What Is Perimenopause?

Menopause is a normal part of a woman’s life and marks the end of their reproductive years. However, before menopause starts, the body experiences a transitional period known as perimenopause. This is the time when many menopausal symptoms occur, such as hot flashes and sleep issues, and it can be a difficult period to navigate. So, exactly what is perimenopause? How long does it last? And are there any perimenopause treatments?

Here’s what you need to know about perimenopause.

What Is Perimenopause?

Perimenopause means ‘around menopause’ and is the natural transition period that occurs when the female body begins preparing for menopause. During this period, the ovaries begin producing fewer hormones in anticipation of the end of the menstrual cycle, causing irregular or erratic periods. Also known as the menopausal transition, perimenopause is a completely normal stage in a woman’s reproductive cycle and signifies that the body is coming to the end of its reproductive years[i].

What’s The Difference Between Menopause and Perimenopause?

Menopause is when a woman stops having periods completely and is no longer able to get pregnant naturally. On the other hand, perimenopause is the stage before this, when the body prepares for the decline of reproductive hormones that halt fertility. Often, people confuse menopause with perimenopause. During perimenopause, a woman will experience all the symptoms commonly related to menopause, including hot flashes and mood swings, as the hormones fluctuate[ii].

When Does Perimenopause Start?

Most women begin experiencing perimenopause symptoms in their early 40s, with 51 being the average age for women to reach menopause[iii]. However, perimenopause has been known to affect women in their mid-30s in some cases[iv].

Symptoms of Perimenopause

Although perimenopause symptoms vary from person to person, there are changes in the female body that regularly take place during this transitioning period. The most common symptoms of perimenopause are:

Irregular Periods – As hormone production fluctuates, there may be some severe changes in the menstrual cycle. It’s not uncommon for periods to be further apart or closer together, lighter or heavier, or even completely non-existent during this time.
Hot Flashes – Hot flashes, or a sudden rush of warmth in the upper body, are common throughout perimenopause. It’s believed that decreased oestrogen levels cause the body to become more sensitive to changes in temperature[v].
Sleep Problems – Hot flashes and other perimenopause symptoms can negatively affect sleep. Also, the loss of reproductive hormones can lead to the development of sleep disorders such as sleep apnea[vi]. However, sleep can be affected even without these afflictions.
Vaginal/Bladder problems – As oestrogen levels reduce, the muscle tissue of the vagina can lose elasticity and natural lubrication. This can cause pain during intercourse, vulnerability to vaginal and urinary infections and incontinence.
Incontinence – Urine leakage is more common than you might think. During perimenopause, the lining of the urethra (the tube that carries urine out of the bladder) can weaken, increasing the chances of urinary incontinence.
Mood Swings – Changes in mood can occur during perimenopause as a result of the hormonal changes happening in the body. Also, other symptoms such as sleep problems and incontinence can contribute to mood swings.
Decreased Fertility – As the natural menstrual cycle changes, the ability to become pregnant reduces. However, pregnancy is still possible if you are having periods, so make sure to use birth control until you’ve had no periods for at least 12 months.
Changes In Sexual Arousal – Due to the significant drop in hormones during perimenopause, changes in sexual arousal and desire may occur.
Bone Density – Oestrogen helps maintain bone structure and turnover. As this hormone is reduced through perimenopause, the body starts to lose bone density quicker than it replaces it. This can increase the risk of osteoporosis, a disease which causes weakened bones.
Fluctuating Cholesterol Levels – Adverse changes in blood cholesterol levels may occur as a result of declining oestrogen levels. Often, this includes an increase in LDL (low-density lipoprotein) cholesterol and a decrease in HDL (high-density lipoprotein) cholesterol, which can contribute to an increased risk of heart disease[vii].

What Are the First Signs of Perimenopause?

Although perimenopause can start at any time between the mid-30s and late 40s, there are a couple of signs that indicate the body is beginning perimenopause. Usually, the first sign of perimenopause is an unpredictable menstrual cycle.

Most women will experience changes in their cycle very early in perimenopause, leading to irregular periods with an unpredictable flow. However, many women will also report common symptoms of perimenopause, such as hot flashes and vaginal dryness, quite early in the transitional period[viii].

