Perimenopause: Symptoms, Causes, Treatment, and Diagnosis

Perimenopause or around menopause or the menopausal transition is the time period during which a woman’s body makes its own natural transition toward permanent infertility (menopause).

Women can have this at any age and you may notice the symptoms such as menstrual irregularity as early as mid-30s or in their 40s. During perimenopause the level of your estrogen which is the main female hormone rises and falls unevenly. You may have menstrual cycles when your ovaries doesn’t release an egg (ovulate) or they may shorten or lengthen.

Menopause-like symptoms such as sleep problems, vaginal dryness and hot flashes might occur too.

There are treatments to relieve you of the symptoms and if you had 12 consecutive months of not having menstruation, it means that the perimenopause is over and you are already menopause stage.

Some of the symptoms of perimenopause are:

Menstrual irregularity: Your ovulation becomes unpredictable, your flow may be light to heavy, you may skip periods and the length between periods may be shorter or longer. You may be in early perimenopause if you have a persistent change of seven days or more in terms of the length of your cycle but you are in late perimenopause if you have a space of 60 days or more between periods.
Sleep problems and hot flashes: The length, frequency and intensity may vary and due to night sweats and hot flashes, sleep problems may occur. Sleep problems are unpredictable; Mood changes – you may experience irritability, increased risk of depression and mood swings and the cause of this might be sleep disruption caused by hot flashes.
Decreasing fertility: Your ability to conceive decreases as ovulation becomes irregular but pregnancy is still possible as long as you have your periods. Use birth control until you have no periods for 12 months if you do not want to be pregnant.
Vaginal and bladder problems: Your vaginal tissue will lose elasticity and lubrication when estrogen levels diminish making it hard and painful to intercourse. Urinary and vaginal infection may also be the effect of low estrogen levels and low tissue tone might cause urinary incontinence.
Loss of bone: You will start to lose bone quickly than you replace it if you have declining estrogen levels that can lead to osteoporosis which means you have fragile bones.
Changes in sexual function: Desire and sexual arousal may change.
Changing cholesterol levels: Your blood cholesterol may change because of declining estrogen levels. You will also have an increase in low-density lipoprotein (LDL) cholesterol (bad cholesterol) that can cause heart disease while high-density lipoprotein (HDL) cholesterol (good cholesterol) will decrease in many women that can also increase the risk of heart disease.

Consult your doctor if you cannot tolerate the symptoms or perimenopause.

Decreasing estrogen is the cause of the changes that you will encounter during perimenopause.

Your body’s production of estrogen and progesterone rises and falls as you went through the menopausal transition.

No one test or sign is enough to diagnose perimenopause.

Your family doctor will recommend you to a gynecologist that specializes in female reproductive system.

Before going to the doctor, write down your menstrual cycles for the past few months including first and last date of bleeding in each cycle and if the flow is heavy or light.

Write down the symptoms that you are experiencing. Write down the major stresses in your life or recent changes. You can also list down the medications, supplements and vitamins that you are taking. Ask a family member or friend to accompany you.

Some of the basic questions that you can ask your gynecologist are:

What is causing my symptoms?
Are there any possible causes other than this?
What tests do I need?
Will this be temporary?
What treatments are available?
I have other conditions, how can I manage them both?
Do I need to follow any restrictions?
Should I see a specialist?
What websites do you recommend?

Your doctor will likely ask you some questions such as:

Do you still have menstrual period?
What are your symptoms?
For how long have you experienced the symptoms?
How much distress does it cause you?

Your doctor will consider your menstrual history, your age and what kind os symptoms are you experiencing, come doctors will recommend testing of your hormone levels and thyroid function.

Drug therapy is the most common treatment for perimenopausal symptoms such as:

Hormone therapy or systematic estrogen therapy: That comes in skin patch, pill, cream or gel is the most effective treatment to reduce the night sweats and hot flashes and can help prevent bone loss. Your doctor may recommend this depending on your personal and family history and if you still have your uterus, progestin along with estrogen will be given to you,
Vaginal estrogen: In a form of cream ,vaginal tablet or ring so you will be relieved of your vaginal dryness, urinary symptoms and discomfort in intercourse,
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) to relieve you of hot flashes and for mood disorders,
Gabapentin (Neurontin): To reduce hot flashes as well as to treat seizures. This is use for women who have migraines and who cannot take estrogen. Consult your doctor first before taking any of these.

There is no way of preventing perimenopause but we can reduce the symptoms by taking some of these steps:

avoid smoking cigarettes,
do not consume too may caffeine and alcohol,
reduce your intake of sugar,
eat foods that are rich in vitamin D and calcium,
eat fish that are rich in omega 3 fatty acids,
exercise regularly,
and lead an active life.

Some of the alternative remedies used for perimenopause symptoms but still under study are:

Black cohosh: To treat hot flashes but can be harmful to liver or women who are at risk to breast cancer.
Phytoestrogens: Two types of phytoestrogens are isoflavones that are found in chickpeas, legumes and soybeans and lignans that are found in whole grains, some fruits and vegetables and flaxseed.
Dehydroepiandrosterone (DHEA):A natural steroid but there are some concerns about its harmful use.
Bioidentical hormones: Some bioidentical formulations are approved by the FDA while compounded bioidentical hormones are not supported by the Food and Drugs Administration.

Yoga, acupuncture and breathing exercises may help in reducing the symptoms and your stress and improve your psychological well being but some studies show that relaxation will improve hot flashes. Consult your doctor first before taking any of these alternative medicines and therapy.

To reduce the symptoms of perimenopause try some lifestyle tips such as:

eat a healthy diet – high-fiber, low-fat, calcium-rich diet that’s rich in whole grains fruits and vegetables,
avoid caffeine and alcohol that will trigger the symptoms or perimenopause,
decrease vaginal discomfort – used water-based vaginal lubricants (Astroglide, K-Y Intrigue) or moisturizers (Replens, others) without glycerin to avoid irritation,
get enough sleep,
exercise regularly for like 30 minutes or more to elevate your mood, prevent weight gain, to strengthen bone density and improve your sleep,
practice stress-reduction technique to promote good health and relaxation.

Some factors that will make you at risk of perimenopause at an earlier age include:

family history,
smoking – the onset is one to two years compared to those who does not smoke,
cancer treatment with pelvic radiation or chemotherapy,
and hysterectomy – if you have your uterus removed you will have menopause at an early age.

Consult your doctor if the symptoms are not normal such as: