Perimenopause

Perimenopause

Alternate Names

  • premenopause

Definition

Perimenopause refers to the time just before menopause, that is, before a woman stops menstruating completely.

What is going on in the body?

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.

Risks

What are the causes and risks of the condition?

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.

Prevention

What can be done to prevent the condition?

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.

Diagnosed

How is the condition diagnosed?

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.

Long Term Effects

What are the long-term effects 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.

Other Risks

What are the risks to others?

Perimenopause poses no risks to others.

Treatments

What are the treatments for the condition?

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

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the condition?

Most symptoms of perimenopause go away after menstruation ceases.

Monitor

How is the condition monitored?

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.

Sources

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

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