Signs That Perimenopause Is Ending

During the final stages of perimenopause, it’s not uncommon to notice several symptoms worsening or new ones beginning. Throughout the late stage of perimenopause (usually around six months before the beginning of menopause), oestrogen levels will drop greatly. Often, this results in severe hot flushes, insomnia, vaginal dryness, and painful intercourse. Unfortunately, these symptoms can continue throughout the first few years of menopause.

How Long Does Perimenopause Last?

Naturally, the length of perimenopause is entirely dependent on the person. Some people may experience the stages of perimenopause for a few months, while others may remain in the transitioning period for several years. However, the average length of perimenopause is around four years. If you haven’t had a period in more than 12 months, your body has fully transitioned from perimenopause to menopause[ix].

How To Deal with Perimenopause

Although perimenopause is unpleasant for many women, there are several things that you can do to make the transitional period easier to deal with. Treatments that work for some people may not work for others, so consult with your GP before trying any natural remedies or professional treatments for extreme symptoms.

1) Tackling Perimenopause Symptoms

In most cases, perimenopause symptoms are not a major cause for concern. However, they can be difficult to deal with and finding ways to tackle them yourself can relieve pain and embarrassment.

For example, incontinence pads can help control any urine leakages, and your GP may prescribe you medication to help with insomnia and other sleep-related issues. For many women, perimenopause symptoms, particularly hot flashes, can be controlled by taking low-dose birth control birth pills or hormone replacements for a short time.

Make sure you consult your GP if you experience any of the above symptoms.

2) Lifestyle Changes

Often, perimenopause symptoms may be relieved with some healthy lifestyle changes. By making changes to your lifestyle, such as regularly exercising and drinking less alcohol, you will be taking care of your body and helping maintain your long term health. Giving your body what it needs to function at its best may also help relieve symptoms of both perimenopause and menopause. Some lifestyle changes to consider include:

Regular exercise
Consuming more calcium
Adding protein and fibre to diet
Limiting highly refined carbohydrates
Drinking less caffeine
Stop smoking
Getting at least 7 hours of sleep each night
Going to sleep and waking up at the same time
Drinking less alcohol
Maintaining a healthy weight
Considering taking a multivitamin – you can talk to your doctor about this

3) Professional Treatments

Finally, if perimenopausal symptoms can’t be controlled at home, your doctor may recommend medications to treat them. The most commonly prescribed medications are:

Hormone Replacement Therapy – Systemic oestrogen therapy is the most effective treatment option for perimenopausal symptoms. The treatment comes in pill, cream, spray or skin patch form and helps replace hormones that have been reduced as the body approaches menopause.
Neurontin – Neurontin, or gabapentin, is generally used to treat seizures; however, it can help reduce hot flashes and other symptoms. This may be prescribed to women who aren’t able to use hormone therapy.
Vaginal Oestrogen – To relieve vaginal dryness or discomfort, vaginal oestrogen may be administered. This treatment comes as a vaginal tablet, ring or cream that releases oestrogen to be absorbed by the vaginal tissue.
Antidepressants – Certain antidepressant treatments may reduce perimenopausal symptoms, including mood swings and hot flashes. These are often prescribed to women who can’t take oestrogen.

Before beginning any of these treatment courses, discuss your options with your doctor to make sure that you receive the treatment that is right for you.

When To Get in Touch With A Doctor

It’s best to talk to your GP if you’re having perimenopausal symptoms that are affecting you or if you’re experiencing symptoms before the age of 45.

Although it is natural for menopause to start before this age, you should have any issues checked to get a confirmed diagnosis. A doctor can affirm whether you’re experiencing perimenopause from your symptoms. However, they may be required to take a blood test to measure your hormone levels.

Perimenopause is a natural part of ageing that all women will experience. With treatment and some help from your GP, you can get just as much, if not more, enjoyment from life throughout this transitional period.

Do you have any tips on dealing with perimenopause? Let us know in the comments.

Sources

[i] https://my.clevelandclinic.org/health/diseases/21608-perimenopause

[ii] https://www.cwcobgyn.com/blog/whats-the-difference-between-perimenopause-and-menopause

[iii] https://www.nhs.uk/conditions/menopause/

[iv] https://www.mountsinai.org/health-library/report/menopause.

[v] https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790

[vi] https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-does-menopause-affect-my-sleep

[vii] https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666

[viii] https://my.clevelandclinic.org/health/diseases/21608-perimenopause

[ix] https://my.clevelandclinic.org/health/diseases/21608-perimenopause