Perimenopause 101

You may be less familiar with the term ‘perimenopause’ than the more commonly used ‘menopause’, but both represent important stages of reproductive health in women’s lives. Unfortunately, there are still varying levels of stigma when it comes to discussing women’s reproductive and hormonal health, but this shouldn’t be a secretive or clandestine topic. Just over 26% of the world’s female population are of reproductive age, while a substantial portion of the remaining population are entering menopause, and so it’s critical to discuss the ‘why’ and ‘how’ behind these changes. With this increased knowledge, we are better able to understand our bodies, talk about symptoms, and manage them more effectively (with help from trusted medical professionals), if necessary.

So what is perimenopause? And how does it differ from menopause? We’ll be diving into discussing symptoms, treatment options (which are often only explored if symptoms become bothersome or difficult to manage), and the biological process behind perimenopause. Let’s dive in!

What is perimenopause?

Perimenopause marks the transitional time in between a woman’s fertile years and the years she spends in menopause. Lasting anywhere from 2 years to 10 years, Harvard Health reports that the average duration for a woman to spend in perimenopause hovers around 3 to 4 years. Experts have differing opinions on what range of symptoms mark the exact ‘beginning’ and ‘end’ of perimenopause, but for the most part, the start of this stage begins with irregular menstrual cycles, and is considered finished a year after a woman’s last period.

It’s worth noting that perimenopause has a lot of variation: what may be normal for your friend or even another female family member, may not end up being the case for you. Some women’s perimenopause stage can be as short as under a year, and it can last all the way up to 10 years, as we mentioned earlier. So what triggers perimenopause?  

The process of perimenopause

As with most things reproductive health, hormones are the cause of perimenopause. Specifically, estrogen levels, which peak during reproductive years (ranging anywhere from ages 11 to 49), begin to fall as your ovaries produce less of this hormone in your mid-40s onwards. Of course, as estrogen levels decrease, this impacts the balance between estrogen and progesterone (which is also produced by the ovaries). Together, the two hormones responsible for ovulation and menstruation go up and down, sometimes in an unpredictable way, which can lead to unpleasant perimenopause symptoms for some women. Eventually, the amount of estrogen released by the ovaries will be low enough that periods will stop altogether, ultimately leading to menopause.

Symptoms of perimenopause

Symptoms of perimenopause vary by person, but typically women in this stage will notice irregular periods, alongside:

• Periods that are heavier or lighter than usual
• Hot flashes
• Night sweats
• Joint and muscle aching
• Headaches
• Changes in sexual desire
• Vaginal dryness (this could also lead to some discomfort during sex)
• Urinary urgency
• Sleep problems (such as insomnia)
• Changes in mood (mood swings, irritability, depression

Symptoms may peak and trough as well; for instance, Johns Hopkins notes that when estrogen levels are higher, symptoms that mimic PMS may show up, while when estrogen levels dip, night sweats and hot flashes are more likely. Even more confusing for some women is the fact that perimenopause symptoms can show up between and during normal cycles, meaning you may go a few months getting your period as usual, but symptoms can intersperse themselves in the meantime.  

Fertility during perimenopause

Wait, so if perimenopause marks the transition stage out of your reproductive years and into your menopausal years, then do you still ovulate in the perimenopause stage? Well, it’s best to assume that if you’re still getting a period (even if it is irregular), then you are still ovulating. Until you haven’t had a period for 12 consecutive months, there is the possibility you are still fertile. In fact, the pregnancy rate for perimenopausal women is approximately 10 to 20% of women in the ages of 40 to 44, and 12% in the ages of 45 to 49. Though not common, if a woman is aged 50 and having unprotected sexual intercourse, the chances of getting pregnant hover around 5%. The takeaway here? While fertility drops with age, until you are into menopause (meaning you have not had a period for 12 months in a row), you should assume there is a small chance you could become pregnant, so use protection if necessary.

Is perimenopause something to be worried about?

What is important to keep in mind is that, though symptoms may be unpleasant (or in some cases, require treatment), perimenopause and menopause themselves are very natural stages of reproductive health. If, however, symptoms are interfering with your everyday life, or you feel something is off, then you should absolutely book an appointment with your primary care physician.

Treatment options for perimenopause

For many women, symptoms of perimenopause can be inconvenient or even bothersome, but they go away with time without medical treatment, while other women hardly experience any symptoms. Everyone is unique, so keep that in mind, and if a symptom is bothering you, it’s always best to err on the side of caution. That being said, for the small subset of women whose perimenopause symptoms interfere with daily life, it may be worth discussing potential solutions with a medical provider.

Let’s briefly touch on each of the most popular treatment plans available:

• Hormone therapy
• This involves the use of estrogen or estrogen and progestins to balance steep surges and declines in hormone levels
• Antidepressants
• These can be employed to stabilize mood, though they do come with side effects.
• Lifestyle changes
• Increase calcium intake
• During perimenopause, changes to bone health can occur, which is why some doctors may recommend consuming 1,000mg to 1,200 mg of calcium each day
• Exercise regularly
• This can help with both mood (exercising is known to decrease anxiety and depression) as well as overall physical health
• Consider keeping a diary of triggers
• For some women tea or coffee may trigger hot flashes; try to be mindful about symptoms that occur soon after consuming food and beverages, and consider reducing foods known to provoke bothersome symptoms

When to consider seeing a doctor

For some women, they go through perimenopause and into menopause without having to consult with their doctor because their symptoms do not cause unreasonable trouble on a daily basis. However, there are cases in which you should absolutely make an appointment with your doctor, such as:

• Blood clots in menstrual discharge
• Spotting between periods
• Vaginal bleeding after sex
• Emotional or psychological symptoms that make daily tasks difficult
• If you are overcome with anxiety, sadness, depression, or another negative emotion, then it is worth speaking to your doctor to check your physical health, as well as potentially beneficial to make an appointment with a therapist to discuss CBT or DBT focused exercises that can help you cope better day to day

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