What is Perimenopause?

by Dr. Joy’El Ballard

Most patients who come to me have heard of menopause but have never heard of perimenopause before and, because there is so little education about this stage of a woman’s life, most women don’t know about perimenopause until they’ve entered it. So, what the hell is perimenopause?! The term “peri” means “around” so perimenopause refers to the changes that occur as reproductive hormones start to fluctuate during the years leading up to a woman entering menopause. Perimenopause is the transition from a woman’s reproductive years to the non-reproductive phase of life when the amount of estrogen — the main female hormone — starts to rise and fall haphazardly. Perimenopause can start as early as your late 30s but the average age is around 45. Perimenopause is not the same as “premenopause,” in fact, most OB/GYNs rarely use the term to describe the stage before menopause, we just refer to it as the reproductive years, it precedes menopause.

Menopause is the start of the non-reproductive years and is defined by the absence of a menstrual cycle or any type of bleeding for 12 consecutive months. If you don’t bleed for 11 months then have a period, you have to start the countdown again. So if you are still having some sort of bleed or period, you are perimenopausal. The average age of full-stop menopause is 52. By this time, estrogen has declined to extremely low amounts.

How do I know if I’m experiencing perimenopause?

Perimenopause can look different for every woman but it’s usually characterized by changes in menstrual cycles and/or the start of menopausal symptoms. The change in menstrual cycles is basically any change in your normal flow, frequency, or associated symptoms. Your period flow could be heavier or lighter. Your cycle can start to skip a month or come twice a month. You may have more cramps or worsening premenstrual symptoms (PMS) like bloating, breast tenderness, or mood swings. Consult your physician if your period is heavier than your normal flow — particularly if you’re soaking through pads and/or your period is causing fatigue.

Common signs and symptoms of perimenopause are:

• Hot flashes or night sweats
• Mood swings or irritability and this can include crying for no reason and/or angry outbursts
• Brain fog, poor concentration
• New anxiety or depression or recurrence of previous anxiety or depression
• Vaginal dryness
• Pain with sex
• Bladder leakage or irritation
• Decrease in libido or sexual desire
• Dry skin or “creepy crawling” sensation
• New or increased acne breakouts
• Fatigue
• Insomnia or difficulty sleeping
• Weight gain, especially around the midsection
• Hair loss or thinning
• Joint pain

Yes, I know, fun times ahead!! There are some women who may only experience a few of these symptoms, others may get many of them and some get lucky and don’t get any! Each woman can have their own unique response to “the change.” Some may experience symptoms similar to the way their moms experienced them but this is not always the case. Any symptom that affects your quality of life is worth discussing with your healthcare provider to determine what options are available to improve your symptoms. Vaginal symptoms, especially, should be addressed early because these symptoms can worsen if ignored.

Let’s review the terminology and timeline of this stage in a woman’s life.

Premature or early menopause refers to menopause that occurs at the age of 40 or younger. It occurs in approximately 1% of women in the United States. Premature menopause can be caused by medical treatments like chemotherapy or radiation or by surgery with the removal of ovaries. It can also be spontaneous or an unknown cause. Other factors that can lead to premature menopause are genetic conditions like Turner Syndrome or Fragile X syndrome; autoimmune disorders like thyroiditis; or a family history of early menopause. Primary ovarian insufficiency (POI),formerly known as premature ovarian failure (POF), can also lead to premature menopause because it is characterized by transient or permanent loss of ovarian function in women younger than 40.

Perimenopause is the transitional period until menopause begins. This transition is when reproductive hormones are fluctuating which can last an average of 2–8 years. Some may even say that they feel “like a teenager again,” because the hormones are on a roller coaster. It can start as early as the late 30s when women notice menstrual irregularities and menopausal symptoms stated above. Women can still get pregnant during this phase. If menopause is medically or surgically induced, for example, by surgical removal of the ovaries, a woman would skip this transition period and go straight into menopause.

Menopause is a natural physiologic process, not a disease. It is defined by the final menstrual period and the loss of ovarian function. Post-menopause, your body will experience a permanent decline in production of the hormones estrogen and progesterone. Women also produce the male hormone, testosterone, and its level also declines during menopause but at a slower rate compared to estrogen. Menopausal symptoms are the result of the decline of these hormones. Menopause can occur spontaneously any time between the ages of 40 and 58, a small percentage of women will start at 60 but the average age is 52 years old. Women can no longer get pregnant spontaneously after menopause starts.

Postmenopause starts the year after menopause and lasts for the rest of a woman’s life. Menopausal symptoms start to improve or even resolve at this phase. There is a risk of high blood pressure, increase in “bad” cholesterol and osteoporosis (or bone loss). Therefore, it is important to be proactive starting in your perimenopausal phase by eating healthy, exercising regularly (including strength training), and avoid smoking.

The perimenopause into menopause transition is a natural (although it doesn’t feel natural), physiologic process that women experience as they age. I encourage you to listen to your body, have an open and honest conversation with your healthcare provider about your symptoms and if any of your symptoms are affecting your overall well-being or quality of life, discuss them with your physician to determine the best treatment plan for you.

The information provided on StateOfMenopause.com is not intended and should not be construed as medical advice, treatment, or diagnosis. Always seek the guidance of a qualified healthcare provider with any questions or concerns regarding your health.