Perimenopause

Did you know that perimenopause can begin as early as your mid-30s? This natural transition phase, which occurs before menopause, has an impact on millions of women worldwide. Perimenopause brings about significant hormonal changes that can last for several years, affecting various aspects of a woman's life.

Understanding what perimenopause is and recognising its early signs is crucial for women to navigate this phase with confidence and ease. Let's explore what perimenopause is, its common symptoms, and when it typically begins. Additionally, we'll discuss the hormonal shifts that occur during this time, potential complications, and available treatment options. 

What is Perimenopause? 

Perimenopause is the natural transition phase that occurs before menopause, marking the end of a woman's reproductive years. This period typically begins in a woman's 40s. But sometimes, it can start as early as her mid-30s. During perimenopause, the body of a woman undergoes significant hormonal changes, particularly in oestrogen levels, which can rise and fall unevenly. 

The term 'perimenopause' means 'around menopause' and is also known as the menopausal transition. This phase can last for several years, varying from a few months to up to a decade. Throughout this time, women may experience a range of perimenopause symptoms similar to those associated with menopause, such as irregular periods, hot flashes, and mood changes. 

What are The Hormonal Changes during Perimenopause? 

• Fluctuations in Oestrogen Levels: During a woman's peak reproductive years, oestrogen levels rise and fall in a predictable pattern throughout the menstrual cycle. However, as women enter perimenopause, typically in their late 30s or early 40s, this balance begins to shift. 
  • In perimenopause, oestrogen levels can become erratic, sometimes spiking higher than normal or dropping sharply. As a result, women may experience irregular periods, with cycle length and menstrual flow varying significantly. 
• Less Progesterone Production: In perimenopause, progesterone hormone decreases more steadily than oestrogen. Women may experience irregular or missed periods and spotting between cycles. 
• Changes in FSH and LH: The body attempts to compensate for oestrogen and progesterone changes by increasing levels of follicle-stimulating hormone (FSH). FSH levels rise to try to stimulate the ovaries to produce more oestrogen. LH levels also fluctuate, contributing to the irregularity of ovulation. 

Symptoms of Perimenopause 

Perimenopause brings about a range of symptoms that can vary from woman to woman, such as: 

• Irregular Periods: Menstrual cycles become longer or shorter than usual. The flow may also become heavier or lighter. 
• Hot Flashes and Night Sweats: Sudden sensation of warmth accompanied by sweating & a flushed face 
• Mood changes: Irritability, depression, or anxiety 
• Vaginal Dryness: Thinning & drying of vaginal tissues. It can lead to discomfort during intercourse. 
• Decreased Libido: Low sexual desire 
• Urinary Issues: Increased frequency or urgency 
• Other Symptoms: Trouble concentrating, memory issues, headaches, joint or muscle aches, or weight gain 

Causes and Risk Factors of Perimenopause 

Several factors can determine the onset & duration of perimenopause. They are: 

• Genetics: According to some studies, up to 50% of women may experience perimenopause at a similar age to their mothers. Smoking: Women who smoke regularly enter this phase one to two years earlier than non-smokers. 

Other risk factors for early perimenopause include: 

• Cancer treatments (chemotherapy or radiation therapy) 
• Certain surgical procedures like hysterectomy or oophorectomy 
• Some health conditions, including autoimmune diseases and chromosomal abnormalities 

Complications of Perimenopause 

Perimenopause, while a natural process, can lead to several health complications, including: 

• Increased risk of osteoporosis 
• Impact on heart and blood vessel health, potentially increasing the risk of heart disease. 
• Mood disorders, such as depression and anxiety 
• Impact on sexual health, which may affect intimate relationships. 
• Increased frequency of urinary tract infections 
• Some women may experience cognitive changes during perimenopause, including difficulties with memory and concentration, often referred to as "brain fog". 

Diagnosis 

Diagnosing perimenopause can be difficult sometimes because the symptoms often overlap with other conditions. 

• Medical History: Diagnosing perimenopause is primarily based on a woman's symptoms and medical history rather than specific tests. Doctors typically make a diagnosis based on the presence of common symptoms like irregular periods, hot flashes, and mood changes. 
• Hormone Testing: 
  • Follicle-Stimulating Hormone (FSH): Elevated FSH levels can indicate the ovaries are producing less oestrogen. 
  • Oestrogen Levels: These may be checked; oestrogen levels vary throughout the cycle. 
  • Thyroid Function Test: Doctors may perform a thyroid function test to rule out conditions like hypothyroidism or hyperthyroidism. 
• Additional Tests: Sometimes, doctors may conduct other tests, including: 
  • Bone density testing 
  • Lipid profile 

Treatment for Perimenopause Symptoms 

Perimenopause treatment aims to alleviate symptoms and improve quality of life. 

