Perimenopause: The change before the change

Perimenopause, or “menopause transition,” refers to the time leading up to the cessation of menstruation when estrogen production slows down.

It usually starts in a woman’s 40s, but can start in the 30s as well. It is a gradual process that can begin eight years before menopause (the point when the ovaries stop releasing eggs), or it may last only a few months. The average length is usually four years.

In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many women can experience menopause symptoms. Women are still having menstrual cycles during this time and can get pregnant.

The transition into menopause varies greatly from one woman to the next. Some women sail through this period, but some aren’t so lucky. In fact, so wild and unpredictable are some of the symptoms, a lot of women think they are losing control and going crazy.

It can also be difficult to distinguish the hormonally-based symptoms of perimenopause from more general changes due to aging or common midlife events such as children leaving home, later-in-life pregnancy, changes in relationships or careers or the death or illness of parents.

Symptoms

Perimenopause is usually characterized by irregular menstrual cycles and marked hormonal fluctuations. The most common symptom is hot flashes, which occur in up to 80 percent of women in some cultures.

Women can also experience some or all of the following symptoms:

▪ Weight gain

▪ Night sweats

▪ Vaginal dryness

▪ Difficulty sleeping

▪ Emotional changes (irritability, mood swings, mild depression, anxiety)

▪ Racing heart

▪ Headaches

▪ Joint aches

▪ Change in libido (sex drive)

▪ Difficulty concentrating

▪ Memory problems

▪ Hair loss or thinning

Treatment

There are plenty of treatment options available for perimenopause symptoms.

For hot flashes:

▪ Avoid possible triggers of hot flashes, which include warm air temperatures, hot beverages, alcohol, caffeine and spicy foods.

▪  Dress in layers.

▪ The most effective treatment for severe hot flashes is estrogen. Discuss with your clinician the use of low-dose birth control pills until menopause or hormonal therapy to see if they are right for you.

▪ Women with severe hot flashes who don’t want or can’t take a hormonal therapy or women with mood swings, may get relief from anti-depressant medications.

For vaginal dryness, your clinician may recommend the use of low-dose contraceptives, vaginal estrogen or over-the- counter vaginal moisturizers or lubricants.

Talk to your doctor if you are having problems with your sex drive. He or she may be able to recommend a counselor or therapist to help you.

You may also feel better if you do things that enhance your general well-being such as dietary changes, exercise, getting more sleep, stopping smoking, nutritional supplements and even alternative and complementary therapies such as yoga and acupuncture.

Transition into menopause can be a positive time of life. Although it can cause some noticeable and uncomfortable changes, these can be effectively managed. Talk to your doctor about your specific symptoms and goals of treatment. This will help him or her make a plan that is right for you.

This story was originally published January 27, 2015 at 7:00 AM with the headline "Perimenopause: The change before the change."