you deal with these issues.

When Does Usually Perimenopause Start?

Typically, perimenopause starts about 8 to 10 years before menopause. It usually starts in your mid-40s, but for some women, it can start earlier. Having menopause before attaining 40 is known as premature menopause. This can be caused by some procedures or medicines. If early menopause is caused without any surgical or medical causes, it is called primary ovarian insufficiency.

How Long Does Perimenopause Last?

Perimenopause usually lasts about 4 years, but it can last up to 8 years. Some women can be in this phase for just a few months, while others have several years.

How Can You Know if You’re in Perimenopause?

Every woman’s body is different, and hence everyone has a different experience of perimenopause. The first sign of perimenopause is irregular periods. From predictable menstrual cycles to random spotting to missing periods altogether – different women experience perimenopause differently.

Many women also experience other symptoms of menopause such as hot flashes and vaginal dryness.

When Should You See a Doctor?

Different women experience different symptoms of perimenopause. Some women seek medical advice for such symptoms, while others tolerate the changes. For some women, the symptoms are not severe enough for them to seek medical attention.

In many cases, the symptoms are subtle and come gradually. Hence, you may not realize the symptoms at all. If the symptoms interfere with your life and well-being such as mood swings, hot flashes or changes in sexual functions, see a doctor.

Risk Factors of Perimenopause

Menopause is a normal phase of life. All women experience it, although some may experience it earlier. Certain research shows that certain factors may lead to starting perimenopause at an earlier stage such as:

Family history: A family history of early menopause can lead to women transitioning into perimenopause.
Smoking: Smoking regularly can result in women experiencing perimenopause and menopause earlier.
Hysterectomy: Hysterectomy is a surgical procedure where the uterus is removed, but not the ovaries. Since the uterus is removed, you will not have periods, but the ovaries still produce oestrogen. However, the surgery may cause menopause earlier than normal. If one ovary is removed, the other ovary eventually stops working, leading to menopause.
Cancer Treatment: Certain cancer treatments such as pelvic radiation therapy or chemotherapy have been linked to early menopause.

Complications of Perimenopause

The signature symptom of perimenopause is irregular periods. In most cases, this is fine and nothing to be worried about. However, meet your doctor if you experience:

Very heavy periods due to which you have to change your pads or tampons every hour or two.
Periods lasting for more than seven days.
Bleeding in between periods.
Regularly having periods 21 days apart.

These can be a sign of problems with your reproductive system which may require diagnosis and treatment.

Diagnosis of Perimenopause

Whether you are experiencing perimenopause or not is determined by physical examination and understanding your symptoms, age and medical history. However, it is not necessary to see a healthcare provider for an official diagnosis.

Certain hormone tests can indicate whether you are in perimenopause or not. For example, testing your follicle-stimulating hormone or FSH can indicate whether you are beginning perimenopause. Produced by the pituitary gland, FSH is a hormone that stimulates the ovaries to release an egg during ovulation.

A consistently high level of FSH can be an indication that you are near menopause. However, the test can be sometimes misleading during perimenopause as hormones rise and fall frantically during this phase. Certain health conditions and medications may also interfere with hormone levels resulting in faulty results in hormone tests.

Unfortunately, there are no tests to confirm perimenopause. However, your doctor may order some tests to rule out some other conditions such as fibroids, infections, polyps, cancer, blood clotting disorders and others.

Perimenopause Treatment

Perimenopausal symptoms are usually treated with medications.

