Perimenopause

What is perimenopause?

Perimenopause refers to the transitional period of time before menstruation actually stops, which is marked by changes in the menstrual cycle, along with other physical and emotional symptoms. Perimenopause can last two to 10 years and during this time the following processes are occurring within a woman's body:

• Ovaries release eggs less regularly

• Ovaries gradually produce less estrogen and other hormones

• Fertility decreases

• Menstrual cycles shorten, there are fewer ovulations, and more cycle irregularity

• Circulating levels of estrogens and progesterone are markedly reduced

• Androgen (androstenedione) is reduced

• Testosterone decreases

What causes perimenopause and perimenopausal symptoms?

Perimenopause is caused by the declining function of the ovaries. Ovulation may become erratic and then stop altogether. The menstrual cycle length and flow may become irregular before the final menses (last menstrual period).

As fluctuations of hormones occur, symptoms result from the changing levels of estrogen and progesterone in the body. At times, estrogen levels may be higher, which may trigger symptoms similar to premenstrual syndrome (PMS). At other times, the estrogen levels may decrease, which may trigger hot flashes or night sweats. This fluctuation of estrogen levels may be interspersed with normal menstrual cycles during perimenopause. Research studies demonstrate that perimenopausal women show varying patterns of hormonal fluctuations. No two women will experience perimenopause in the same way.

What are the symptoms of perimenopause?

The following are the most common symptoms of perimenopause. However, each woman may experience symptoms differently. Symptoms may include:

• Mood changes

• Changes in sexual desire

• Difficulty concentrating

• Headaches

• Night sweats

• Hot flashes

• Vaginal dryness

• Sleep disturbances

• Joint and muscle aches

• Extreme sweating

• Frequent urination

• Similar symptoms as experienced with PMS

The symptoms of perimenopause may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

Treatment for perimenopause

Specific treatment for perimenopause will be determined by your health care provider based on:

• Your age, overall health, and medical history

• Current symptoms

• Your tolerance for specific medications, procedures, or therapies

• Your opinion or preference

More and more health care providers are treating perimenopausal symptoms. These treatments may include:

• Hormone therapy using estrogen or estrogen and progestins (to keep hormone levels more constant)

• Antidepressants (to stabilize mood swings)

Other lifestyle changes your health care provider may recommend include the following:

• Eat a healthy diet with fruits and vegetables and whole grains.

• Get at least 1,000–1,200 mg of calcium each day through your diet or supplements.

• Exercise regularly.

• Identify what triggers hot flashes (i.e., coffee, tea, etc.) by keeping a diary or record— to help reduce their likelihood.

• Discuss the use of herbal treatments such as soy and black cohosh (which may have some effectiveness in relieving certain symptoms) with your health care provider.

Some of the same suggestions used for coping with hot flashes in menopausal women may also be helpful for perimenopausal women. It is important to remember that herbal supplements are not subject to regulation by the FDA, and, therefore, have not been tested in an FDA-approved clinical trial to prove their effectiveness in the treatment or management of medical conditions. Consult your health care provider about symptoms you are experiencing and discuss herbal supplements before beginning use.