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What is Perimenopause?

Just heard you're in perimenopause? Not sure what it is or what to expect? Don't worry! We've got the goods.

Finding it hard to sleep because you’re just too darn hot all of a sudden? Struggling with putting on and taking off layers all day? You could be experiencing hot flashes.

“What do you mean ‘hot flashes’? That’s the menopause! I’m only 40!”

Well, if you have a menstrual cycle you could be entering perimenopause.1 Don’t panic! It’s not as dramatic as it sounds. It doesn’t mean you are no longer fertile2 and it doesn’t necessarily mean you will enter menopause next week. Some of you might even be ready to celebrate putting periods behind you. It can, however, have some inconvenient effects on your body. To be forewarned is to be forearmed, so let’s get stuck into this under-discussed phenomenon.

What is perimenopause?

Perimenopause is the transitional period to menopause.1 It is a gradual process. Over several years, the ovaries slowly make less estrogen, and eventually stop functioning. As time goes on, our hormone levels will change, we will ovulate less frequently and our menstrual cycles will lengthen. This can also show up as our periods becoming longer and less predictable.3 On top of this, the ups and downs of our hormone levels during cycles can be more extreme than we are used to. These changes bring with them some unfortunate side effects. We say a woman has entered menopause when she has gone twelve consecutive months without a period. If you still have a cycle, even if you have all the other symptoms people associate with menopause, you are in perimenopause.

When does perimenopause happen?

Although most women start to experience perimenopause symptoms between the ages of 40 and 44, women as young as 30 can be affected.1 While in North America, perimenopause ends with menopause at around 51 years, in contrast the average age is 46 in India.4 The length of perimenopause can also vary from one person to the next. Some pass through this phase quickly, while for others, perimenopause can span four to eight years.3

What should I look out for?

Changes in how much estrogen your ovaries produce trigger perimenopause. Progesterone and estrogen levels rapidly rise and fall during this phase. As anybody who has experienced ovulation can vouch, we are no strangers to the highs and lows of these powerful hormones each month. During perimenopause, however, extreme changes in estrogen levels each month are like going from diving off a springboard to base jumping.

 When estrogen levels plunge, they trigger the characteristic hot flashes and night sweats. In contrast, when estrogen levels spike, progesterone will plummet, causing heavy uterine bleeding, vaginal dryness and in some cases fibroid growth.1

Hot flashes are a very common experience during perimenopause. On average, these sudden bursts of heat occur in almost 80% of perimenopausal women.1 However, it’s important to remember that not everyone will experience perimenopause the same way. Some women will glide through this phase of life blissfully unaware of the upheaval within. For the majority of people, though, the most common signs and symptoms include:

  • Hot flashes.
  • Night sweats.
  • Headaches
  • Low mood or anxiety
  • Lack of energy.
  • Weight gain.
  • Joint and muscle aches.
  • Vaginal dryness.
  • Loss of sex drive.
  • Trouble sleeping.
  • Problems with memory and concentration.2

How do I treat Perimenopause?

Unfortunately, we can’t skip perimenopause. Just like puberty the change is part of life. On the other hand, there’s no need to spend the next few years suffering in silence! Remember how earlier, we said people with a menstrual cycle might notice the onset of perimenopause? That was intentional. It’s long been observed that women who use hormonal birth control tend to escape a lot of symptoms of perimenopause.5

Hormones

Taking a low dose hormonal contraceptive can even out your perimenopausal rollercoaster. Hormone-based treatments centred around hormone replacement therapy (HRT) are also a safe and effective treatment for perimenopause. HRT works by supplementing the low levels of estrogen and progesterone in your body, easing perimenopausal symptoms. This therapy comes in pill, implant, spray and patch format. Your GP can talk you through which option would work best for you based on your specific needs. 1, 5 6 Since you could be ovulating even if your periods are irregular, you might want to stick with contraceptive methods that work for you. 

