What is perimenopause?

Menopause is a normal physiological process in every woman’s life. The period around menopause when a woman’s body undergoes certain changes as a transition to menopause is called ‘menopausal transition’ or ‘perimenopause’.

At what age does the perimenopause begin?

The age at which perimenopause begins varies in each woman. Generally, the majority of the  women experience perimenopause sometime in the early to mid 40s. However, in some women perimenopause may begin as early as their mid-30s.

What are the changes a woman experiences during perimenopause?


A woman may experience some subtle — and some not-so-subtle changes in her body throughout the perimenopause period. The most common changes and symptoms include:

  • Irregular periods due to the unpredictable ovulation cycle. The period cycle might get  longer or shorter or there might be light to heavy flow changes. There might be missed periods too. Generally a persistent change of seven days or more in the period cycle length is a sign of early perimenopause, whereas, a space of 60 days or more between periods, is a sign of late perimenopause.
  • Decreasing fertility - menopause actually marks the end of the fertility period in a woman. So, during the perimenopause, there is a significant decrease in fertility.
  • Vaginal problems which may include dryness, irritation, itching, and susceptibility to infections.
  • Changes in sleep pattern (usually disturbed and reduced sleep).
  • Mood changes and irritability.
  • Increased risk of depression.
  • Hot flashes.
  • Bladder problems which may include urinary incontinence and frequent urinary tract infections.
  • Sexual dysfunction such as lack of sexual arousal, low libido, and painful intercourse.
  • Changes in cholesterol levels due to declining estrogen levels. There may be an increase in low-density lipoprotein (LDL) cholesterol and a decrease in high-density lipoprotein (HDL) cholesterol or the "good" cholesterol which may in turn increase the risk of heart disease.
  • Bone loss.

What is the cause for perimenopause symptoms?

During perimenopause the levels of the estrogen and progesterone  keep rising and falling. Estrogen and progesterone are two key female hormones that play a significant role in fertility.  The decreasing levels of estrogen is responsible for the perimenopause symptoms.

Are there any factors that may cause perimenopause at an early age?

There are no causes that have been established for  perimenopause at an early age, however, there are a few evidence pointing at certain risk factors that may start perimenopause at an earlier age, which include:

  • Smoking
  • History of hysterectomy
  • Family history of early menopause
  • Cancer treatments with chemotherapy

Is it necessary to see a doctor for perimenopause symptoms?

Some women may want to see a doctor for their perimenopausal symptoms. Some may not seek medical attention simply because their symptoms were too subtle to notice or they tolerate their symptoms. However, if the symptoms are too severe or interfering with daily life or well being it is advisable to see a doctor. The severe symptoms include:

  • Heavy flow that soaks the pads every hour or two for two or more hours.
  • Bleeding continues for more than seven days.
  • Bleeding occurs between periods.
  • Periods occurring regularly less than 21 days apart.

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