The term, which literally means “around the menopause,” refers to the “menopausal transition.” Just like the menopause, the perimenopause is usually a gradual process. The ovaries begin to produce lower amounts of hormones. The reduced amounts of hormones cause menstrual periods to become irregular. The hormonal changes often cause other symptoms as a result of fluctuations in the hormone levels produced by the aging ovaries.

Most women go through the perimenopause between ages 42 and 50. In the US the average age for menstrual periods to stop completely is 50.

What are the symptoms?

You may have both physical and psychological symptoms during the perimenopause. Symptoms may occur for a few weeks, a few months, or sometimes over several years. Your symptoms may come and go, or they may occur regularly.

These physical symptoms are common during the perimenopause:

irregular menstrual periods
hot flashes
night sweats
disturbed sleep patterns
vaginal dryness and shrinkage of genital tissues, sometimes resulting in discomfort or pain during sexual intercourse
dry skin
more frequent urination or leakage of urine (urinary incontinence)
more frequent minor vaginal and urinary infections.

The perimenopause usually occurs at a time in life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement, or career changes. These changes, in addition to the changes in your body, may result in psychological or emotional stress.

Psychological symptoms of perimenopause may include:

anxiety
depression
tearfulness
irritability
sleeplessness
less desire for sex
lack of concentration
more trouble remembering things.

Other changes that may occur during the perimenopause include:

reduced fertility
heavier menstrual flow
more painful menstrual cycles
skipped periods
frequent headaches

How is it diagnosed?

The perimenopause can often be diagnosed through your medical history. Your health care provider will then examine you. He or she may order blood tests. Often, blood tests for “hormone levels” will be interpreted as “normal.” However, just because these levels are evidence that “menopause” has not yet arrived, fluctuations of ovarian hormones still take place with the resultant symptoms you might be experiencing. A pelvic exam and Pap smear may show effects of decreased estrogen.

Don’t assume that hot flashes and other changes during the perimenopause are caused by approaching menopause. Many perimenopausal changes can also be caused by something else, such as thyroid disease or disorders and some can be signals of serious disease. Report any changes to your healthcare provider so serious causes can be ruled out.

How is it treated?

The perimenopause is a natural part of a woman's life cycle. It is not a disease and does not necessarily require any treatment. However, certain health problems, such as osteoporosis and increased heart disease, are associated with low estrogen. To help prevent such problems, many women choose to take birth control pills at this time to replace what their body is no longer producing. This treatment is called “hormone supplemental therapy.”

You and your health care provider should discuss the pros and cons of hormone supplemental therapy for you. Factors such as your age, race, family history, and health history will be considered in the discussion. This supplemental is the most effective treatment for preventing the symptoms associated with this time period as well as reducing menstrual irregularity and worsening cramps associated with menses. However, it is not the right treatment for every woman. Women who have had some types of breast cancer or other cancer, blood clots, certain liver disease or smoke heavily should not take birth control pills.

Ask your health care provider about any side effects or special precautions you should know about while you are taking hormones. Make sure that your provider knows about any other medications you are taking.

How long will the effects last?

Symptoms of the perimenopause usually last for several years. Unlike the menopause, this transitional period continues until loss of estrogen is low enough to inhibit menses altogether.

If you have had no menstrual periods for several months and then have bleeding from the vagina, check with your health care provider promptly. Vaginal bleeding in a woman, who has not had periods for months, or especially years, can be a symptom of cancer.

How can I take care of myself?

See your health care provider annually for your exam and to review any concerns you might have dealing with the perimenopause.
Have a mammogram every 2 years between the ages of 40 and 50, and every year after age 50.
Eat more foods that are high in calcium, such as dark green vegetables and nonfat (skim) milk and dairy products.
Obtain an adequate intake of dietary calcium (1,200-1,500 mg per day).
Obtain an adequate intake of vitamin D (400-800 IU per day).
Reduce saturated fats in your diet. Check labels for product contents before you buy them.
Get regular physical exercise. Exercise will help you fight depression and maintain good circulation, mobility, bone density, and a sense of well-being.
Use birth control during sexual intercourse until your health care provider says that you may stop. It is not possible to know exactly when you will stop being able to get pregnant and it is important to avoid high-risk pregnancies.
Take one baby aspirin (81 mg) per day to decrease the blood’s ability to clot.
Supplement your diet with fresh fruits and antioxidants (e.g., vitamin C and E).

You may also choose to:

Wear cotton sleep ware to reduce discomfort from night sweats.
Use a vaginal lubricating cream or jelly if intercourse is painful. This problem is usually caused by a lack of estrogen and should be discussed with your health care provider.
Talk and share feelings with a friend or family member who understands what you are experiencing.
Join a support group for women who have been or are going through the perimenopause.

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Robert B. McWilliams, MD Reproductive Endocrinology and Gynecology

Perimenopause

Robert B. McWilliams, MD
Reproductive Endocrinology
and Gynecology