What Is Perimenopause?

Perimenopause (PER-ee-MEN-oh-pawz), or the menopausal transition, is the time leading up to your last period. Perimenopause means “around menopause.”
Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly. During this transition, your ovaries make different amounts of the hormones estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE) than usual.

Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.

Perimenopause, the transition to menopause, usually starts in a woman’s mid- to late 40s.1 On average, women are in perimenopause for four years before their periods stop.

Can I Get Pregnant During Perimenopause?

Yes. You can still get pregnant during perimenopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months. But it is impossible to know for sure when you will ovulate. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs.

What Are The Symptoms Of Menopause?

Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
• Your periods might be heavier or lighter than before.
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness. Sexual intercourse may be uncomfortable or painful.
• You may have less interest in intercourse.
• Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.

When Does Menopause Typically Occur?

The average age of menopause is 52. The range for women is usually between 45 and 58.2 One way to tell when you might go through menopause is the age your mother went through it.

Menopause may happen earlier if you:

• Have never had children. Pregnancy, especially more than one pregnancy, may delay menopause.
• Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.
• Have had chemotherapy or surgery to remove both ovaries.

How Do I Address Menopause Symptoms?

Hot Flashes

Hot flashes are a sudden feeling of heat in the upper part of your body. Your face and neck may become red. Red blotches may appear on your chest, back, and arms. You may also get heavy sweating during hot flashes or cold chills after the hot flashes. Some women get more cold chills (also called cold flashes) than hot flashes.

• Consider medicines. Try low-dose hormonal treatments to relieve hot flashes. If are not an option for you, ask your doctor about prescription medicines used for other health problems. Certain antidepressants, epilepsy medicine, and blood pressure medicines may help with hot flashes, even if you don’t have these specific health problems.
• Track your hot flashes. Write down what triggers your hot flashes and try to avoid those things. Possible triggers might include spicy foods, alcohol, caffeine, stress, or being in a hot place.
• Drink cold water. Keep ice water close by to drink when you feel a hot flash coming on.
• Take off a layer of clothing. Dress in layers as much as possible.
• Use a fan. Turn on a fan at night by your bed and keep one at work if possible.
• Take deep breaths. Try taking slow, deep breaths when a hot flash starts. Slow, deep breaths tell your body that it is time to relax and be calm. This might make hot flashes shorter.
• Lose weight. Hot flashes may be worse in women who have overweight or obesity. A recent study found that losing weight may help improve hot flashes.4

Vaginal Problems

Vaginal problems, such as vaginal dryness, may start or get worse in the time around menopause. Low levels of estrogen may cause your vaginal tissue to get drier and thinner. This can cause itching, burning and pain or discomfort.

• Vaginal lubricant or moisturizer. Over-the-counter vaginal lubricants and moisturizers can help make intercourse more comfortable and keep the vagina lubricated.
• Prescription medicine. You can also talk to your doctor about other ways to treat vaginal dryness, including hormonal birth control, menopausal hormone therapy, or a prescription estrogen cream, gel, or ring that is inserted into your vagina.

Problems Sleeping

Many women in menopause find it hard to sleep through the night. Low levels of progesterone can make it hard to fall and stay asleep. Low estrogen levels can also cause hot flashes that make you sweat while you sleep.

• Exercise. One of the best ways to get a good night’s sleep is to get regular physical activity. But you may need to work out earlier in the day. Too much activity close to bedtime can make you more awake. Certain exercises, such as yoga and stretching, may help improve hot flashes.
• Do not eat, drink alcohol, or smoke before bed. Avoid large meals, smoking, and drinking alcohol right before bedtime. Avoid caffeine after noon.
• Drink warm drinks. Try drinking something warm before bedtime, such as caffeine-free tea or warm milk.
• Limit screen-time near bedtime. Limit TV, phone, or computer use near bedtime, especially in your bedroom. The bright light of the screens tell your brain to wake up instead of sleep.
• Don’t nap during the day. Try to go to bed and get up at the same times every day.
• Train your brain. If you wake during the night and can’t get back to sleep, get up and do something relaxing until you’re sleepy again.
• Talk to your doctor or nurse. Talk to your doctor or nurse about your sleep problems, as it could be something serious. Many women develop sleep apnea. Treating sleep problems can also help improve chronic pain.
• Consider treatment for hot flashes. Talk to your doctor or nurse about treatment for your hot flashes if they are causing your sleep problems. This will usually improve your sleep.

Memory Problems

You might become forgetful or have trouble focusing. As many as two-thirds of women going through perimenopause say they have problems with memory or trouble focusing. Menopausal hormone therapy does not treat or prevent memory loss or brain diseases, including dementia and Alzheimer’s disease. In a recent study, memory problems were linked to depression and loss of sleep but not to levels of the hormone estrogen.

• Stay socially active. Join a group or club that focuses on activities you enjoy, such as a hiking club or a quilting bee. Social interaction may help delay memory loss and prevent diseases such as dementia and Alzheimer’s disease.
• Stay mentally active. You may be able to boost your memory and focus by doing mental activities like crossword puzzles, taking a class, or learning a new skill like a foreign language.
• Talk to your doctor if forgetfulness or other mental problems affect your daily life.

Urinary Problems

Many women develop bladder or urinary problems during menopause. Lower estrogen levels may weaken the uthera. Some women find it hard to hold their urine long enough to get to the bathroom. This is called urinary urge incontinence. Urine might also leak out when you sneeze, cough, or laugh. This is called urinary stress incontinence. Some women have disrupted sleep during menopause because of the need to urinate during sleep. Urinary problems after menopause are not a normal part of aging and can be treated.

• Treatment can include limiting or avoiding caffeine, taking medicine, using special medical devices, physical therapy, or having surgery, depending on the cause of the condition.
• If you have urine leakage, you can try urinary incontinence products such as pads, a urethra cap, or a pessary. A urethra cap fits over your urinary opening. It is reusable. A pessary is a round disk that is inserted into your vagina to support your bladder. Your doctor or nurse will fit you for your pessary, but you can remove, wash, and reinsert it yourself.
• Talk to your doctor or nurse about things you can do at home to help treat urinary incontinence. These may include Kegel exercises for your pelvic floor muscles. Your doctor or nurse may also suggest losing weight, since extra weight puts more pressure on your bladder and nearby muscles.

Mood Changes, Depression & Anxiety

If you had mood changes with your monthly periods, you may be more likely to have mood changes with menopause too. Mood changes at this time also could be from stress, family changes, or feeling tired. Your risk for depression and anxiety is also higher during the time around menopause. You may experience sadness or depression over the loss of fertility or the changes in your body.

• Sleep. Try to get enough sleep. Most adults need between seven and eight hours of sleep each night. Lack of sleep is linked to depression.
• Exercise. Get at least 30 minutes of physical activity on most days of the week. Exercise is proven to help with depression.
• Limit alcohol. Limit how much alcohol you drink, if any. A moderate amount of alcohol for women is one drink a day, and no more than seven drinks in a week. More than four drinks at a time is considered binge drinking.
• Lower stress. Set limits for how much you take on. Look for positive ways to unwind. Try relaxation techniques, reading a book, spending some quiet time outdoors, or other healthy ways to unwind.
• Join a support group online. Also network with other women who are also going through menopause.

Content Source: Womenshealth.gov