A Perimenopause Primer

Have you started to notice irregular periods, mood swings, hot flashes, or trouble falling asleep? You could be entering perimenopause.

Perimenopause, or menopause transition, is the stage of a woman’s reproductive life in which her ovaries gradually begin to produce less estrogen. While it may begin as soon as her early 30s, most women notice the signs of perimenopause sometime between their mid-40s to mid-50s. The average length of perimenopause is four years, but it varies: For some women this stage may last only a few months, for others it can continue for up to ten years.

During the last one to two years of perimenopause, the decline in estrogen accelerates. In medical terms, a woman officially reaches menopause when she goes 12 consecutive months without menstruating.

Perimenopause is a process, a gradual transition that signifies the beginning of a new stage in life. For many women, the postmenopausal years offer a wonderful new world of sexuality and physical confidence. But the unknown is scary and the realization of advancing age, decreasing fertility, and some unpleasant physical side effects can take an emotional toll.

Symptoms:
The symptoms of perimenopause are very similar to the symptoms of menopause. According to the Mayo Clinic, some things you might experience include:

• Irregular periods
• Hot flashes
• Decreased libido
• Mood swings
• Changes in urination/urination leakage
• Sleeplessness

Significance:
Even though the transformation may be subtle, perimenopause can be difficult for women as they begin to grasp the physical and emotional changes that accompany menopause, including irregular periods and declining fertility. (It’s important to remember that as long as you're having periods, pregnancy remains a possibility. If you wish to avoid pregnancy, use birth control until you go 12 consecutive months without having a period.)

In addition, many women experience changes in sexual function, including changes in desire and arousal. While this can impact their sexual experiences, most women who had satisfactory sexual intimacy before menopause will continue to have it after.

What to Do:
Though we may not all share the same symptoms or even the severity of them, we all share the desire to lessen our discomfort. By monitoring your menstrual cycles and recording your signs and symptoms for several months, you'll gain a better understanding of the changes occurring during perimenopause.

If you do experience symptoms that interfere with your life or well-being, such as hot flashes, mood swings, or changes in sexual function that concern you, see your doctor. Possible therapies to treat perimenopausal symptoms include:

• Progestin therapy. If you have irregular periods, but you can’t — or choose not to — use oral contraceptives, cyclic progestin therapy may regulate your periods. Some women with heavy bleeding during perimenopause may find relief from a progestin-containing intrauterine device (IUD).
• Endometrial ablation. Endometrial ablation may provide relief from the heavy bleeding some women experience during perimenopause. During the procedure, the lining of the uterus (endometrium) is destroyed using a laser, electrical energy, or heat, which effectively reduces menstrual flow or ends menstruation. This procedure isn’t the right choice for everyone, so talk with your doctor about what is best for you.

Making healthy lifestyle choices is a valuable prescription no matter your stage of life and may help ease some of the symptoms of perimenopause. Good nutrition, regular exercise, and stress-reduction techniques including yoga and meditation serve as the first line of defense to keep the perimenopausal symptoms from negatively impacting your life.