We talk a lot about menopause and the changes our bodies go through. However, we don’t discuss the full menopause transition (MT). Menopause doesn’t happen abruptly; it occurs gradually over three phases: perimenopause, menopause and postmenopause. Perimenopause is the beginning of the MT, but many people may not know what it is. We’re breaking down the signs and symptoms, what you can expect, and how to care for yourself during this transitional phase.
What is Perimenopause?
Perimenopause means ‘around menopause’ (‘peri’ meaning about or around from the Greek word ‘peripeteia’). This is the period of time leading up to menopause when a woman’s body shifts from having regular periods to none at all. This stage officially ends 12 months after the final period, marking the start of menopause.
During perimenopause, the ovaries gradually stop releasing eggs, and estrogen production slows, leading to several symptoms. These symptoms can vary from person to person, but can include irregular periods, hot flashes, mood swings, and other symptoms as the body adjusts to decreasing hormone levels.
What Age Does Perimenopause Start?
For most people, menopause occurs between the ages of 45 and 55, and perimenopause can begin during the early 40s or even late 30s. Researchers recently found that genetics may play a part in when women start menopause and how long it lasts. In a study of 200,000 women, they identified 20 genetic variants that may be able to predict when menopause will occur, though the research is still in its early stages.
If you are in your early to late 30s and experiencing the symptoms of menopause (hot flashes, irregular periods, etc.), you should see your healthcare provider to ensure that there aren't any underlying conditions.
What are the Hormonal Changes During Perimenopause?
The biggest hormonal change during perimenopause is the declining levels of estrogen, an important reproductive hormone. Estrogen, produced by the ovaries, is crucial for maintaining the reproductive system, and as it decreases, it disrupts the balance with another hormone, progesterone. Estrogen levels continuously decline over the course of perimenopause, and eventually, levels are so low that your ovaries stop releasing eggs, and you stop ovulating, meaning you can no longer get pregnant and you won’t have periods anymore.
How Do You Know You’re in Perimenopause?
The biggest clue that you’re in perimenopause is you begin to have irregular periods (if you usually have regular periods and do not have any underlying conditions like polycystic ovary syndrome). There are two stages of perimenopause: early and late stage. In early-stage perimenopause, you may be a few days late here and there. By late perimenopause, you may go 60+ days without a period. You may also have other telltale signs, mostly hot flashes, which is one of the most common symptoms.
What Are the Symptoms of Perimenopause?
Perimenopause isn’t the same for everyone–but a handful of symptoms are commonly observed in perimenopausal women. Research has identified four main symptoms areas: vasomotor (hot flashes), poor sleep, mood disorders and vaginal dryness, though there are also other changes many women report like irregular periods and physical changes.
Vasomotor Symptoms
When estrogen levels drop, your body may struggle to regulate its temperature. A part of the brain called the hypothalamus thinks the body is overheating, so it triggers a hot flash, which is a momentary, uncomfortable feeling of heat and flushing. Similarly, night sweats are when your body’s sweat glands overreact, and you end up drenched in sweat. As many as 50% of perimenopausal and menopausal women report regularly experiencing hot flashes and/or night sweats.
Mood Disorders
Perimenopause symptoms aren’t limited to physical, they can also be physcological and emotional. During the MT, women may be at increased risk for depression and anxiety. A 2019 study potentially linked these changes to a form of estrogen called estradiol and declining progesterone levels.
Sexual Dysfunction
Vaginal dryness, along with irritation and dysuria (painful or irritation when urinating) are all common menopausal symptoms. The three symptoms together make up a condition called ‘genitourinary syndrome (GSM)’ caused by declining estrogen levels. GSM can occur earlier in the MT, though researchers are not sure why. Women commonly report painful sexual intercourse and urination, as well as general vaginal dryness.
Poor Sleep
Sleep disruptions, mostly due to hot flashes and night sweats, increase significantly during perimenopause. More recent research also attributes poor sleep quality to stress, the physical signs of aging and poor mood.
Irregular periods
One of the telltale signs of perimenopause is an irregular period. As estrogen levels begin to decline, you will menstruate less. By the time you go 12 consecutive months without a period you are considered menopausal.
Physical symptoms
Perimenopause typically happens around middle age, which is when other physical changes begin to happen, i.e., metabolism slows down, stress levels go up, and you begin to notice changes in your skin and hair. Some of these changes include:
- Weight: Weight gain is not a symptom of perimenopause, but other physical changes that occur around the same time (metabolism, loss of lean muscle) can make it more difficult to lose weight in your 40s and 50s
- Hair Loss: Some women experience hair thinning and loss due to aging and changing hormones. In research, menopausal women with higher levels of male sex hormones, like testosterone and dihydrotestosterone (DHT) were more likely to lose hair or have thinning hair.
