Perimenopause Symptoms, Diagnosis, and Treatment

What is Perimenopause?

Perimenopause is the phase during which your body begins its transition into menopause. This transitional period is marked by the ovaries producing fewer hormones, which results in menstrual cycles becoming less consistent or irregular.

As perimenopause progresses, your body moves closer to the end of your reproductive years. While this is a natural phase, it often brings both physical and emotional changes to the woman. Some of these changes can disrupt daily life or lead to discomfort.

Perimenopause may occur as early as the mid-thirties or as late as the mid-fifties in women. For some, this phase lasts only a short while, but for others, it can extend over several years. Despite the unpredictability of your menstrual cycle and declining hormone levels during this phase, pregnancy is still possible during perimenopause.

Perimenopause marks the transitional journey towards menopause, which is when menstrual cycles cease entirely. If you don't experience a period in 12 consecutive months, you have officially reached menopause.

What are the hormonal changes during perimenopause?

The hormonal fluctuations that occur during perimenopause primarily stem from declining oestrogen levels. The ovaries, which are responsible for producing oestrogen, play an essential role in maintaining the functioning of the reproductive system.

As oestrogen levels drop, the balance between oestrogen and progesterone, another hormone produced by the ovaries, is disrupted. Hormone levels during perimenopause tend to fluctuate significantly, often mimicking a rollercoaster pattern of highs and lows.

Upon reaching menopause, oestrogen levels drop so significantly that ovulation—the release of eggs by the ovaries—stops altogether. This leads to the cessation of menstrual cycles, marking the end of the reproductive phase in a woman's life.

What is the typical age for perimenopause to start?

On average, perimenopause begins approximately eight to ten years before the onset of menopause. For most individuals, this occurs in their mid-forties, though it may begin earlier.

Menopause occurring before the age of 40, is referred to as premature menopause. Certain medical conditions or surgical procedures can cause menopause to start prematurely. If no medical or surgical reason is identified for this early onset, it is termed primary ovarian insufficiency.

How long does perimenopause last?

The duration of perimenopause varies widely between individuals, but the average length is approximately four years. However, it can last as long as eight years.

For some, this phase may only span a few months, whereas others may experience this transition for several years. The length of perimenopause depends on how your body responds to hormonal changes.

How do you know you're in perimenopause?

It's important to note that every individual's body reacts differently to perimenopause, and the signs can vary greatly from person to person.

In most cases, irregular menstrual cycles are the earliest indication of perimenopause. Your regular menstrual cycle may become unpredictable, with random spotting or missed periods. Additionally, many individuals experience early signs commonly associated with menopause, such as hot flushes and vaginal dryness, during this transitional phase.

What are the symptoms of perimenopause?

As your oestrogen levels begin to decline, your body undergoes hormonal changes that may manifest differently for each individual. While some people notice only minimal physical changes apart from skipped periods, some may experience more intense symptoms, including mood swings and hot flushes.

Although the symptoms vary from one person to another, many individuals experience at least one or more of the following:

• Irregular menstrual cycles or skipping periods entirely
• Periods that are noticeably lighter or heavier than usual
• Mood changes, including irritability, depression, or frequent mood swings
• A decrease in sexual desire (low libido)
• Hot flushes
• Night sweats
• Vaginal dryness, which may cause discomfort during intercourse
• An increased sense of urgency to urinate or frequent urination
• Sleep disturbances, including difficulty falling asleep or insomnia

Because many of these symptoms overlap with those of other medical conditions, it is advisable to consult a healthcare provider. They can confirm whether your symptoms are related to perimenopause or another health issue.

What does perimenopause anxiety feel like?

While there are limited studies focused specifically on anxiety during perimenopause, healthcare providers know that mental health challenges, such as depression, are common during this phase. Many individuals also report experiencing heightened anxiety.

Anxiety during perimenopause can involve persistent worry or fear that may interfere with daily life. Physical symptoms such as excessive sweating, nausea, or muscle tension can also occur. Perimenopause-related anxiety can disrupt your sleep and make routine activities challenging to manage.

If you feel that perimenopause is affecting your mental well-being, seek advice from a healthcare professional. They may recommend treatments like behavioural therapy or medication to improve your emotional health.

What are periods like during perimenopause?

As your body produces less of the hormones that regulate ovulation, your periods can become irregular. The length of your menstrual cycle may vary, becoming shorter or longer than usual.

Additionally, your bleeding patterns may change, resulting in periods that are either much heavier or significantly lighter than before. Some women will notice that their premenstrual syndrome (PMS) symptoms worsen during perimenopause.

Do you still ovulate during perimenopause?

