Many people are familiar with the hallmark signs and symptoms of menopause — including hot flashes, low sex drive or weight gain. The concept of perimenopause, on the other hand, often remains more of a mystery.
Perimenopause is the natural process when an individual transitions to menopause. Sometimes described as a “second puberty,” knowing what to expect when going through it can be helpful for women as they age.
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Perimenopause vs. Menopause
Perimenopause refers to the years leading up to menopause.
“Menopause is complete cessation of periods,” explains Sobia Khan, a certified menopause and women’s health specialist with Cleveland Clinic in Ohio.
This transitional period is not defined as menopause until women have gone a full year without a period, says Stephanie Faubion, the medical director of the North American Menopause Society and director of Mayo Clinic‘s Center for Women’s Health in Rochester, Minnesota.
Symptoms that begin to manifest after a woman is in menopause are considered post-menopausal.
What Is Perimenopause?
Perimenopause is the period of time, usually six to 10 years, leading up to the last menstrual period, when the body’s ovaries may not be working at 100%.
“There could be some cycle lengths of variation,” Faubion says, adding that the time between menstrual cycles could get closer together, or further apart, during this time. “Some months, women may miss periods altogether when they’re getting into the later stages of that menopause transition.”
Menopausal transition or perimenopause is a period of dynamic change in women’s life.
“For some women, it is not a very noticeable milestone,” Khan says. “But for some, this transition carries quite a bit of impact because there are hormonal changes, ovarian changes and some physiological and emotional effects, as well.”
When Do You Go Through Perimenopause?
The normal age of menopause is age 45 and over. While most women have gone through menopause by age 55, a few women may go through it after that.
It’s considered early menopause if women go through menopause under age 45, and it’s premature menopause if they go through under age 40. About 1% of women go through menopause prematurely, according to Faubion.
Unfortunately, there’s no crystal ball that reveals when you’ll begin the menopause transition. But genetics may be a potential indicator.
“Sometimes having a discussion with their family members and identifying when their sisters or when their mother went through menopause is actually very helpful,” Khan says.
Though this may shed some light, at the end of the day, it’s very personalized to each individual.
Symptoms of Perimenopause
Becoming familiar with the signs of perimenopause is important for women.
“If they are not informed, they are really interpreting some of these symptoms in a very generalized way,” Khan says. “If they’re having palpitations, they think it’s because of heart disease. If they’re having hot flashes, they think that they are in menopause. If they are having irregular periods, they also think that there’s something abnormal going on.”
Symptoms that may begin to appear during perimenopause include:
— Cognitive issues. Typical memory- and focus-related issues include forgetfulness and brain fog.
— Heart palpitations. This may feel like your heart skipped a beat or like rapid fluttering in the chest. It may also manifest as a pounding sensation in the chest or neck.
— Hot flashes. This occurs as intense, sudden feelings of warmth that rush the body, often affecting the face, neck and chest areas.
— Low libido. The low levels of estrogen during perimenopause can decrease a person’s sex drive.
— Menstrual cycle irregularities. Your menstrual cycle could get closer together or further apart during this time. And periods could be short or very long, or they could be very heavy at times, Khan says.
— Mood disturbances. Women may feel more irritable, tense or depressed, for example.
— Night sweats. Hormonal changes affect your body’s ability to regulate its temperature, causing night sweats.
— Sleep disruption. This could mean poor-quality sleep or frequent sleep disturbances throughout the night.
— Vaginal dryness. Because of the decrease in estrogen during perimenopause, your vaginal tissues become thinner and prone to irritation.
— Weight gain. Often your metabolism slows down during this time.
“Women have these symptoms well before their last menstrual period, and they often are blown off in their care providers’ offices because people say, ‘Oh you’re having regular periods, you can’t possibly be having menopause symptoms,'” Faubion says.
Perimenopausal women experience these symptoms at varying intensities due to hormonal fluctuations.
Sometimes doctors are able to run basic tests — such as blood tests to determine specific hormone levels — to tell whether their patient is going through perimenopause transition or if they have entered menopause.
However, this is not always advised.
“We cannot generalize or recommend these tests for every perimenopausal woman since hormone levels fluctuate significantly prior to actual menopause,” Khan says.
Treatment of Perimenopause Symptoms
Treatment is very personalized and individualized to what kind of symptoms a woman going through perimenopause is experiencing.
“Preparation is the key for menopause,” Khan says.
According to Khan, lifestyle changes are essential to getting relief from perimenopausal symptoms:
— Stress management. Khan would recommend incorporating meditation, yoga and aerobic activities in moderation throughout the week.
— Regular exercise. Exercise can help improve restful sleep, aid in weight management and provide overall health benefits during this transitional stage. Federal guidelines recommend aiming for at least 150 minutes to 300 minutes of moderate-intensity physical activity spread throughout the week, such as walking, swimming or biking.
— Sleep hygiene. “Sleep hygiene is critical,” Khan says. Making sure to unwind at night and waking up around the same times, in addition to exposing yourself to morning light, all help to regulate hormonal changes.
— Nutrition. Addressing diet can help curb weight gain associated with perimenopause. Khan recommends aiming for an organic, whole-food diet and limiting gluten, dairy and sugar intake because pro-inflammatory foods can enhance symptoms.
— Addressing vitamin and mineral deficiencies. Khan recommends discussing with your clinician about phytonutrients, adaptogens and botanical supplements.
It’s common practice to continue women on birth control pills — if they’re healthy and can otherwise take birth control pills — until they go through menopause, Faubion says. Some of the reasons why women wouldn’t be able to use an oral contraceptive pill include:
— History of blood clots in the leg or lung.
— Migraine with aura.
— Actively smoking.
— History of heart attack or stroke.
— History of breast cancer.
Oral contraceptive pills will typically take care of symptoms related to hormone deficiencies, including hot flashes, night sweats, sleep disturbance and mood disturbances.
“The decision about the use of combined hormonal contraception, hormonal intrauterine device, progesterone-only treatment or hormonal therapy is contingent upon the hormonal changes affecting frequency and intensity of menstrual periods,” Khan says. “It is shared decision-making among clinician and patient and personalized to the presentation of perimenopausal symptoms.”
Can You Get Pregnant During Perimenopause?
Yes, you can definitely get pregnant during this period. In fact, the second most common time of unwanted pregnancy beyond the teens is in a woman’s 40s, according to Faubion.
In fact, you can get pregnant until your periods are completely stopped and, in some cases, even a shortly after that, as well.
“You can occasionally ovulate even after you haven’t had a period for a few months,” she says. “That’s rare, but I would suggest that women need contraception if they do not want to become pregnant, or it’d be a catastrophe if they became pregnant, until they have gone a year without a period.”
When to See Your Doctor
Perimenopause is an opportunity for women to be reintroduced to health care, establish a relationship with their women’s health physician and stay up to date with their preventive screenings, health care assessments and education in preparation for menopause.
Khan says she is noticing that more women are seeing their doctors earlier to discuss symptoms and hormonal changes they’re experiencing an average of five years ahead of time.
According to a 2021 study published in the journal Menopause, women are likely to begin experiencing symptoms — like hot flashes, night sweats and mood disturbances — well before significant cycle irregularity begins.
“The most important thing is that they should seek advice from a woman’s health specialist, rather than a primary care, because not all the primary care physicians are knowledgeable on the subject of menopause,” Khan says.
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