Perimenopause (Pre-Menopause) and Menopause

You may think that you are experiencing menopause when you are actually in a “menopause transition” phase known as perimenopause. Many women say they are “in menopause” but they are actually in perimenopause.

Perimenopause is characterized by symptoms such as hot flashes, weight gain and moodiness—it is a slow biological process that can begin many years before entering menopause. During this transition period, your body is moving toward the end of your reproductive stage as your ovaries begin to produce less estrogen and progesterone. Perimenopause usually begins in your 40s, but some women experience changes as early as their mid-30s. On average, perimenopause lasts about 4-5 years, but someone women experience perimenopause for 10+ years.

Menopause is a diagnosis that occurs when a woman has not had a menstrual period for exactly 12 consecutive months. Menopause is officially the end of perimenopause. The time after menopause is postmenopause, a stage that lasts the rest of your life. Menopause usually occurs around the age of 51. Premature menopause happens when the ovaries fail before the age of 40.

Removal of the ovaries with or without the uterus will initiate immediate menopause. Menopause can also be caused by chemotherapy or radiation of the pelvis.

What are the symptoms of perimenopause (or menopause transition)?

Perimenopause symptoms can include:

• Irregular periods

• Decreased fertility

• Vaginal dryness

• Hot flashes

• Sleep disturbances

• Mood swings

• Weight gain and increased abdominal fat

• Thinning hair

• Loss of breast fullness

• Lack of interest in daily activities; lack of motivation

• Withdrawal from friends/family

• Loss of energy or slowed movement

• Difficulty concentrating

• Forgetfulness

• Changes in appetite

• Changes in sexual function and/or painful sex

• Joint and muscle pain

• Restlessness, agitation

• Feelings of guilt, worthlessness or inadequacy

• Thoughts or ideas about suicide, even if in passing (seek immediate medical care)

These symptoms are due to the fluctuations of your hormones during menopause transition. Some medical issues, medication, stress and other environmental factors can influence hormone shifts and can therefore affect perimenopause. Severity of symptoms varies. If you are experiencing these symptoms and would like to discuss them with your healthcare provider, please reach out to your primary care physician, gynecologist or OB/GYN.

How are perimenopausal symptoms managed?

Your doctor may recommend:

• Non-hormonal medications

• Hormone therapy, including bioidentical hormone therapies or lower dose oral contraceptives

• Integrative medicine practices such as acupuncture (link to Hoag For Her)

• Cognitive behavioral therapy

• Counseling, psychotherapy and support groups

• Antidepressants and anti-anxiety medications

• Lifestyle & behavioral consulting such as the following changes that may reduce perimenopausal symptoms

  • Weight loss if you are overweight

  • Daily exercise (in moderation: strenuous activity can trigger hot flashes)

  • Avoiding caffeine, alcohol, spicy foods and nicotine

  • Wearing cool breathable layers, wicking pajamas

  • Maintaining good sleep hygiene