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Guide to Menopause
|What Is Perimenopause?
Perimenopause (also known as pre-menopause) is the transition journey a woman's body takes between regular ovulation and menstruation towards menopause. Menopause is reached when a woman has missed periods for 12 consecutive months. When perimenopause starts, hormones (estrogen and progesterone) begin to fluctuate and periods become unpredictable. This transition stage can last 5 to 10 years depending on the woman. In fact there is some debate as to whether this phase deserves its own label, some scientists think it should just be called the first phase of menopause.
When Does It Begin?
While the signs of approaching menopause do not usually start before women reach their early 40s, some signs of menopause such as irregular periods, can start as early as the mid 30s. This is one of the reasons why pregnancy after 35 can be more difficult. However some cynics suggest that the only people who benefit from extending the menopause 'label' to this vague perimenopause period are the drug companies who can now market their products to younger women. See also, What is considered middle aged?
Can I Test For It?
Perimenopause is a gradual process and there is no one menopause test or sign that indicates when a woman has begun the transition. If you ask your doctor for a diagnosis they are likely to take several factors into consideration including your age, family and menstruation history and symptoms. They may even order a blood test to check for hormone levels. These tests can check estrogen, follicle stimulating hormone (FSH) or luteinizing hormone (LH) levels.
What Are the Symptoms?
During early perimenopause, subtle changes start to occur in the body which gradually over time, become more obvious. A woman may experience some or all of the symptoms below, many of which often extend into postmenopause. The most common symptoms are:
As ovulation becomes more erratic, so do periods. The menstrual cycle can shorten which means periods last less long and sometimes become heavier. Gradually a woman may begin to miss periods altogether. Late perimenopause is characterized by two missed periods and an interval of at least 60 days between menstrual flows. Gradually periods become infrequent and may be replaced by spotting before stopping altogether.
Premenstrual Syndrome (PMS)
Some women find that PMS symptoms become worse, while other women experience them for the first time.
Hot flashes & Hot Flushes
As hormone levels decline, hot flashes and flushes become more common, particularly during late perimenopause (and extending into postmenopause). Hot flushes are a sudden feeling of warmth. If the body reacts by becoming red or sweating, this is known as a hot flush. Hot flashes or night sweats can lead to sleep deprivation which in turn causes depression and irritability.
Vaginal dryness (atrophy)
As estrogen levels decline, vaginal dryness becomes a more common problem after periods stop (menopause), but it can begin in perimenopause. Vaginal tissues are highly sensitive to estrogen levels and become thin and dry as hormones decline. This can lead to painful sexual intercourse and urinary tract infections. It is also linked to low libido problems in menopause.
Reduction in Fertility
As ovulation becomes irregular the ability to conceive declines. A woman's fertility is slowly in decline in her early 30s. This becomes much more substantial in the late 30s and early 40s. Very few women are still fertile after 44.
Mood Changes: Hormone changes can cause mood swings, irritability and increased risks of suffering from menopause depression. Some women find losing weight becomes more difficult than it used to be. See weight gain during menopause.
As soon as estrogen levels decline osteoporosis risk factors and the risk of heart disease in women increase. This tends to be more of a problem after menopause however when estrogen levels remain low long-term.
Is your skin extra dry? See menopause skin problems, or check out our list of recommended books on menopause for some useful guides.
How Is It Treated?
As symptoms usually occur gradually a woman may not realize she has started perimenopause and may seek treatment for seemingly unrelated problems, such as heavy periods. On the other hand, other women experience very subtle symptoms which may not even warrant attention. For those that do experience symptoms which interfere with their lifestyle, such as mood swings and hot flashes, it is worth talking to their doctor. Possible treatment options include:
Even if you do not require them for birth control, low dose oral contraceptives (the pill) are good for regulating hormone levels. This can help regulate menstruation, reduce hot flashes and delay vaginal dryness. Read also, is it safe to take the contraceptive pill after 35?
A man-made version of progesterone, progestins are used to help regulate painful periods and heavy periods. The most popular form is an intrauterine device (IUD) such as Mirena. IUDs are also used to alleviate symptoms of chronic pelvic pain, endometriosis and anemia.
Endometrial ablation is a treatment for heavy bleeding. During this procedure a laser destroys a thin layer of the lining of the uterus (womb). This effectively stops menstrual flow in many women. The procedure is not right for everyone, particularly women who are still hoping for pregnancy.
Many women find that perimenopause symptoms can be alleviated naturally by following a healthy diet, exercising regularly and practicing relaxation techniques such as meditation and yoga. It is worth reading PMS Treatment for some more tips.
When Do I Need To See A Doctor?
Some women seek a doctor’s advice because they want to know if perimenopause has begun. This is a particularly important question if pregnancy is still desired. Other women seek medical attention because symptoms are so severe they interfere with daily life. If bleeding is more frequent that every 21 days or lasts more than 8 days, seek medical attention. This is not a normal symptom of perimenopause and could indicate either endometrial cancer or cervical cancer.
Can Anything Cause Perimenopause To Start Early?
Perimenopause and indeed menopause is a normal part of life, and not something to prevent. However, there are some indications that certain factors may predispose a woman to start menopause at an earlier age. Those factors are:
Family History: Women tend to experience perimenopause around the same time as their mother or sisters, so look to your family history as an indication of what to expect.
Smoking: Studies show that menopause occurs 2 years earlier in women who smoke compared to those who do not.
No Children: A woman who has never given birth may be more likely to start menopause earlier.
Hysterectomy: A hysterectomy which removes the uterus but not the ovaries does not normally induce menopause earlier (as estrogen is still produced). Where the ovaries are removed, premature menopause is induced.
Is Birth Control Still Necessary?
Most doctors recommend taking some birth control method, if pregnancy is not desired until menopause. That is, when periods have stopped for 12 months. In practice however, pregnancy after 44 without the aid of infertility treatment is highly uncommon.