Non-hormonal Options

If you aren’t sold on hormonal treatments, there are alternative approaches. Doctors can prescribe Selective Serotonin Reuptake Inhibitors (SSRIs), gabapentin, clonidine or oxybutynin to relieve hot flashes and night sweats. You can manage the low mood and anxiety sudden hormone drops can trigger, with medication or cognitive behavioural therapy (CBT).5,6 Some women claim that phytoestrogens can be helpful, but there is no evidence that it works. Since these diet supplements are intended to replace estrogen, perhaps looking into HRT options might be a better bet.5

Weight gain

Studies have also found a link between BMI and the severity of perimenopause.7

Researchers discovered that obesity worsens perimenopause symptoms, particularly those associated with vasomotor functions (hot flashes, night sweats, insomnia etc).7 However, it is unclear whether the excess fat makes symptoms worse, or the drops in estrogen cause especially severe symptoms including weight gain.9 Estrogen has an important role in glucose metabolism.8 Losing most of your estrogen supplies can, therefore, make piling on the pounds more easy than it should be.9 Making healthy lifestyle changes during perimenopause could pay dividends once you hit menopause.10    

Taking Control of Your Health

At the end of the day, perimenopause is a natural and inevitable stage of life. Most ovary owners spent a few years going through menstrual mayhem—and everything that goes with it, in their teens. This time, however, you are the one in control of your healthcare decisions! Make life a little less unpredictable and a little more comfortable by getting in touch with your GP or gynaecologist now.

Now you have the basics, if you are ready to read more about perimenopause, or you want to get involved in perimenopause research/clinical trials… The Centre for Menstrual Cycle and Ovulation Research based in western Canada is an excellent resource.

References
  1. Perimenopause. The Centre for Menstrual Cycle and Ovulation Research. Accessed March 14, 2024. https://www.cemcor.ubc.ca/resources/life-phases/perimenopause ↩︎
  2. Allen RH, Cwiak CA, Kaunitz AM. Contraception in women over 40 years of age. CMAJ. 2013;185(7):565-573. doi:10.1503/cmaj.121280 ↩︎
  3. https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/perimenopause-premature-menopause-faqs. Accessed March 14, 2024. https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/perimenopause-premature-menopause-faqs ↩︎
  4. Ahuja M. Age of menopause and determinants of menopause age: A PAN India survey by IMS. Journal of Mid-life Health. 2016;7(3):126. doi:10.4103/0976-7800.191012 ↩︎
  5. Duralde ER, Sobel TH, Manson JE. Management of perimenopausal and menopausal symptoms. BMJ. 2023;382:e072612. doi:10.1136/bmj-2022-072612 ↩︎
  6. Menopause – Treatment. nhs.uk. Published October 23, 2017. Accessed March 14, 2024. https://www.nhs.uk/conditions/menopause/treatment/ ↩︎
  7. Koo S, Ahn Y, Lim JY, Cho J, Park HY. Obesity associates with vasomotor symptoms in postmenopause but with physical symptoms in perimenopause: a cross-sectional study. BMC Women’s Health. 2017;17(1):126. doi:10.1186/s12905-017-0487-7 ↩︎
  8. Mair KM, Gaw R, MacLean MR. Obesity, estrogens and adipose tissue dysfunction – implications for pulmonary arterial hypertension. Pulmonary Circulation. 2020;10(3):2045894020952019. doi:10.1177/2045894020952023 ↩︎
  9. Opoku AA, Abushama M, Konje JC. Obesity and menopause. Best Practice & Research Clinical Obstetrics & Gynaecology. 2023;88:102348. doi:10.1016/j.bpobgyn.2023.102348 ↩︎
  10. Hao S, Tan S, Li J, et al. Dietary and Exercise Interventions for Perimenopausal Women: A Health Status Impact Study. Front Nutr. 2022;8. doi:10.3389/fnut.2021.752500 ↩︎
Lauryn Doherty
Lauryn Doherty
Lauryn is a science correspondent for Medical News Bulletin. She graduated from Trinity College Dublin with a Bachelor of Science in Human Health and Disease. Lauryn has expertise in the fields of neuroscience and immunology, which she developed through her work as a research assistant. Her interest in scientific writing blossomed during her final year of university whilst completing her undergraduate thesis on the ‘Neuroinflammatory effects of Birth Asphyxia’. Lauryn has also worked on various medical education projects during her time as an intern. She is particularly passionate about public health and clinical epidemiology and dreams of pursuing a career in medical writing.
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