Most women are familiar with menopause but not all realize that this season of life is part of a series of stages that can last up to 10 years. Perimenopause is a transitional period that occurs in the years just before menopause. During perimenopause, your hormone levels start to change, and you may notice various symptoms commonly associated with menopause.
There is no one age at which perimenopause and subsequent menopause begin.
In general, perimenopause lasts between one and four years.
Women who experience menstrual migraines may notice a reduction in headache intensity and frequency near the end of perimenopause.
Statistics provided by the North American Menopause Society indicate up to 23% of perimenopausal and menopausal women experience mood swings.
Medical professionals state menopause begins when a full 12 months have passed since your last period.
What is perimenopause?
The word perimenopause means “around menopause.” For women, the symptoms of perimenopause signal a time when the body begins to shift into menopause and away from monthly cycles that can lead to pregnancy. There is no one age at which perimenopause and subsequent menopause start. Some women may notice signs and symptoms of their body, hormones, and cycle changes in their early 40s, while others may begin to transition as early as their 30s.
In addition to natural progression related to aging, other external factors, such as certain surgical procedures and a history of cancer treatment, may contribute to an earlier onset of perimenopausal symptoms for some women. Smoking may also trigger the onset of perimenopause. Some statistics show menopausal symptoms begin an average of two years earlier for women who smoke.
Perimenopause is a journey each woman walks differently. As a result, no two women will experience the same signs and symptoms of perimenopause at the same time, in the same order, or at the same severity. Also, some women may experience symptoms that others may not. In general, perimenopause lasts between one and four years and is accompanied by various symptoms.
Hot flashes are one of the two most common symptoms women experience during perimenopause. Hot flashes involve a sudden and unpredictable wave of heat often accompanied by elevated heart rate, sweating, and flushed skin. Hot flashes usually last between one and five minutes and are sometimes followed by feeling "chilled." Hot flashes can occur at any time. When they occur at night, they are commonly referred to as night sweats.
Irregular periods are another very common symptom of perimenopause. During perimenopause, your “normal” ovulation pattern becomes more unpredictable. The length of time between your periods may sometimes change from month to month. Also, your periods may become very heavy or virtually stop. Researchers suggest if you experience a persistent change in your menstrual cycle of a week or more, it may suggest early menopause. In contrast, going for more than 2 months between your periods indicates you have entered late perimenopause.
Reduced estrogen levels affect your vaginal tissues. As your body produces less estrogen, the tissues within the vagina are less lubricated and elastic. This can make intercourse painful and unpleasant. Vaginal dryness may also lead to reduced desire and difficulties with sexual intimacy.
Low estrogen levels can also affect your bladder, leaving you vulnerable to more frequent urinary tract and bladder infections.
Irritability and mood swings are familiar symptoms of monthly menstrual cycles, but mood changes are also part of perimenopause. Alterations in your mood can occur due to lack of sleep (from night sweats), depression, and other hormonal changes.
Estrogen plays an essential role in bone metabolism. With the onset of perimenopause and eventually menopause, your estrogen levels begin to decline. As a result, many women start to lose bone mass and experience challenges with bone density. This can increase your risk of bone breaks and fractures and your risk of osteoporosis.
Some women report more frequent headaches during perimenopause. Headaches often occur due to rapid fluctuations in hormone levels. For most women, headaches begin to subside as they progress through menopause and their hormones stabilize.
Signs that perimenopause is ending
As mentioned above, no two women experience the changes brought about by perimenopause in the same way. As a result, the signs of perimenopausal symptoms are ending, and menopause is beginning will vary. In some instances, you may notice symptoms improve or disappear. But the opposite is also true. Some symptoms may appear for the first time, or preexisting perimenopausal symptoms may worsen as perimenopause ends.
During perimenopause, your periods have likely become a bit more unpredictable and irregular. As you progress through the stages of perimenopause, the time between each period will increase until they eventually stop. For some women, especially those who have experienced difficult periods, this may be the best part about menopause.
Statistics provided by the North American Menopause Society indicate up to 75% of perimenopausal and menopausal women experience mood swings. Fortunately, as menopause approaches, hormone levels begin to level out, leading to improved mood. Although they will be notably lower than before perimenopause, hormone levels generally remain more consistent, which helps to regulate mood.
During late perimenopause, hormone levels begin to stabilize, leading to reduced intensity and intrusiveness of some symptoms. One such example is headaches. Women who experience menstrual migraines may notice a reduction in headache intensity and frequency near the end of perimenopause.
More hot flashes
And now the bad news. As menopause approaches, most women report experiencing more hot flashes. Near the end of perimenopause and during the first couple of years of menopause, hot flashes may increase in frequency and intensity before symptoms begin to improve.
Because hot flashes, night sweats, hormonal changes, and mood swings are more common near the end of perimenopause, so too is reduced sleep.
How to know if menopause has started
Menopause signals the end of a monthly menstrual cycle and the end of a woman's fertile years. With the onset of menopause, the body stops producing eggs, and the levels of specific hormones required for fertility decline. The monthly cycle that leads to a release of an egg for fertilization also ends with the onset of menopause. Medical professionals state menopause begins when a full 12 months have passed since your last period.
Because perimenopause and menopause are journeys unique to the individual, it can be challenging to pinpoint precisely when perimenopause ends, and menopause begins. It may help to write down your symptoms in a journal or track them with an app so you can discuss them with your provider at your next appointment. Although most symptoms of perimenopause are manageable without intervention, if you experience significant challenges managing your symptoms, treatments are available to help reduce their intensity and impact on your quality of life.