Women approaching their 40s are often worried about transitioning towards the end of their reproductive cycle. Will it be scary? Will it be painful? Could it not be easier? These are frequent questions in the minds of females who are moving towards menopause. Before your period cycle ends completely, you go through a stage of transition that can last from a few months to a few years. This transitional stage is known as perimenopause.
Perimenopause can begin at different ages, and it is impossible to predict at which age it may occur. On a global scale, the age range for perimenopause can vary from the mid-30s to even the late 60s. The duration of perimenopause is different as well for women. You may experience it for a few months, and your friends may experience it for a year. Despite the unpredictability, it is still important to understand perimenopause signs and effective ways to manage them.
The major signs of perimenopause occur due to changes in your body’s estrogen levels. Estrogen is the primary female hormone that plays a critical role in the menstruation and reproductive cycle. The decline in the level of estrogen results in multiple indicators of perimenopause that may vary for different women. These indicators include:
Irregular menses: This is the primary sign of transition towards menopause. The duration of menses and the interval between two menses can become unpredictable. Eventually, the interval increases from a few weeks to a few months. The flow of menstrual bleeding can vary as well.
Hot flashes: This can vary in severity from a mild feeling of warmth to an extreme perception of a full-body flush. Women who are not used to experiencing hot flashes during menses can find it difficult to adjust to this sudden change. Hot flashes can last from 2 to 5 minutes.
Mood swings: You may experience recurrent changes in your mood with or without an apparent cause. Increased irritability may be present during this stage. Some females may go through a period of depression, but it can be linked to other causes as well.
Sleep disturbance: Disruptions in normal sleep patterns can be present, although multiple factors may cause it. Women also experience night sweats at times which can disturb their sleep.
Vaginal dryness: During this transition stage, your vaginal tissues become thinner, and the ability to produce natural lubrication decreases. This may cause vaginal itching, and the risk of vaginal infections increases. Sexual intercourse can become painful during this stage, and external lubrication is required.
Reduced fertility: As the level of estrogen falls in your body, your natural reproductive cycle begins to move towards its end. Conceiving a child can become difficult during this stage of transition.
Decreased sexual desire: This is experienced by many women who are going through menopause. The decline in hormonal levels reduces sexual arousal or the desire to have sex.
Loss of bone density: Estrogen levels are important to maintain the density and thickness of your bones. Reduced estrogen can make the bones weaker, making you more prone to develop osteoporosis.
Changes in cholesterol level: Hormonal changes may also be accompanied by changes in the level of cholesterol in your body. LDL, also called bad cholesterol, rises, increasing the risk for other systemic diseases.
Mild signs and symptoms of perimenopause can be managed, but severe symptoms may need professional consultation. If you have severe hot flashes, heavy menstrual flow, vaginal infections, extreme pain during intercourse, decreased sexual arousal, etc., it is better to discuss them with your doctor.
Your doctor may recommend hormonal therapy in which estrogen is prescribed in oral or topical form. This can help in reducing the severity of the signs associated with perimenopause. It may also be prescribed to prevent early bone loss and reduce the risk of osteoporosis.
If you do not wish to conceive, oral contraceptives can be used in prescribed dosages to reduce menstrual irregularities and heavy bleeding. These medications should only be used after consultation with your doctor. If you experience symptoms of depression, it is better to consult a mental health specialist for suitable treatment options.
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Karen Matta Toomey MD
Sirpa Talvikki Autio MD
