Perimenopause: Symptoms and Treatments

THURSDAY, June 22, 2023 (HealthDay News) -- Often women in their 40s are busy with family, job, helping aging parents and many other things that fill their days. So when the changes that come with perimenopause sneak up on them, it may take them by surprise.

All of a sudden they find themselves experiencing disruptive and frustrating symptoms. It’s too early for menopause. What's going on? This is perimenopause. This article will explain what it is, when it starts, how long it usually lasts and the most common symptoms.

What is perimenopause?

Perimenopause, or what is sometimes called the menopausal transition, is the period when your body starts making its move to menopause. Menopause signals the end of your reproductive years.

During perimenopause, your body stops releasing eggs regularly, according to Johns Hopkins Medicine. You produce less estrogen, become less fertile, and your menstrual cycles will shorten and become irregular.

When does perimenopause start?

Perimenopause, according to the Cleveland Clinic, normally begins eight to 10 years before menopause as the ovaries gradually produce less and less estrogen. A common perimenopause age is somewhere in the 40s, although some women may find themselves experiencing an earlier perimenopause.

How long does perimenopause last?

Perimenopause lasts until the beginning of menopause, which occurs when the body stops releasing eggs and menstrual cycles cease, the Cleveland Clinic says. During the last year or two of perimenopause, the drop in estrogen accelerates. Signs that perimenopause may be ending include an increase in menopausal symptoms and no period for several months. You are officially in menopause once you have gone 12 months without a menstrual period. Until that point, it is still possible to get pregnant, so it is wise to continue birth control until you are certain you are in menopause.

According to Mayo Clinic, a persistent change of seven days or more in the length of your menstrual cycle signals that you may be in early perimenopause. If you go 60 days or more between periods, you're likely in late perimenopause.

Perimenopause symptoms:

During menopause you may experience some or all of these symptoms:

• Irregular periods: You may skip months, or find yourself with an extra cycle.
• Hot flashes and sleep disruptions: Hot flashes are often the cause of sleep problems during perimenopause. But sleep issues can come even without the hot flashes.
• Mood changes: Depression, irritability or mood swings may also occur during perimenopause. Often, sleep disruption can cause this. Hormonal changes are another culprit. The mood changes may also be due to something unrelated to perimenopause.
• Bladder and vaginal issues: The drop in estrogen may cause dryness in the vagina, resulting in discomfort with intercourse. It can also lead to an increase in vaginal and bladder infections, as well as urinary stress incontinence.
• Decreased fertility: With the decrease in egg production comes a decrease in fertility.
• Changes in sex drive: Some women experience a decrease in sexual arousal and intimacy.
• Bone loss: A drop in estrogen can lead to bone loss, which can lead to osteoporosis.
• Cholesterol level changes: The drop in estrogen can cause undesirable changes in your cholesterol levels.

Perimenopause treatments:

Mayo Clinic says medications used to treat perimenopausal symptoms include:

• Hormone therapy: Systemic estrogen is the best way to resolve the symptoms of perimenopause. Depending on your history and family history, your health care provider may recommend low-dose hormone replacement. If you still have your uterus, you will need to take a progestin. Estrogen can also protect from bone loss.
• Vaginal estrogen: This can help treat vaginal dryness, discomfort with intercourse and some urinary symptoms.
• Antidepressants: Certain antidepressants help with hot flashes.
• Fezolinetant (Veozah): A new, non-hormonal treatment for hot flashes.
• Gabapentin: This medication can help with hot flashes and migraines.

According to Hopkins Medicine, some lifestyle changes your health care provider may suggest include:

• Exercise: Regular exercise is helpful in alleviating some of the symptoms.
• Healthy diet: Make sure you get plenty of fruits, vegetables and whole grains.
• Calcium: Make sure you are getting enough calcium either through your diet, or with supplemental calcium.
• Keep a log: Discover what triggers your hot flashes by keeping a record so you can work to avoid the triggers.

Perimenopause can be a difficult time in a woman’s life as it signals the transition from childbearing years to menopause. But with knowledge of what to expect and steps that may help, it can be much less difficult to navigate.