Perimenopause is the transitional period before the onset of menopause. Menopause is when menstruation ceases. This stage of life can last a few months or up to 10 years. The female hormone estrogen rises and falls inconsistently during perimenopause. Estrogen affects almost every part of the female body. The hormone affects your reproductive system, heart, bones, brain and many other parts of the anatomy. Your menstrual cycle can become chaotic and unpredictable. Perimenopause is experienced differently by every woman. The main sign of perimenopause is menstrual irregularity.
Symptoms usually start sometime in the 40s but can begin as early as the 30s. Perimenopausal women can experience the bulk of symptoms associated with menopause during perimenopause. The majority of them can occur in the perimenopausal stage instead of the menopausal stage for some women. Many women have mild symptoms during menopause or none at all. Others may have debilitating symptoms throughout perimenopause and menopause, such as very heavy bleeding and severe mood swings. These symptoms can exhibit for a few months or many years. Some common symptoms of perimenopause include hot flashes, mood swings, and irregular periods.
Perimenopausal symptoms are primarily caused by lower production of estrogen and progesterone, which are the female sex hormones. These hormones play a major role in many functions of the female body. The perimenopausal period is considered officially over after 12 consecutive months without a menstrual period. You should see your health care provider if perimenopausal symptoms are affecting your quality of life.
1. Irregular periods
One of the main symptoms of perimenopause is irregular periods. Your period may become longer or shorter some months. You might skip one or more cycles. You may bleed heavily or scantily. You may also experience spotting instead of a normal period. The time between your periods may increase or decrease. You are still fertile during perimenopause and pregnancy should be ruled out if you miss a period. The levels of estrogen and progesterone don’t follow the pattern of a normal menstrual cycle during menopause. Hormone levels become erratic and this causes irregular bleeding. Heavy bleeding afflicts some women during this stage of life.
It can become very stressful and embarassing. You may bleed through your pad or tampon in a short period of time. There are treatments available for heavy bleeding related to perimenopause. But it can also be a sign of health issues not related to perimenopause. Be sure to advise your doctor of occurrences of heavy bleeding, especially if it lasts longer than your normal cycle. Other indications of a health issue include heavy bleeding occurring more often than every 3 weeks, after sex, or between periods. In addition, bleeding after perimenopause transitions into menopause can be a sign of a serious condition like cancer.
2. Sleep problems
Sleeping through the night can be difficult for perimenopausal women because of hormonal changes. Sleep problems are common among perimenopausal women. Some symptoms of perimenopause can cause sleep disturbances like insomnia. Hot flashes brought about by fluctuating levels of estrogen and progesterone can disrupt sleep. Excessive sweating can drench your clothes and sheets. You may awaken too early and have trouble going back to sleep. Lack of sleep can give rise to irritability and fatigue during daytime hours. Women who had sleep problems before entering the perimenopausal stage may have even more difficulty getting a good night’s sleep. If your sleep problems persist, contact your doctor.
3. Hot flashes
Hot flashes are very common for women going through perimenopause. Hot flashes are thought to be caused by a gradual decrease in estrogen during perimenopause and menopause. They can occur at anytime, even during sleep. It’s a feeling of extreme warmth or intense heat. You may awaken in the middle of the night drenched in sweat. Hot flashes can occur in certain areas of the body or all over. It may cause you to feel flushed or appear red in the face and neck area. A hot flash can be mild, very intense, or somewhere in between. The duration can be less than a minute or up to ten minutes. Hot flashes can start in perimenopause and continue throughout menopause and afterwards. They typically become less intense over time. Treatment options are available for hot flashes.
4. Mood changes
The decreasing levels of estrogen during menopause can cause mood swings for some women. Emotional symptoms can be as severe as physical symptoms. Some symptoms that may affect mood include irritability, anxiety, aggressiveness, fatigue, and depression. Irritability is reported as the most common emotional symptom experienced by women during perimenopause. Irritability can lead to impatience and a short temper. Hormonal fluctuations can cause extreme highs and lows. It’s not unusual for a perimenopausal woman to have crying fits for no apparent reason. Anxiety and depression is also common and can become debilitating. Feeling nervous, tense, and worrisome can lead to panic attacks. Women having difficulty with any of these issues should seek help from a healthcare professional.
5. Decreased fertility
Fertility diminishes during perimenopause because your ovaries’ production of estrogen and progesterone starts declining. These are the hormones that help women to conceive and sustain a pregnancy. Your ability to conceive will lessen as ovulation becomes more irregular. In addition, the quality and quantity of eggs will progressively decline as you go through perimenopause. Your ovaries may not consistently release an egg every month. Perimenopause is a transitional period signifying the decline of fertility. The decrease in certain hormones have been linked to a higher rate of miscarriage for perimenopausal women. Birth control is still necessary to avoid unwanted pregnancies.
6. Changes in sexual function
The hormones that fluctuate during perimenopause are also responsible for sexual function. Your libido may increase or decrease at different times during perimenopausal years. Reduced estrogen can slow the pace of reactions that lead to orgasm or make it more difficult to achieve. Vaginal dryness can occur due to decreased production of estrogen and progesterone. This affects the moisture coating the vaginal walls. Vaginal atrophy is another condition that’s brought about by reduced levels of estrogen. It causes thinning and inflammation of the vaginal walls. Signs include dryness, itching, burning, and problems with urination. Vaginal atrophy can cause shortening and tightening of the vaginal canal. These conditions can make sex painful but there are prescription and over-the-counter medications available to treat them.
7. Bladder issues
Lowered levels of estrogen during perimenopause increases a woman’s risk of urinary tract infections and bladder issues. Bladder issues include frequent or painful urination and loss of bladder control. Urinary incontinence is common in perimenopausal women. The tissues in the urethra and vagina lose their elasticity during perimenopause. The lining of those areas start to thin out. Pelvic muscles may begin to weaken. This can create the feeling of a constant need to urinate. Staying hydrated and avoiding consumption of excessive amounts of alcohol can help. Kegel exercises can strengthen pelvic floor muscles and reduce the severity of symptoms. If you experience a burning sensation while urinating or any issues with your bladder, see your doctor promptly for diagnosis and treatment.
8. Loss of bone
Bone loss is a natural occurrence and is a normal part of the bone breakdown and buildup process. The process shifts slightly around age 30, which is the approximate age of peak bone mass. Women start experiencing more breaking down and less building up after this time. This occurs as a result of declining estrogen levels. Estrogen helps to hinder bone loss and also works to maintain calcium in the body. Low progesterone levels also disrupt the process of bone breakdown and repair. This increases a woman’s risk of osteoporosis, which is a condition that causes brittle bones. A woman typically loses about 10% of her bone mass during perimenopause. Other factors including poor diet, lifestyle, and genetics can add to the risk of bone loss during the perimenopausal years. The combination of these factors can cause long-term damage to bones.
