What is Perimenopause?

Perimenopause begins with menstrual cycle irregularities and ends following one year of absent menses. The average age of perimenopause is 47 and the average age of menopause is 51-52. Perimenopause lasts about 4-8 years but tends to be longer in smokers and in those with earlier symptom onset. While everyone talks about menopause symptoms, it is perimenopause (MT) that is usually the most symptomatic for women.

Common perimenopause symptoms include:

  • Menstrual cycle changes
  • Hot flashes
  • Vaginal/vulvar dryness with painful sex
  • Poor sleep
  • Weight gain
  • Difficulty concentrating and concerns about ones memory
  • Mood changes, depression, anxiety

Menstrual cycles vary depending on whether ovulation (the release of an egg) occurs. About 25% of menstrual cycles in the perimenopause are ovulatory. Ovarian follicle aging progresses in the perimenopause. Progesterone and estrogen levels are highly variable, which changes bleeding patterns. Very heavy bleeding or bleeding in between periods is abnormal, and a visit with your clinician is needed. Cycles in early perimenopause are seven or more days shorter, while cycles in late perimenopause are at least 60 days apart.

Hot flashes that occur during perimenopause are the result of a narrowing in the brain’s thermoregulatory center. This area of the brain is estrogen-sensitive. When estrogen levels decline, the body is not able to accommodate as quickly. Therefore, skin redness, sweating, sometimes anxiety, and waking up at night result. About 75% of women report hot flashes, with an average duration of about 5-7 years.

Metabolism goes down about 25% for perimenopausal women, which results in weight gain. Most women have no idea this will happen and are unprepared.

Be aware that bone loss starts during perimenopause. Risk factors for heart disease increases in the MT like high blood pressure and high cholesterol.

 The “latest and greatest” data points to being proactive, planning ahead, being open to treatment options, and being prepared. By doing so, you help yourself be healthier in the postmenopause. Women, on average, are living 1/3 of their lives in postmenopause. The New York  Times recently referred to perimenopause as “The Puberty of Midlife,” and most importantly, the conversation is not being heard enough. Women are hungry for accurate health information. Perimenopause is not “doomsday”. Recognizing what is normal, common symptoms and their causes/treatments, and with a preventive /proactive mindset, these symptoms can largely be abated. Perimenopause remains a wonderful time to check in with your clinician for help.

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