• Hormone Replacement Therapy (HRT): To replace the declining hormones in the body. HRT can help with various perimenopause symptoms, including hot flashes, vaginal dryness, night sweats & mood swings. 
• Anti-depressants: Selective serotonin reuptake inhibitors (SSRIs) & other anti- depressants medicines can reduce hot flashes. 
• Vaginal Oestrogen: For those experiencing vaginal dryness, low-dose vaginal oestrogen treatments can provide relief without affecting the whole body. 

When to See a Doctor 

While some women manage perimenopause symptoms without medical intervention, others may need professional help. It's crucial to seek medical attention: 

• If symptoms interfere with your daily life or well-being 
• If you suspect you're experiencing perimenopause 

Home Remedies for Perimenopause 

Several natural or home remedies can manage perimenopause symptoms. They are: 

• Regular exercise, especially aerobic activities and strength training, can improve sleep, mood, and bone density. 
• A well-balanced diet enriched in fruits, vegetables, and calcium-rich foods like milk and kale can support bone health and help manage weight. 
• Some women find relief from hot flashes by wearing light, breathable clothing made from natural fabrics like cotton or linen. 
• Herbal supplements (red clover, black cohosh, and evening primrose oil) are sometimes used to alleviate symptoms of perimenopause. For vaginal dryness, water-based lubricants or moisturisers can provide relief. 
• Reducing caffeine and alcohol intake may help with sleep issues and hot flashes. 
• Maintaining a cool bedroom environment can improve comfort during night sweats. 
• Some women find aromatherapy massage helpful for relaxation and symptom management. 

Prevention 

While perimenopause is a natural process that can't be entirely prevented, certain healthy lifestyle choices can manage symptoms and promote overall health during this transition. 

• Consuming 1,000 to 1,200 mg of calcium daily through diet or supplements can maintain strong bones. 
• Regular exercise, such as aerobic activities, & strength training, can improve sleep, mood, and bone density. 
• Identifying and avoiding triggers for hot flashes can be helpful. Some women find that alcohol, caffeine, or spicy foods can bring on these uncomfortable episodes. Keeping a record of potential triggers can help pinpoint personal sensitivities. 
• A study led by Leeds University found that a diet rich in legumes and fish might delay the natural onset of menopause, while foods high in carbohydrates may accelerate it. Each daily portion of fish and fresh legumes was associated with a delay of over three years in menopause onset. 

Conclusion 

Perimenopause is a natural and significant phase in a woman's life that brings about various changes. Understanding these changes and their effects on physical and emotional well-being can help women navigate this transition more easily. From irregular periods to mood swings, the symptoms of perimenopause can have an impact on daily life, but there are many ways to manage them effectively. 

While perimenopause can't be prevented, adopting a healthy lifestyle can make a big difference in how women experience this phase. Eating a balanced diet, exercising regularly, and seeking medical advice when needed are key steps to take. Remember, every woman's experience with perimenopause is unique, and what works for one may not work for another. By staying informed & proactive about their health, women can welcome this new phase of life with confidence and vitality. 

FAQS 

1. How long does perimenopause last? 

Perimenopause can last from a few months to over a decade. Typically, it lasts between four to eight years. The duration varies significantly, with some experiencing a shorter transition while others having a longer journey. 

2. Does perimenopause affect my sleep? 

Yes, perimenopause can significantly impact sleep patterns. Up to 57% of women report sleep disturbances during this time. Night sweats, a common symptom of perimenopause, can disrupt sleep by causing frequent awakenings. Additionally, hormonal changes can affect sleep quality, leading to insomnia or difficulty staying asleep. 

3. At what age does perimenopause start? 

Perimenopause typically begins in a woman's 40s, but it can begin in the mid-30s. The average age for the onset of perimenopause is between 45 and 47 years old. However, it's important to note that every woman's experience is unique, and the timing can vary significantly. 

4. Can I get pregnant in the perimenopausal stage? 

Yes, it's possible to get pregnant during perimenopause. Although fertility declines during this time, ovulation can still occur, albeit less regularly. Until you've gone 12 consecutive months without a period (which marks the inception of menopause), there's still a chance of conception. 

5. What not to eat during perimenopause? 

During perimenopause, it's advisable to limit certain foods that may exacerbate symptoms. These include: 

• Processed carbohydrates, which can destabilise blood glucose levels 
• Spicy foods, which may trigger hot flashes in some women 
• Alcohol, which can disrupt sleep and potentially worsen symptoms 
• Caffeine, which can interfere with sleep 

6. What is the difference between premenopause and perimenopause? 

Premenopause refers to the entire reproductive period before menopause, while perimenopause specifically denotes the transitional phase leading up to menopause. During pre-menopause, women have regular menstrual cycles and no menopausal symptoms. Perimenopause, on the other hand, is characterised by hormonal fluctuations, irregular periods, and the onset of menopausal symptoms such as hot flashes & mood changes. 

Dr. Neha V Bhargava

MS, DNB (obgyn), MNAMS, Fellow (Gynae Oncology)
Ganga CARE Hospital Limited, Nagpur

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