As women move into their late 40’s and early 50’s, they experience some natural, but significant, changes. Perhaps none as substantial as perimenopause, where period patterns can change, and new symptoms may emerge.

What is Perimenopause?

Perimenopause is the time when a woman's body begins the transition into menopause, which is defined as having no period for one year. This represents the end of reproductive years.

When Does Perimenopause Happen?

The average age of menopause is 52. But menopause can occur in a wide range of ages, from 40-58 or so. Perimenopause is the time frame leading up to menopause and can occur either a few months or up to 4-5 years before the period actually stops. This is a natural transition as we age.  Menopause can also happen if you have surgery to remove both ovaries or uterus (hysterectomy) and can be referred to as “surgical menopause.”

What Causes Perimenopause?

Perimenopause occurs as a woman’s ovaries naturally begin to stop producing eggs.

What Are Perimenopause Symptoms?

Symptoms of perimenopause depend on the woman and their bodies, but the most common symptoms are:

• Hot flashes. These are sudden feelings of heat in your body. Some describe it as a warmth that spreads from your feet to your head. They can vary in length and frequency and are one of the most common symptoms.
• Night sweats. You may experience excessive sweating at bedtime or waking up in a cold pool of sweat.
• Mood change. The hormonal changes, combined with their side effects, can significantly impact mood. This includes depression and anxiety.
• Sleeping problems. Sleep issues are common during perimenopause and may coincide with hot flashes and sweating, which make it difficult to sleep. Sleep deprivation can also make it harder to cope with the mood changes.
• Vaginal dryness. As your hormone levels shift, vaginal tissue becomes thinner and loses some of its elasticity. This may cause irritation.
• Changing sex drive. Perimenopausal women may find they are not as easily aroused, which may cause less interest in having sex. Also, vaginal dryness can lead to painful sex, which can decrease desire for sex in the future.  
• Bone density loss. When estrogen levels diminish during this time, your body undergoes some profound changes, include loss of bone density. This increases the risk for osteoporosis.
• Irregular period. While missed periods can mean a variety of things, one of the hallmarks of perimenopause is that the menstrual cycle becomes erratic and difficult to predict. This can lead to worry about pregnancy, uncertainty of when the cycle is coming, and a need to “be prepared” all the time.
• Infertility. As the ovaries have fewer and fewer eggs to release, the ability to conceive declines. As the period is unpredictable, however, it still is possible to get pregnant, and contraception must be considered. It is not until a full year has elapsed, and then official menopause has occurred, where you lose the ability to get pregnant.

What Are the Differences Between Perimenopause, Menopause, and Postmenopause?

Perimenopause is the timeframe leading up to menopause, which is defined as one year without a period. Perimenopause varies in duration, and can be from months to years, depending on the woman.

Menopause is diagnosed after a woman has gone through 12 consecutive months without having a period. At this point, the ovaries have stopped releasing eggs.

Postmenopause is another term, representing any time after menopause has occurred. Typically, the farther from the date of the last period, the more likely the uncomfortable symptoms tend to ease. Other changes that can occur include decreased metabolism, weight gain, changes in cholesterol, and decreased bone density. This can lead to health complications including:  

• Heart disease
• Osteoporosis
• Weight Gain

Perimenopause Treatments

While perimenopause and menopause are inevitable parts of life for women, there are things you can do to deal with the uncomfortable symptoms.

• Estrogen. Estrogen therapy may provide some relief of perimenopause symptoms and may help avoid a decrease in bone density; however, extended use of hormone therapy carries its own risks. Not every woman is a candidate for this therapy, which must be prescribed by a physician.
• Vaginal estrogen. If you experience vaginal dryness, your doctor can administer estrogen to the vagina to relieve dryness. Other options include water-based lubricants.
• Osteoporosis medication. Keeping ahead of bone loss during perimenopause is crucial. Make sure to talk to your doctor about the important building blocks for bone that include calcium and vitamin D. Weight-bearing exercise is also important for keeping bones strong. If you are noted to have bones that are less dense and could increase the risk of future fractures, there are medications that may be helpful.
• Antidepressants. Some antidepressants have been noted to not only help with mood swings, anxiety, and of course, depression brought on by perimenopausal symptoms, but also decrease the frequency of the physical symptoms of hot flashes and night sweats.
• Diet and Exercise. Make sure to eat leafy greens and get adequate exercise. Not only does this help with managing weight changes, but also most who are active report fewer menopausal symptoms. Cut back on red wine, spicy food, and hot beverages, as these can trigger hot flashes. Adequate water intake is also important.