What is perimenopause?

Perimenopause refers to the transitional period of time before menstruation actually stops, which is marked by changes in the menstrual cycle, along with other physical and emotional symptoms. Perimenopause can actually last up to 10 years and during this time the following processes are occurring within a woman's body:

• ovaries release eggs less regularly
• ovaries gradually produce less estrogen and other hormones
• fertility decreases
• menstrual cycles shorten, there are fewer ovulations, and more cycle irregularity
• circulating levels of estrogens and progesterone are markedly reduced
• androgen (androstenedione) is reduced
• testosterone decreases

What causes perimenopause and perimenopausal symptoms?

Perimenopause is caused by the declining function of the ovaries. Ovulation may become erratic and then stop altogether. The menstrual cycle length and flow may become irregular as much as 10 years before the final menses (last menstrual period).

Q: "I am 44 years old and starting to think I’m going crazy. I have three school-aged children and work full-time, so, granted, I am under a great deal of stress. The last six months I’ve had a few irregular menstrual cycles where I’m two weeks late for my period, and my PMS symptoms, which used to be quite mild, are worse than ever - coupled by severe mood swings. Also, I feel my level of concentration diminishing and I'm forgetting things I should not be forgetting. I hear a lot about these things happening as a woman gets closer to menopause, but my mother says I’m a little young for this. What could be going on?" A: Menopause actually occurs when a woman permanently stops having menstrual periods. The transitional period of time before menstruation completely stops is referred to as perimenopause. During this period of time there are great fluctuations in hormones, which can produce many of the same symptoms you are experiencing. Many women think they are too young to be going through perimenopause, but, while perimenopause generally starts between one and six years before menopause, it can actually start up to 10 years before menopause. And, with the average age of menopause being 51 years of age, that starting age for perimenopause could be as young as 41 years old. It is important to describe all of your symptoms to your physician. He or she may even have you chart a few cycles and keep track of your symptoms. Your physician will also recommend ways to relieve your symptoms and help you through the transitional years of perimenopause with as little discomfort and disruption as possible. The symptoms of perimenopause may resemble other medical conditions. Always consult your physician for a diagnosis.

As fluctuations of hormones occur, symptoms result from the changing levels of estrogen and progesterone in the body and may trigger symptoms similar to premenstrual syndrome (PMS). At other times, the estrogen levels may decrease, which may trigger hot flashes or night sweats. This fluctuation of estrogen levels may be interspersed with normal menstrual cycles during perimenopause. Research studies demonstrate that perimenopausal women show varying patterns of hormonal fluctuations. No two women will experience perimenopause in the same way.

What are the symptoms of perimenopause?

The following are the most common symptoms of perimenopause. However, each woman may experience symptoms differently. Symptoms may include:

• hot flashes
• abnormal bleeding
• mood changes
• changes in sexual desire
• difficulty in concentrating
• headaches
• night sweats
• vaginal dryness
• sleep disturbances
• joint and muscle aches
• extreme sweating
• frequent urination
• similar symptoms as experienced with premenstrual syndrome (PMS)

The symptoms of perimenopause may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for perimenopause:

Specific treatment for perimenopause will be determined by your physician based on:

• your age, overall health, and medical history
• current symptoms
• your tolerance for specific medications, procedures, or therapies
• your opinion or preference
• your desire for fertility

More and more physicians are treating perimenopausal symptoms. These treatments may include:

• low-dose birth control pills (to keep hormone levels more constant)
  
  
• antidepressants (to stabilize mood swings)
  
  
• progesterone (to treat abnormal bleeding patterns)

Other lifestyle changes your physician may recommend include the following:

• Add soy and flax to your diet.
  
  
• Exercise regularly.
  
  
• Take vitamin E.

• Identify what triggers hot flashes (i.e., coffee, tea, etc.) by keeping a diary or record - to help reduce their likelihood.
  
  
• Discuss other herbal treatments such as ginkgo biloba, Evening Primrose Oil, and black cohosh (which may have some effectiveness in relieving certain symptoms), with your physician.

Some of the same suggestions used for coping with hot flashes in menopausal women may also be helpful for perimenopausal women. Consult your physician for more information.