Perimenopause

What is Perimenopause

Perimenopause is the normal time of life before and after menstrual periods stop completely (menopause). Perimenopause can begin 2–8 years before menopause, and it usually lasts for 1 year after menopause. During perimenopause, the ovaries may or may not produce an egg.

4 Interesting Facts of Perimenopause

1. Hormonal changes culminating in cessation of menses
2. Cutaneous flushing is a hallmark feature, as with carcinoid syndrome
3. Presence of sweating, insomnia, irregular menses, mood changes, and vaginal dryness may help distinguish menopause from carcinoid syndrome
4. Differentiated by patient history (age and change in regularity of menses), elevated levels of follicle-stimulating hormone and luteinizing hormone, and decreased level of estradiol

What are the causes?

This condition is caused by a natural change in hormone levels that happens as you get older.

What increases the risk?

This condition is more likely to start at an earlier age if you have certain medical conditions or treatments, including:

• A tumor of the pituitary gland in the brain.
• A disease that affects the ovaries and hormone production.
• Radiation treatment for cancer.
• Certain cancer treatments, such as chemotherapy or hormone (anti-estrogen) therapy.
• Heavy smoking and excessive alcohol use.
• Family history of early menopause.

What are the symptoms?

Perimenopausal changes affect each woman differently. Symptoms of this condition may include:

• Hot flashes.
• Night sweats.
• Irregular menstrual periods.
• Decreased sex drive.
• Vaginal dryness.
• Headaches.
• Mood swings.
• Depression.
• Memory problems or trouble concentrating.
• Irritability.
• Tiredness.
• Weight gain.
• Anxiety.
• Trouble getting pregnant.

How is this diagnosed?

This condition is diagnosed based on your medical history, a physical exam, your age, your menstrual history, and your symptoms. Hormone tests may also be done.

How is this treated?

In some cases, no treatment is needed. You and your health care provider should make a decision together about whether treatment is necessary. Treatment will be based on your individual condition and preferences. Various treatments are available, such as:

• Menopausal hormone therapy (MHT).
• Medicines to treat specific symptoms.
• Acupuncture.
• Vitamin or herbal supplements.

Before starting treatment, make sure to let your health care provider know if you have a personal or family history of:

• Heart disease.
• Breast cancer.
• Blood clots.
• Diabetes.
• Osteoporosis.

Follow these instructions at home:

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Eat a balanced diet that includes fresh fruits and vegetables, whole grains, soybeans, eggs, lean meat, and low-fat dairy.
• Get at least 30 minutes of physical activity on 5 or more days each week.
• Avoid alcoholic and caffeinated beverages, as well as spicy foods. This may help prevent hot flashes.
• Get 7–8 hours of sleep each night.
• Dress in layers that can be removed to help you manage hot flashes.
• Find ways to manage stress, such as deep breathing, meditation, or journaling.

General instructions

• Keep track of your menstrual periods, including:
  • When they occur.
  • How heavy they are and how long they last.
  • How much time passes between periods.
• Keep track of your symptoms, noting when they start, how often you have them, and how long they last.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take vitamin supplements only as told by your health care provider. These may include calcium, vitamin E, and vitamin D.
• Use vaginal lubricants or moisturizers to help with vaginal dryness and improve comfort during sex.
• Talk with your health care provider before starting any herbal supplements.
• Keep all follow-up visits as told by your health care provider. This is important. This includes any group therapy or counseling.

Contact a health care provider if:

• You have heavy vaginal bleeding or pass blood clots.
• Your period lasts more than 2 days longer than normal.
• Your periods are recurring sooner than 21 days.
• You bleed after having sex.

Get help right away if:

• You have chest pain, trouble breathing, or trouble talking.
• You have severe depression.
• You have pain when you urinate.
• You have severe headaches.
• You have vision problems.

Summary

• Perimenopause is the time when a woman’s body begins to move into menopause. This may happen naturally or as a result of other health problems or medical treatments.
• Perimenopause can begin 2–8 years before menopause, and it usually lasts for 1 year after menopause.
• Perimenopausal symptoms can be managed through medicines, lifestyle changes, and complementary therapies such as acupuncture.