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. MT 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 if ovulation (release of egg) occurred. About 25% of menstrual cycles in the perimenopause are ovulatory. Ovarian follicle aging progresses in the perimenopause. Progesterone and estrogen levels are extremely variable which changes bleeding patterns. Very heavy bleeding or bleeding in between periods are ABNORMAL and a visit with your clinician is needed. Cycles in early perimenopause are 7 or more days shorter while cycles in the late perimenopause are at least 60 days apart.

Hot flashes that occur during the perimenopause are the result of a narrowing in the brains 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, waking up at night result. About 75% of women report hot flashes with the average duration of about 5-7 years.

Metabolism goes down about 25% for perimenopausal women which results commonly with weight gain. Most women have no idea this is going to happen and are therefore not prepared.

So .... what other good news ? Bone loss starts in the perimenopause. Risk factors for heart disease increases in the MT like high blood pressure and high cholesterol.

Tell me something good please!!!!!! That I can do!!! The “latest and greatest” data clearly points to being proactive, planning ahead, be open to treatment options, and be prepared. By doing so, you

help yourself be healthier in the postmenopause. Women on average are living 1/3 of their lives in the 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 information pertaining to health. Perimenopause is not “doomsday”. By 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 to help in this process.