A Normal Stage in Life
Perimenopause is the time in a woman's life when levels of hormones, estrogen and progesterone in the body drop. A woman who has skipped periods for 12 consecutive months has reached menopause. Perimenopause is a normal experience and lasts between 4 and 10 years, often beginning when a woman is in her 40s or earlier. Many symptoms indicate that a woman is in the perimenopause stage of life.
When Does It Occur?
Most women start experiencing symptoms of perimenopause in their 40s or sometimes even their 30s. The average woman is 51 years old at the time of menopause. The transition is marked by fluctuating hormone levels. Follicle stimulating hormone (FSH) levels begin to increase about 5 years before menopause. During this stage, symptoms like hot flashes, irritability, anxiety, mood changes, bone loss, and memory problems start. These symptoms may mimic those of other health conditions.
As a woman enters perimenopause, one of the first symptoms she may notice is changes in her menstrual period. Bleeding may be lighter or heavier than usual. The period may be longer or shorter than normal. Periods may come in varying intervals. Your doctor can prescribe treatment to make the transition easier. The doctor may test your thyroid hormone levels to make sure they are not contributing to menstrual irregularities. In addition to thyroid abnormalities, other health problems may mimic symptoms that occur in perimenopause and after menopause. Only a doctor can determine the cause of your signs and symptoms and prescribe appropriate treatment. Pregnancy may be one potential reason for a skipped period.
A Note on Pregnancy
A woman may still become pregnant during the perimenopause years, even though hormone levels are decreasing. Take care to use birth control to prevent unwanted pregnancy during the perimenopause. Unprotected sex poses risks of pregnancy and health risks like sexually transmitted infections. It is normal to experience changes in the length, flow, and time between periods during this stage, but remember...pregnancy is still possible, so take precautions. Period changes may be a normal part of this stage or they may signal a potential health problem.
Many women experience heavy bleeding during perimenopause years. This happens because the uterine lining becomes thicker before shedding. This happens due to lower levels of the hormone progesterone. Health conditions affecting the uterus, like fibroids, may also be responsible for increased bleeding. Any abnormal bleeding associated with your period is a sign of a potential problem and should be evaluated by a doctor. Heavy bleeding may be a sign that something is wrong with your body.
Sudden Waves of Heat
Hot flashes are a common symptom of perimenopause or approaching menopause that many women find distressing. They are sudden waves of heat and flushing that often occur on the upper portion of the body. Red blotches may appear on the face, chest, and arms at the same time. Sweating heavily is a common experience during hot flashes. They often interfere with sleep. Decreased hormone levels cause hot flashes and anxiety.
Tips for Hot Flashes
Hot flashes and night sweats are a troubling symptom of perimenopause. Health care providers may prescribe low-dose oral contraceptives (birth control pills) to manage the condition. Menopausal hormone therapy (MHT) may also help. Hormone therapy is not without risks. Women with a personal or family history of breast cancer or cardiovascular disease may not be able to take it. A few medications used to treat mood disorders, high blood pressure, or epilepsy are sometimes prescribed to treat hot flashes. Some other strategies to manage hot flashes include avoiding triggers like stress, caffeine, spicy foods, and alcohol. It's helpful to dress in layers that you can remove if you get a hot flash. To stop it in its tracks, start breathing deeply to relieve it.
An Uncomfortable Symptom
Less estrogen in perimenopause causes vaginal dryness as the tissue thins out. The tissues of the urethra also become thinner, and pelvic muscles weaken, all of which may lead to incontinence. A woman may experience soreness, itching, discomfort, and pain during sex, all of which may decrease the desire to be intimate and lead to anxiety. If the thought of being intimate when you have vaginal dryness is unpleasant, there are many things you can do to be more comfortable. Over-the-counter products, like water-based vaginal lubricant and moisturizer, can make intimacy more comfortable. For severe symptoms, the doctor may prescribe hormone therapy or topical estrogen cream to treat your condition. Ask your doctor for medical advice regarding how best to deal with dryness and whether prescription treatment is appropriate for you.
Many women approaching menopause experience sleep difficulties due to night sweats and other symptoms. Lack of rest can interfere with the ability to carry out daily life activities. Get in the habit of establishing a regular nighttime routine to set the stage for a good night's sleep. Reading a good book is a good way to wind down. Take care not to be too physically active before bedtime. Avoid smoking and large meals that may interfere with sleep. Start to cut back on or eliminate caffeine. Establish regular bedtimes and wake up times every day and stick to them. Your bedroom should be quiet, dark, and cool to promote sleep. Only use the bed for sleep and sex. Many postmenopausal women find they require less sleep to feel rested than they did before this stage in life. However, adequate, uninterrupted rest is still necessary to maintain good health and minimize any symptoms related to menopause or perimenopause.
Highs and Lows
Mood changes often occur around the time of perimenopause and menopause when hormone levels are decreasing. You may experience mood swings, either high or low mood, or anxiety. You may have crying spells and feel irritable. Women who have experienced severe premenstrual syndrome (PMS) symptoms may experience the most severe mood changes with perimenopause and menopause. If you are experiencing mood symptoms or distressing thoughts, talk to your doctor about it. Effective treatments are available for mood conditions and anxiety.
Hormones or Life Stress?
Hormone changes may be to blame for a woman's mood swings, but life stresses unique to this time in life may be the real underlying reason. The menopausal years are often when a woman deals with growing children or empty nest syndrome. She may even care for aging parents, which can take a big toll on her own health. If anxiety and mood changes impact your life, speak to you doctor about it.
Are You Forgetful?
Many women are more forgetful during perimenopause and as they approach menopause. This is due to decreasing levels of estrogen. You may lose your train of thought, misplace items, or forget appointments as estrogen levels in the body drop. While memory loss is common, it is not normal. If you begin to experience these symptoms, see your doctor for an evaluation. Memory loss and forgetfulness may be symptoms of perimenopause or other health conditions.
If you are experiencing memory loss due to decreased estrogen in perimenopause, there are things you can do to aid your memory. Start writing down your appointments on a wall calendar or in an appointment book. Keep often lost items like keys, eyeglasses, medications, and cell phone in a dedicated basket or box. Set an alarm to help you remember when to take medications you take for other health conditions.
Estrogen Loss, Bone Loss
As estrogen levels drop in perimenopause, bone loss increases. Loss of minerals from bones increases the risk of osteoporosis. The doctor can check your bone density via a special type of X-ray. Get adequate calcium and vitamin D to keep bones as healthy and as strong as possible. Do weight-bearing exercise, like walking or weight training, to keep your bone density up. Exercise is good for your whole body. Aim for at least 30 minutes of physical activity on most days of the week. The doctor may prescribe certain medications to increase bone density and bone health.
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- National Institute on Aging: “Menopause,” "Menopause: Time for a change."
- WomensHealth.gov: “Menopause and Menopause Treatments Fact Sheet.”