Yes, ovulation can still occur during perimenopause as long as you are experiencing periods, even if they are irregular. You remain fertile until you have gone 12 consecutive months without menstruating.

Ways to Reduce Risks of Perimenopause Complications

Although irregular periods are a common and normal occurrence during perimenopause, they can also indicate other underlying health conditions. To rule out other causes, it is essential to consult a healthcare provider if any of the following apply to you:

• Your menstrual flow becomes excessively heavy or contains large blood clots
• You need to change pads or tampons every one to two hours due to heavy bleeding
• Your periods last several days longer than usual
• You experience spotting or bleeding between periods
• You notice bleeding after engaging in sexual activity
• If it is less than 21 days between your menstrual cycles

Your healthcare provider will work to exclude other potential causes of abnormal vaginal bleeding. Some of the conditions that may need to be ruled out are:

• Infections
• Uterine fibroids
• Blood clotting disorders
• Uterine polyps
• Certain types of cancer

How is perimenopause diagnosed?

A diagnosis of perimenopause can typically be made based on your age, symptoms, and medical history, alongside a physical examination conducted by a healthcare professional.

It is worth noting that an official diagnosis is not always necessary for perimenopause. Some individuals recognise the bodily changes they are undergoing and manage mild symptoms without seeking medical intervention. However, if the symptoms become unmanageable or cause significant discomfort, consulting a healthcare provider can be beneficial.

What tests can diagnose perimenopause?

Although hormone testing is not mandatory to confirm perimenopause, certain tests can provide insight into whether this transition has begun. For instance, a healthcare provider may measure your levels of follicle-stimulating hormone (FSH). This hormone, which is produced by the pituitary gland, stimulates the ovaries to release eggs during ovulation.

When there is a consistently high level of FSH, it may suggest that menopause is approaching. However, hormone levels often fluctuate significantly during perimenopause, which makes these tests somewhat unreliable. Furthermore, certain health conditions and medications can interfere with hormonal results.

There are no imaging tests designed to diagnose perimenopause specifically. However, your provider might recommend scans or other evaluations to rule out alternative conditions.

Can perimenopause be treated?

Perimenopause itself is a natural stage of life, and there is no treatment that can prevent it. This phase eventually concludes when your periods cease completely, leading to menopause.

Nonetheless, healthcare providers can recommend strategies to help alleviate symptoms that may cause discomfort. While some individuals find that lifestyle changes alone are sufficient to manage symptoms, others may benefit from medications that can significantly enhance their quality of life.

Your provider may suggest the following treatment options based on your specific symptoms and needs:

• Antidepressants: These can alleviate mood swings, anxiety, depression, and hot flushes
• Birth control pills: These help stabilise hormone levels and provide relief from symptoms
• Hormone replacement therapy (HRT): This involves using oestrogen or a combination of oestrogen and progesterone to increase hormone levels, especially for those who experience menopause before the age of 40
• Hormone therapy (HT): Like HRT, this therapy uses oestrogen or a combination of oestrogen and progesterone to boost hormone levels. Healthcare providers typically use this term for individuals experiencing menopause at a natural age (45 and older)
• Gabapentin (Neurontin®): Originally a medication for seizures, it also provides relief from hot flushes
• Oxybutynin: A medication designed to treat overactive bladder, which can also reduce hot flushes
• Fezolinetant (VEOZA™): A newer treatment specifically approved for severe hot flushes
• Vaginal creams and lubricants: These can be prescription-based or over-the-counter solutions that ease vaginal dryness and make sex more comfortable

Your healthcare provider will explain these treatments' potential risks and advantages, tailoring recommendations to suit your circumstances.

What lifestyle changes can help manage perimenopause symptoms?

For some individuals, perimenopause symptoms can be effectively managed through lifestyle changes rather than medication. Here are some strategies to consider:

• Incorporate plenty of fruits, vegetables, lean protein, whole grains, and healthy fats into your diet
• Engage in weight-bearing exercises, such as walking, hiking, or resistance training
• Wear layers of clothing to make it easier to adjust to changes in body temperature caused by hot flushes
• Use a fan at home or maintain a cool indoor environment
• Practice good sleep hygiene by avoiding screens before bedtime and engaging in relaxing activities to wind down
• Limit the consumption of alcohol and caffeinated beverages
• Try stress-relief practices such as meditation or deep-breathing exercises
• Quit smoking or using tobacco products
• Maintain a healthy body weight for your frame and overall health

What factors can make perimenopause worse?

