Menopause is a phase that every woman goes through after she is 40 years old. Menopause is defined as the natural stopping of your monthly menstruation or periods (bleeding of your uterine tissues through the vagina), marking the end of your fertility. Menopause results in a whole lot of physical changes that can affect your mental and social health as well. Menopause is seen in women between 45 and 55 years of age, with the average age being 51 years. During this time, if you have missed your periods for 12 months, then you are said to have hit menopause.
The time preceding menopause is known as perimenopause. While there is no proper medical definition of perimenopause, it is the onset of menopausal symptoms.
Introduction to Perimenopause
Perimenopause is referred to as the transition period to your menopause and is often called “the time around menopause”. It usually starts at the age of 40 years in most women but can also start in your late 30s. Perimenopause can last for 4 to 8 years before menopause. Your body starts to prepare itself for menopause and you go through a lot of changes during perimenopause, mainly due to two reasons: changes in your ovary function and hormonal changes.
You are born with a fixed number of eggs (the female gamete cell which fuses with the male sperm, leading to pregnancy) and your ovaries (the primary reproductive organs) produce a certain number every month. If these eggs are not fertilized by sperm after sexual intercourse, the eggs degenerate and die. Your uterine lining that was preparing your body for pregnancy also degenerates and is passed out of your body through the vagina in the form of blood (this process is known as menstruation). Unless pregnancy occurs, this cycle repeats every month.
As you age and near your 50s, your ovaries begin to decline in function and continue or further decline until menopause. When perimenopause starts, your ovaries do not produce eggs regularly and thus you start to have erratic or irregular periods (when periods do not follow the regular cycle of 28 to 35 days).
Similarly, your ovaries are also responsible for producing the female sex hormones called estrogen and progesterone. Estrogen performs various vital functions: helps control your menstrual cycle, keeps your cholesterol in control, and protects your bone health. Progesterone is responsible for regulating your menstrual cycle and supporting your pregnancy. Perimenopause leads to an imbalance in your hormones that have various effects on your overall health.
Two Stages of Perimenopause or Stages of Menopausal Transition
Perimenopause is often referred to as the final years of your reproductive life. There are two stages to the perimenopause or menopausal transition:
Early perimenopause, or the early transition, or, where cycles are mostly regular, with relatively few interruptions
Late perimenopause, or the late transition, or, where your period cycles become more prolonged and last for at least 60 days.
Each of these stages is a result of hormonal changes and are associated with particular symptoms.
Premenopause and Perimenopause
Perimenopause means “around menopause” and premenopause means “before menopause”; most healthcare professionals do not use the terminology premenopause but use perimenopause to refer to the time before menopause. Now that you have some idea about what perimenopause is, it is imperative to mention premenopause.
Premenopause is when you have no symptoms of perimenopause or menopause. Your periods are mostly regular and occur within your reproductive years. There are no evident changes or symptoms during premenopause.
Symptoms of Perimenopause
Perimenopause can produce some or all of these symptoms:
1. Hot flashes. Hot flashes are a sudden feeling of warmth over your neck and face and can happen from time to time, followed by extreme sweating. Hot flashes are a result of decreased estrogen levels and can be extremely disturbing. Hot flashes are very common throughout perimenopause and menopause.
2. Irregular or erratic periods. Estrogen is also responsible for regulating and causing your periods monthly. Once perimenopause starts, both your eggs and estrogen is not produced regularly by your ovaries, leading to irregular or erratic periods. Irregular periods can cause major mood swings because your period might come unexpectedly and irritate or trouble you.
3. Breast tenderness. When your periods occur regularly, estrogen is also produced regularly and it helps in maintaining fluid-retention in your breasts, keeping them strong and in shape. During perimenopause, your estrogen levels are diminished and this affects your breasts, making them tender and painful.
4. Mood swings. Hot flashes and irregular periods can cause mood swings, depression, anxiety, and low energy. Hot flashes and sweating at night can disturb your sleep patterns and result in irritability the following day. If you experience mood swings during perimenopause, your personal and social relationships might be affected which can further cause a bad mood.
5. Lower sex drive. Decreased libido (your overall sexual drive or the need for intimacy) or lower sex drive is a result of mood swings and disturbed sleep patterns. Your testosterone levels affect your sex drive. As you near perimenopause, your ovaries produce less testosterone, and thus, you experience reduced sex drive.
6. Insomnia. Insomnia is a condition in which you find it difficult to fall or stay asleep. Hot flashes and night sweats can disrupt sleep patterns and eventually lead to insomnia. Irritability and mood swings can also cause insomnia. Hormonal changes can also be equally responsible for disturbed sleep and insomnia.
7. Fatigue. Fatigue during menopause is a result of various factors- hot flashes, night sweats, irritability, and insomnia. You tend to get tired easily during perimenopause and might experience body pains as well. The hormones estrogen and progesterone help in regulating your cellular energy and their imbalance can make you feel extremely tired.
8. Weight gain. Changes in estrogen levels can sometimes cause swelling of your body and excess fluid retention can contribute to gradual weight gain. Additionally, altered estrogen production can increase hunger and you may end up eating more than usual, leading to weight gain.
9. Stress urinary incontinence (SUI). Urinary Incontinence (UI) is the loss of bladder control or the involuntary leakage of small amounts of urine when you cough, sneeze or laugh. SUI is the most common form of urinary incontinence in women.
Stress incontinence is common during perimenopause but typically doesn't worsen because of menopause. This happens because of an overly active bladder or the urge to urinate frequently which is another common symptom of perimenopause.
10. Vaginal dryness and pain during sex. Optimal levels of estrogen are required to maintain overall vaginal health and for keeping your vagina hydrated and lubricated. Due to decreased estrogen levels during perimenopause, the cells lining your vagina dry out leading to vaginal dryness. Vaginal dryness results in itching and discomfort.
Your vagina has to be well lubricated for enjoying sexual acts. A dry vagina can cause pain during sexual intercourse and also lead to bleeding at times.
During perimenopause, apart from the above symptoms, if you notice the following symptoms, consult your gynaecologist immediately:
Large blood clots during your period
Spotting (light blood stains) after your period
Bleeding during or after sexual intercourse
Periods that are much longer or shorter than what you have been having
Remember that perimenopause is just preparing your body for the menopausal stage. There are many things you can do to reduce your symptoms which include eating a healthy, nutritious diet, staying calm and positive, exercising regularly, and communicating openly with your loved ones to have their support.
Consult your gynaecologist to understand various treatments available to reduce your symptoms and discuss anything that might worry you.
1. Menopause.org. 2021. Perimenopause, Early Menopause Symptoms | The North American Menopause Society, NAMS. [online] Available at: <https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal> [Accessed 10 February 2021].
2. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016;25(4):332-339. doi:10.1089/jwh.2015.5556
3. National Institute on Aging. 2021. What Is Menopause?. [online] Available at: <https://www.nia.nih.gov/health/what-menopause> [Accessed 10 February 2021].
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