Perimenopause refers to the time just before menopause, that is, before a woman stops menstruating completely.
Estrogen levels decrease during perimenopause. The levels gradually decline until a woman stops menstruating for twelve consecutive months. Until then, a woman is in perimenopause.
Egg production by the ovaries is falling, and estrogen is also diminishing. The production of progesterone also decreases, especially if a woman is no longer ovulating. These hormonal fluctuations vary from woman to woman. Both the amount of hormone produced and the timing of the decline can vary.
The symptoms vary from woman to woman. Only 30% of women see a healthcare professional about symptoms of perimenopause. The rest either have no severe symptoms, or they get used to them. Some women may have hot flashes, sweats, irritability, insomnia, vaginal dryness, depression and short-term memory changes.
About 90% of women have changes in menstruation. It is not unusual to start, stop and then restart the menstrual flow. The amount of bleeding may increase or decrease. Periods may become longer or shorter and happen more or less often. Some women have severe symptoms. Others have mild or no symptoms. Fertility decreases, but women can still get pregnant. A woman who does not wish to get pregnant needs to use birth control.
About 60% of women have hot flashes. A hot flash usually comes on suddenly. It feels like heat in the upper body or even the whole body. The woman's upper body or face often turns red or gets red blotches. She may sweat and then shiver as her body returns to a normal temperature.
Hot flashes can happen at any time, day or night. The hot flash may last only seconds, or it may last up to half an hour. Hot flashes are a result of decreasing estrogen levels and the subsequent effect on the autonomic nervous system. As estrogen levels decline, the body releases other hormones. These can cause the fluctuations in body temperature.
As women get closer to menopause, the risks of osteoporosis, or bone thinning, and heart disease increase. Lower estrogen levels may be part of the reason that these risks increase.
There is no prevention for perimenopause. All women who live long enough will go through either a natural or surgical menopause. Women who, for one reason or another, have surgery that removes their reproductive organs earlier in life may not experience perimenopause but enter immediately into menopause.
Diagnosis of perimenopause is usually made by looking at the woman's medical history and supporting symptoms. A blood test can confirm drops in estrogen levels, but is not considered diagnostic of the condition.
The long-term effects of perimenopause may depend on any treatments. All hormone therapies have side effects and risks of their own.
Perimenopause poses no risks to others.
The most common treatment for perimenopause involves the use of oral birth control pills or hormone therapy. The low-dose pills that are available today regulate menstrual flow and frequency. They also can eliminate or reduce hot flashes, vaginal dryness, and emotional and physical symptoms of the perimemopause.
Dietary changes may also help. Women in perimenopause will benefit from a diet high in calcium, low in fat, and rich in fruits, vegetables, and whole grains. This healthful diet helps prevent osteoporosis, heart disease, and some cancers. It may also help reduce symptoms of perimenopause.
Exercise helps control weight, improve sleep, and keep bones strong. Exercise also helps with mood swings. Thirty minutes of exercise on most, if not all, days is recommended for everyone.
Side effects of HT can include headaches, bloating, and irritability. Long-term use of hormone therapy may increase the number of women who get breast cancer. If a woman has a family history of breast cancer, she should consider the risks of estrogen/progestin therapy. Women who are at higher risk of developing blood clots may also be unable to use hormone therapy.
The American Heart Association recently issued recommendations about hormone therapy (HT) in women. For women who have already had a heart attack or have heart disease, it appears that HT does not protect against having another heart attack or dying from heart disease. The studies that support this information were done with women over 65 years of age. It is unclear if this information also holds true for younger postmenopausal women who take HT.
For women who have not already had a heart attack or who do not have heart disease, HT should not be started for the sole purpose of preventing heart disease because the research is not strong enough to support doing that at this time. Also, it is not necessary for a woman to stop HT if she is doing well on it.
Overall, the decision to use HT should be based upon the proven benefits and risks of HT. A woman should discuss the benefits and risks with her healthcare professional. Together, they can choose the most appropriate course of action.
Most symptoms of perimenopause go away after menstruation ceases.
A woman's progression through menopause is monitored in regular health maintenance exams, which include pelvic and breast exams and Pap smears. Any new or worsening symptoms should be reported to the healthcare professional.
Menopause, National Institute of Aging
Age Page: Hormone Replacement Therapy, National Institute of Aging
Taber's Cyclopedic Medical Dictionary
Perimenopause: A period before your period ends, Mayo Clinic Health Letters, [hyperLink url="http://www.mayohealth.org" linkTitle="www.mayohealth.org"]www.mayohealth.org[/hyperLink]. 1999
Physical Activity and Cardiovascular Health, NIH Consensus Statement, 1995