Hormone Therapy: One of the most common symptoms of hormone therapy is systematic oestrogen therapy. Pills, gels, creams, skin patches, and sprays are some of the most effective treatments used to provide relief from perimenopausal symptoms such as night sweats and hot flashes. Your doctor may recommend a low dosage of oestrogen to provide relief to you. You may be given progesterone too. Systemic oestrogen therapy can prevent bone loss too.
Vaginal Oestrogen: Your doctor may administer oestrogen directly into the vagina using a vaginal cream, ring or tablet. A small amount of oestrogen is released during this treatment, which is absorbed by vaginal tissue. These treatments can relieve vaginal dryness, discomfort during intercourse and certain urinary symptoms.
Gabapentin (Neurontin): Gabapentin is an approved medicine to treat seizures, however, it has been shown to help with reducing hot flashes. This drug is used for women who cannot use oestrogen therapy. It is also useful for women who have migraines.
Antidepressants: Certain antidepressants can also reduce hot flashes. Antidepressants are given to women who cannot take oestrogen for health reasons. Antidepressants are also useful for mood disorders.
Fezolinetant: This is a hormone-free medicinal option for treating hot flashes. It blocks a pathway in the brain that regulates body temperature.

It is essential to talk to your doctor before taking any medication since there are risks and benefits involved with each option. Regular review with your doctor is also important since treatment options may change with time.

Living with Perimenopause

Living with perimenopause may not be easy since some of the symptoms can hinder your daily life. Fortunately, some lifestyle choices can help you deal with the symptoms in a better way.

Here are some of the things you can do:

Eat Healthy: Perimenopause and menopause bring with them an inherent risk of heart disease and osteoporosis. Hence, a healthy diet is of utmost importance. Adapt a high-fibre, low-fat diet rich in whole grains, vegetables and fruits. Also include calcium-rich foods. Caffeine and alcohol can trigger hot flashes. If they do, it is better to avoid them. Your doctor may put you on calcium supplements and vitamin D to help your body absorb calcium.
Be Active: Being physically active can prevent gaining weight, elevate your mood and improve sleep. Include at least 30 minutes of exercise multiple days of the week. Regular exercise has also been proven to reduce the risk of hip fracture in older women and strengthen bone density.
Solutions to Ease Vaginal Discomfort: One of the primary symptoms of perimenopause is vaginal discomfort. You can use over-the-counter, water-based vaginal lubricants or moisturisers to get relief. We suggest choosing products that don’t contain glycerine as it irritates or burns women with sensitive skin. Staying sexually active also helps increase blood flow to the vagina, thus reducing vaginal discomfort.
Getting enough Sleep: A consistent sleep schedule will help you deal with multiple symptoms of perimenopause. Avoid caffeine or drinking too much alcohol, as they can interrupt sleep.
Practice Stress-reduction Methods: Keeping your stress under control is another way to deal with perimenopausal symptoms. Practice yoga or meditation to relax and have overall good health.
Maintain a Healthy Weight: Maintaining a healthy weight can help you deal with multiple symptoms of perimenopause.

What Should You Avoid from Perimenopause Symptoms Getting Worse?

Certain foods and activities can make perimenopausal symptoms worse such as:

Unhealthy foods such as sugary drinks and desserts or foods high in saturated fat.
A sedentary lifestyle can lead to lower energy, mood swings and sleep issues.
Smoking cigarettes or using tobacco products can lead to early menopause as well as a decrease in bone density. It can also worsen vaginal dryness.

A Final Word

Perimenopause is the time when women’s ovaries start declining in function. Symptoms can last on average four to six years before menopause. However, it is important to remember that as long as you have your periods, you can still get pregnant. So, you will still need to use contraception.

While perimenopause really cannot be avoided, you can adopt a healthy lifestyle to deal with the symptoms in a better way. You can know that perimenopause is ending when the symptoms increase but you’ve not had periods for several months. Menopause starts when you’ve not had a period for consecutive 12 months.

Frequently Asked Questions

How do you know if you are in perimenopause?

Each person’s body is unique, and signs of perimenopause can vary widely from one individual to another. Typically, the first indication of perimenopause is having irregular periods. You might notice a shift from having regular menstrual cycles to experiencing random spotting or even skipping periods entirely.

At what age does perimenopause start?

Perimenopause can start in some women during their 30s, but it most commonly begins between the ages of 40 and 44. This stage is characterised by alterations in menstrual flow and cycle length, and there may also be sudden increases in oestrogen levels.

How long does perimenopause last?

Perimenopause typically lasts around four years, but it can extend up to eight years. For some women, this phase may only last a few months, whereas for others, it can continue for several years.

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