For many women, the years leading up to menopause can bring changes that seem to come out of nowhere. Periods become unpredictable, sleep may suddenly become more elusive, and symptoms like hot flashes, mood changes, and brain fog can appear seemingly out of nowhere.
This transition is called perimenopause, and it is a normal part of aging. However, because symptoms can vary widely from person to person, it is not always easy to recognize what is happening. Understanding what perimenopause is, what symptoms to expect and how to manage them can make this stage of life a little easier to navigate.
What Is Perimenopause?
Perimenopause literally means “around menopause”. It is the transitional period when the ovaries gradually begin producing less estrogen and hormone levels start to fluctuate. Perimenopause typically begins during the 40s, although it can begin earlier or later. Some people experience symptoms for several years before reaching menopause.
Menopause itself is defined as having gone 12 consecutive months without a menstrual period. Menopause is a natural life stage or the result of medical procedures such as surgical removal of ovaries, chemotherapy, or hormone-suppressing hormones. The average age menopause through natural aging is between 45 and 55 years. Perimenopause ends when menopause occurs.
What Causes Perimenopause Symptoms?
Hormone levels do not simply decline in a smooth, predictable pattern during perimenopause. Estrogen and progesterone can fluctuate significantly, which contributes to many of the symptoms associated with this stage. These hormonal changes can affect the menstrual cycle, temperature regulation, sleep, mood, sexual health, and other functions of the body.
Common Symptoms of Perimenopause
Everyone experiences perimenopause differently. Some have relatively few symptoms, while others experience significant changes that affect their daily lives.
Common symptoms include:
Irregular periods - Periods may become shorter, longer, lighter or heavier, and more sporadic.
Hot flashes and night sweats - Sudden feelings of intense heat can occur.
Sleep problems - Difficulty falling asleep, staying asleep or getting enough restful sleep is common.
Mood changes - Some people experience increased irritability, anxiety or depression.
Brain fog - Forgetfulness, difficulty concentrating or feeling a lack of mental clarity can occur such as difficulty thinking of words.
Vaginal and urinary changes - Declining estrogen can contribute to vaginal dryness, discomfort during sex and changes in urinary health.
Changes in sexual desire - Libido can increase or decrease during perimenopause.
Headache - Hormonal fluctuations can trigger or worsen headaches.
Joint and muscle aches - Some people notice new or worsening aches and stiffness.
Changes in body composition - It may become easier to gain weight, particularly around the abdomen, while maintaining muscle mass can become more challenging.
Not everyone experiences all of these symptoms, and symptoms can change over time.
Perimenopause and Your Period
One of the earliest signs of perimenopause is often a change in your menstrual cycle. You might notice that your periods are coming closer together or farther apart. Flow may also become heavier or lighter than it used to be. Some changes are expected during perimenopause, but unusually heavy bleeding, bleeding between periods or bleeding after sex should not automatically be attributed to perimenopause. These symptoms deserve a conversation with your healthcare provider because other conditions can cause abnormal bleeding.
Talk With Your Healthcare Provider
You do not simply have to put up with symptoms that interfere with your quality of life. Treatment depends on your symptoms, health history, age, and personal preferences. It’s important to find a healthcare provider who listens to your concerns and complaints and doesn’t dismiss your symptoms.
Several treatments may help manage bothersome perimenopause symptoms. Depending on your circumstances, your healthcare provider may discuss options such as hormone replacement therapy (HRT), nonhormonal medications, or treatments specifically targeted to symptoms such as vaginal dryness.
Do You Need Hormone Testing?
Many people assume that a blood test is necessary to determine whether they are in perimenopause. In many cases, however, healthcare providers can identify perimenopause based on your age, symptoms, and changes in your menstrual cycle.
Hormone levels can fluctuate considerably during perimenopause, so a single hormone measurement can’t really provide a clear picture. Your healthcare provider may recommend testing when symptoms could have another cause or when your situation is atypical.
Perimenopause Is a Transition, not a Disease
Perimenopause is a natural stage of life, but that does not mean its symptoms should be ignored or dismissed. Learning what is happening in your body can help you recognize changes, make informed decisions about your health and know when it is time to talk with a healthcare professional.
Taking care of your health during perimenopause also means looking beyond individual symptoms. Regular physical activity, nutritious food, adequate sleep, stress management and preventive healthcare can all help support your health through the transition and beyond. And above all, be kind to yourself during this bumpy ride.
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