- Dry Skin: The loss of estrogen can also lead to changes in your skin’s ability hold moisture, strength and elasticity.
Treatment options to ease perimenopause symptoms
While the MT is a natural part of life, it doesn’t mean you have to endure the symptoms, especially if they are impacting your quality of life.
Hormone Therapy
Hormone replacement therapy (HRT) works by replenishing the hormones lost during the MT. HRT combines estrogen and progesterone to mimic natural hormones and is most commonly used to treat severe hot flashes. Estrogen can be taken in different forms, like pills, creams, or patches, and progesterone is added to protect the uterus. Each method has its own risks and benefits so it’s important to discuss your individual needs with your healthcare provider.
Antidepressants
Some selective serotonin receptor inhibitors (SSRIs) are used off-label to treat hot flashes, and a few are even FDA-approved specifically for the treatment of hot flashes. Antidepressants are good options for people who cannot take estrogen for health reasons or also have mood disorders.
Phytoestrogens
Phytoestrogens are plant compounds with structures similar to estrogen. Some preliminary research suggests that phytoestrogens can produce estrogen-like effects on the body and may help with perimenopausal symptoms. However, the results are inconsistent and more research needs to be done. Foods like soybeans, flaxseeds and some leafy greens contain high levels of phytoestrogens.
You can also ensure you have other critical nutrients by taking a daily multivitamin made specifically for women’s health. Before taking anything for perimenopausal symptoms, talk to your healthcare provider.
Perimenopause FAQs
Why is there a Transition to Menopause?
Menopause is a transition because organs typically have a gradual decline in function as opposed to stopping all at once. Additionally, estrogen levels also decline gradually.
How Long Does Perimenopause :ast?
Perimenopause can last anywhere between four and ten years and the length depends on several factors, including genetics and lifestyle.
How do I Know When Perimenopause is Over, and Menopause Begins?
You’ll know perimenopause is over when you go 12 consecutive months without a menstrual period. If you experience any vaginal bleeding after menopause, it may indicate a serious underlying condition so you should see a healthcare professional.
What are Periods Like During Perimenopause?
During perimenopause, your estrogen levels are gradually declining, so as perimenopause progresses, your periods will become more irregular. They may become longer or shorter, heavier or lighter, and you may go longer without a period.
Do You Still Ovulate During Perimenopause?
Yes, as long as you’re getting a period, you are still ovulating, though you may ovulate less frequently.
When Should I Talk with My Healthcare Provider?
If you expect that you are entering the MT, you should speak with your healthcare provider as they may want to rule out other possible underlying conditions. Additionally, if you are experiencing severe symptoms like overwhelming hot flashes, sudden depressive symptoms or any other changes, you should seek out medical advice.
What are the Two Stages of Perimenopause?
There are two stages of perimenopause: early and late stage. In early perimenopause, which can begin as early as you’re mid-30s but often starts between the ages of 40 and 44.
: early and late stage. Late stage perimenopause occurs closer to menopause and usually happens in your late 40s to early 50s.
Can I get Pregnant if I am in Perimenopause?
Yes, you can still get pregnant during perimenopause, because you are still ovulating. It may be less likely because of irregular periods but it is not impossible. You should continue to use contraception if you do not want to become pregnant until your healthcare provider says it is safe to stop.
Can Perimenopause Affect my Sex Life?
For some people, perimenopausal symptoms like vaginal atrophy can cause dryness and pain or discomfort during sex. Mood disorders can also impact your libido or desire to have sex. Vaginal lubricants and antidepressants may help–speak with your healthcare provider about possible treatment options.
Does Perimenopause Affect my Sleep?
Yes, one of the common symptoms of perimenopause is trouble sleeping. Perimenopausal people are more likely to experience insomnia and interrupted sleep; frequently attributed to night sweats.
What do Hot Flashes Feel like During Perimenopause?
Hot flashes are sudden, often overwhelming feelings of heat throughout the body, accompanied by sweating and flushing. For some people the feeling is mild, but or some they are intense and debilitating.
Why am I Gaining Weight During Perimenopause?
Weight gain is not a symptom of menopause, but perimenopausal people tend to gain weight faster than younger people. This can be due to lower metabolism as we age, a sedentary lifestyle and several other factors. Regular exercise and a varied and healthy diet can combat weight gain.