While no single factor universally worsens perimenopause for everyone, certain triggers may intensify symptoms. Each individual experiences perimenopause differently, so it is essential to identify and avoid potential aggravating factors that might worsen your symptoms. Generally, the following can contribute to more severe symptoms:

• Unhealthy Eating Habits: Consuming foods or drinks that are high in sugar, saturated fats, or simple carbohydrates may exacerbate symptoms such as weight gain and hot flushes. Opting for nutrient-rich foods may alleviate some discomfort
• Physical Inactivity: Living a sedentary life may worsen energy levels, cause sleep disturbances, and cause mood swings. Regular physical activity has been shown to alleviate these issues
• Smoking and Tobacco Use: Regular smoking is linked to earlier menopause, reduced bone density, and worsening vaginal dryness, along with exacerbating other menopausal symptoms

To better manage perimenopause, discuss your symptoms and lifestyle habits with a healthcare professional. They can create a treatment plan for your specific needs.

What can trigger early perimenopause?

Certain factors are associated with an earlier onset of perimenopause, including:

• Smoking or Tobacco Use: Regular smoking or tobacco product use often leads to earlier menopause, typically one to two years earlier than in nonsmokers
• Family History: If early menopause runs in your family, you may be more likely to experience it yourself
• Cancer Treatments: Therapies such as chemotherapy or radiation can accelerate the onset of menopause
• Surgical Procedures: Removal of the uterus (hysterectomy) or ovaries (oophorectomy) can lead to early menopause

Are there health risks associated with perimenopause?

The hormonal changes that occur during perimenopause, particularly the decline in oestrogen, can lead to health complications associated with menopause, including:

• Osteoporosis: Oestrogen helps maintain bone density. Reduced levels of this hormone during menopause increase the risk of fragile bones, fractures, and osteoporosis. A healthcare provider may recommend supplements like calcium, vitamin D, or multivitamins, in addition to weight-bearing exercises, to mitigate this risk
• Cardiovascular Health Risks: People undergoing menopause may also face a higher risk of heart disease and other cardiovascular problems

Can I get pregnant during perimenopause?

Yes, pregnancy is still possible during perimenopause. Although fertility declines as hormone levels fluctuate, ovulation may still occur as long as you continue to have menstrual periods. When menstrual cycles are irregular, you are more likely to have an unexpected pregnancy.

If you are not planning to expand your family, it is advisable to continue using birth control until your healthcare provider confirms it is safe to stop.

What Questions Should I Ask My Healthcare Provider?

Confidently discussing perimenopause with your medical practitioner is important to understanding and managing your symptoms. Keeping track of your menstrual cycles, including their duration and intensity, may help guide your discussions. Consider asking your provider the following questions:

• Are my symptoms indicative of perimenopause?
• What strategies or treatments could help alleviate these symptoms?
• How long should I expect to experience these symptoms?
• Is hormone therapy a suitable option for me?
• Do I need to start any medications or supplements?
• Are there specific tests or evaluations I should undergo?

When should I contact my healthcare provider?

If perimenopausal symptoms become severe or significantly interfere with your daily life, you should reach out to a healthcare provider. They can suggest appropriate treatments and strategies to minimise the intensity of these symptoms and enhance your overall well-being.

Additional Common Questions

Can Perimenopause Affect My Sex Life?

Yes, perimenopause may affect your sex life. Symptoms like vaginal dryness and discomfort during intercourse may make sex less enjoyable or desirable. Using vaginal lubricants can alleviate dryness. Speak with your provider if changes in sexual desire are problematic, as they can recommend appropriate solutions.

Does Perimenopause Impact Sleep?

Sleep disturbances are common during perimenopause. During perimenopause, people may struggle with insomnia and disrupted sleep, often caused by night sweats or other menopausal symptoms.

What Do Hot Flushes Feel Like in Perimenopause?

Hot flushes are characterised by a sudden sensation of intense warmth that can spread across your body, often accompanied by sweating and facial flushing. This is triggered by declining oestrogen levels, and these episodes can persist for months or even years.

Why Do People Gain Weight During Perimenopause?

A decline in oestrogen can slow your metabolism, making weight gain more likely during perimenopause. Staying active and maintaining a balanced diet filled with nutritious foods may help manage your weight effectively during this phase.

A Final Note

Perimenopause marks the natural transition to menopause. While it can bring both physical and emotional challenges, including symptoms such as irregular periods, mood fluctuations, and changes in weight, it is a phase of life that every individual navigates differently.

If you believe you are experiencing perimenopause, communicate openly with your healthcare provider. They can confirm whether your symptoms are normal, identify any associated health risks such as osteoporosis, and recommend treatments to ease your discomfort.

For individuals experiencing disruptive symptoms, providers may prescribe medications or suggest lifestyle changes to make this transition smoother. Remember, with the right support and information, it is possible to embrace and manage this new stage in life effectively.

Do not hesitate to reach out to us today for further information regarding perimenopause.