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What Is Perimenopause?
The process of menopause begins with perimenopause, which literally means “around menopause.” Perimenopause lasts four years on average, but its duration varies widely, from as short as a few months to as long as 10 years or so. It’s difficult to predict this
duration, but generally, the later perimenopause begins, the shorter it’s likely to be. During perimenopause, changes in your ovaries lead to changes all over your body.
Changes in the Ovaries
Your ovaries store hundreds of thousands of microscopic seeds that, over time, grow into follicles, the sacs that hold and
release your eggs. Follicles also produce several hormones, including two kinds of
estrogen. As a child, estrogen helps your reproductive organs develop; after puberty,
it triggers ovulation once a month.
During your teenage years, your ovaries hold hundreds of thousands of eggs. As you age, the number of eggs decreases steadily, as hundreds of them are used for ovulation and others simply disintegrate. As a result,
the number of follicles drops rapidly as you enter your forties and fifties. Only a few hundred to a few thousand remain; as a result, hormone production slows, and perimenopause begins.
Changes in Hormones
Hormone changes occur gradually but erratically during perimenopause. These changes affect not only hormones produced by the ovaries but also hormones produced by the pituitary gland, which is located at the base of the brain. The affected hormones include the following:
Hormone |
Where It’s Produced |
What It Is/What It Does |
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Estradiol |
Ovaries |
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Estrone |
Ovaries |
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Progesterone |
Ovaries |
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Testosterone |
Ovaries |
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FSH (follicle-stimulating hormone) |
Pituitary gland |
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LH (luteinizing hormone) |
Pituitary gland |
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Changes in Fertility
Perimenopause also impacts fertility. As menopause nears and the number of follicles in the ovaries drops, fertility decreases. However, perimenopausal women can still become pregnant. If you’re sexually active and don’t desire pregnancy, you must continue to use contraception throughout perimenopause.
Changes in Menstruation
A change in your period might be the first noticeable indication that you’re entering perimenopause. Changing hormone levels greatly affect your menstrual periods—during perimenopause, estrogen production suddenly rises and then falls just as quickly. As a result of fluctuating hormones, you might experience the following:
- Missed period(s)
- More frequent periods
- Heavier or lighter menstrual flow
- Bleeding between cycles
In a way, perimenopause is like reverse puberty. In both phases of your life, your periods are erratic and unpredictable. Though irregular periods are perfectly natural, it’s important to keep an eye out for abnormal bleeding during perimenopause, which could be the sign of a more serious medical problem. Some things to watch for include:
- Extremely heavy flow
- Bleeding after sexual intercourse
- Bleeding more often than every 21 days
- Blood clots during menstruation
- Periods that last more than seven days, or two days longer than usual
If any of these changes occur, you should contact your
doctor immediately.
Symptoms of Perimenopause
Because your hormones start to change during perimenopause, it’s common to experience a variety of different symptoms, both physical and emotional. These symptoms vary widely for different women.
Hot Flashes
Hot flashes are the most common symptom that perimenopausal women report. The exact cause of hot flashes during perimenopause is still not definitively known. Some theorize that fluctuating estrogen levels are to blame, whereas others point to changes in the hypothalamus. Hot flashes may occur at any time of day or night. Night sweats are hot flashes that occur wile you sleep.
Hot flashes that include reddening skin, particularly in the upper body, are also known as hot flushes. Other symptoms of hot flashes include:
- Heart palpitations
- Dizziness
- Reddening skin
- Perspiration
- Faintness
- Weakness
- Chills
Though some women can sense when a hot flash is about to occur, most women experience it without warning. Generally, you’ll start to cool off after a few minutes, but for some women, a hot flash can last as long as a half hour.
Though hot flashes are normal, they can also be the sign of other medical problems, including thyroid disease, epilepsy, and leukemia. It’s important to consult a doctor if one of the following occurs:
- Hot flashes happen so frequently that they interrupt your life.
- You lose weight rapidly.
- Your hot flashes don’t respond to lifestyle changes, such as regular exercise.
Triggers
Hot flashes are often brought on by specific triggers. Common triggers include:
- Alcohol
- Caffeine
- Spicy foods
- Stress
- Warm weather
In addition, women who smoke are more likely to experience hot flashes than women who don’t.
How to Cope With Hot Flashes
Besides avoiding triggers, there are a few things you can do to help relieve hot flashes:
- Wear lighter clothing.
- Dress in layers, so that you can remove a layer when a hot flash occurs.
- Drink lots of cool water.
- Exercise regularly.
- Keep a fan beside your bed at night.
- Turn down the thermostat.
- Take slow, deep breaths when a hot flash occurs.
- If you smoke, quit.
You can also keep supplies handy to help deal with the aftereffects of hot flashes. Some things to carry in a handbag or store in a desk drawer include:
- Moist towelettes
- Spare bra or top
- Small bottle of perfume or scented lotion
- Plastic bag to store wet clothing
Other Symptoms During Perimenopause
In addition to hot flashes, you may experience a variety of other symptoms such as the following:
- Migraines: Some women are particularly sensitive to hormonal changes, and as a result, they experience migraines during perimenopause. These severe headaches can be unpredictable, just as estrogen levels are unpredictable.
- Reduced bladder control: Estradiol, the active form of estrogen, helps keep the bladder healthy. As estrogen levels drop, the bladder may weaken, which can lead to incontinence.
- Vaginal dryness: Low estrogen levels can dry out or shrink vaginal tissue, resulting in a feeling of dryness and/or making sexual intercourse painful or uncomfortable.
- Changes in appearance: Low estrogen levels can affect your skin, hair, and weight. You may notice that your skin feels less firm and that you have new wrinkles. Your hair may become drier and thinner, but you may notice new hair growing on your chest, chin, and upper lip. Many women gain some weight during perimenopause, especially near their waists.
- Mood swings: Though no one can say with absolute certainty what causes mood swings during perimenopause, many believe it has to do with the erratic fluctuation of hormones or a drop in estrogen levels.
- Sleep problems: Estradiol also affects the production of serotonin, a neurotransmitter that sends signals from one nerve cell to another. Serotonin helps regulate sleep. Dropping estrogen levels result in a drop in serotonin, which can lead to insomnia. In addition, hot flashes can keep you up at night. For more information on insomnia, see the Quamut guide to Sleep & Sleep Disorders.
- Forgetfulness and lack of focus: Many women complain of forgetfulness, or “fuzzy thinking,” during perimenopause. Again, no one can say for sure what causes this symptom, but it may have to do with changing hormones. This kind of memory loss is not severe, however—you might just forget an occasional thought in the middle of a sentence or misplace your keys. For some women, this symptom subsides as they enter the menopausal stage.
These symptoms of perimenopause are perfectly normal and natural. Not every woman will experience each one of them: women respond to hormonal changes differently, so symptoms can vary greatly from woman to woman.
Health Risks During Perimenopause
Changing hormone levels can also affect your long-term health. Reduced amounts of estrogen that women start experiencing during this time can have other long-term
effects, including:
- Osteoporosis
- Increased risk of heart disease
Again, the risks vary from woman to woman. It’s important to consult your doctor to understand possible treatments and ways to protect yourself as your body changes.
| Acknowledgments & Disclaimer |
