What is Perimenopause?

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As women approach their late 30s or early 40s, they often begin to experience a series of physical and emotional transitions that signal the onset of peri-menopause. This transitional phase, which typically lasts for several years before the onset of menopause, is characterized by hormonal fluctuations that can result in various symptoms. Despite being a natural and inevitable process, perimenopause can be challenging and confusing for many women. This article will delve into peri-menopause, exploring its definition, signs and symptoms, causes, and management strategies to help women navigate this transformative period.

What is Peri-Menopause? 

Perimenopause often called the menopausal transition, is a phase in a woman’s life that occurs before menopause. It is characterized by hormonal changes that lead to the cessation of menstrual cycles and the eventual end of fertility. Peri-menopause can begin as early as the late 30s or as late as the early 50s, varying from woman to woman.

During perimenopause, the ovaries gradually produce less estrogen, causing irregular menstrual cycles. Estrogen is the primary female hormone popular for regulating the menstrual cycle, maintaining bone health, and influencing other bodily functions. As estrogen levels fluctuate, women may experience various physical and emotional signs, such as hot flashes, night sweats, mood swings, sleep disturbances, vaginal dryness, and changes in libido.

Signs and Symptoms of Perimenopause

Peri-menopause is a highly individualized experience, and the signs and symptoms can vary widely from woman to woman. Some women breeze through this phase with minimal discomfort, while others struggle with many symptoms. The most common signs and symptoms of peri-menopause include:

  1. Irregular periods: Menstrual cycles may become shorter or longer, and the flow may become heavier or lighter. Skipping periods or having unpredictable bleeding patterns is also common.
  2. Hot flashes and night sweats: These sudden and intense heat waves can lead to excessive sweating, flushing of the face, and a rapid heartbeat. Night sweats can disrupt sleep patterns and lead to fatigue and irritability.
  3. Mood changes: Hormonal fluctuations can trigger mood swings, irritability, anxiety, and depression. Women may find themselves experiencing emotional highs and lows more frequently.
  4. Sleep disturbances: Insomnia, difficulty falling asleep, or waking up frequently during the night can occur during peri-menopause. Sleep deprivation can exacerbate other symptoms and negatively impact overall well-being.
  5. Vaginal and urinary changes: Decreased estrogen levels can lead to vaginal dryness, itching, and discomfort during intercourse. Some women may also experience urinary symptoms, such as increased frequency or urgency.
  6. Changes in sexual desire: Fluctuating hormones can affect libido and sexual desire. Some women may experience a decreased interest in sex, while others may increase their desire.
  7. Physical changes: Peri-menopause can contribute to weight gain, especially around the abdomen, and changes in skin elasticity and hair texture.

Causes of Peri-Menopause

The primary cause of peri-menopause is the natural decline in reproductive hormones, particularly estrogen and progesterone. As women age, their ovarian follicles gradually become less responsive to hormonal signals from the brain, leading to irregular hormone production. While the exact mechanisms underlying this process are not completely understood, it is believed to be related to the aging of the ovaries and a decline in the number of viable eggs.

Additionally, certain lifestyle factors and medical conditions can influence the timing and severity of peri-menopausal symptoms. These include smoking, excessive alcohol consumption, obesity, certain medications, stress, and underlying health conditions.

Management Strategies for Peri-Menopause

Managing perimenopause involves addressing physical and emotional symptoms to improve the overall quality of life. Here are some strategies that can help:

  1. Healthy lifestyle: Regularly exercise, maintain a balanced diet of vegetables, fruits, & whole grains, and restrict caffeine and alcohol intake. These lifestyle choices can support overall well-being and help alleviate some symptoms.
  2. Hormone therapy: Hormone replacement therapy (HRT) may be recommended to alleviate severe symptoms. HRT involves taking estrogen or a combination of estrogen and progesterone to supplement declining hormone levels. However, it is important to discuss the advantages and risks of HRT with a healthcare provider, as it may not be proper for everyone.
  3. Alternative therapies: Some women find relief from peri-menopausal symptoms through alternative therapies, such as herbal supplements (e.g., black cohosh, evening primrose oil), acupuncture, yoga, or mindfulness meditation. It is essential to consult with a healthcare expert before trying alternative therapies to ensure their safety and effectiveness.
  4. Emotional support: Seek support from friends, family, or support groups. Sharing experiences and concerns can help alleviate the emotional burden associated with peri-menopause.
  5. Symptom-specific treatments: Various medications and treatments are available to manage specific symptoms. For example, low-dose antidepressants may be prescribed to alleviate mood swings and improve sleep quality. Vaginal moisturizers or lubricants can help with vaginal dryness and discomfort.

Perimenopause is a natural phase of a woman’s life that marks the transition to menopause. Although a range of challenging symptoms can accompany it, understanding the process and implementing appropriate management strategies can help women navigate this transformative period more easily. By seeking support from healthcare professionals, adopting a healthy lifestyle, considering hormone therapy, and exploring alternative therapies, women can empower themselves to embrace this life stage and maintain their physical and emotional well-being. Remember, each woman’s experience with peri-menopause is unique, so finding the right combination of strategies may require some experimentation. Embracing self-care and self-compassion will contribute to a smoother transition and pave the way for a fulfilling and vibrant post-menopausal life.

Here we discuss this with Emily Barclay, a menopause coach, to get her thoughts on this topic.

How Long Does Perimenopause Last?

NourishDoc: What is peri-menopause? How long does it last?

Menopause Coach Emily: Peri-menopause is the time leading up to menopause. Menopause is defined as when someone when a woman has gone one whole year without a period and her periods, therefore, have stopped. Peri-menopause is the time before that when everything is just weird. The perception out there is that the menopause symptoms, which are the hot flashes and things like that, but that’s all of it, are actually at the start of peri-menopause, our progesterone drops fairly stable in a fairly stable sort of a way. At the same time, our estrogen does all sorts of crazy stuff. 

Many women very early in peri-menopause suddenly experience anxiety in a way they never had, which is a sign of the progesterone dropping. So identify four or five things that matter and are affecting you. So it might be sleep, hunger, cravings, fatigue, anxiety, anxiety, whatever; find those five or six things affecting you. The more we can understand how that cycle works for us, the more we can sort of be on the front foot and anticipate what’s coming rather than always being at the mercy of it happening to us.

Emotional Phase During Perimenopause

NourishDoc: Talk about the emotional part and other issues during this phase

Menopause Coach Emily: The emotional side is huge and probably has a bigger impact than the physical one. I think because people expect hot flashes, night sweats, and things that can preempt that. Still, a lot of people aren’t expecting that they’re going to be tearful suddenly, or that they’re going to be nervous about things, anxious about things, that they’re going to forget their words, that they’re going to feel really brain foggy

But the emotional side was really scary. We just have less resilience to stress, which can affect our hormones. If we can find little ways to manage stress, chances are, I’m not going to say this is 100% at all. But chances are, we will just be a little bit more stable and, therefore, able to cope with the different symptoms as they come.

Hot Flashes and Night Sweats

NourishDoc: Do hot flashes and night sweats happen before or during menopause?

Menopause coach Emily: It can happen sooner and continue after your periods have ended. That, I think, is another of these misconceptions that, okay, periods have ended, and everything’s fine. But obviously, your body is still getting used to this new state of having lower hormones. So you know, some women have Vaso motor symptoms early in peri-menopause. But for some, they only come in quite late 25% of women don’t even have a hot flash. 

Menopause Is Different For Every Woman

NourishDoc: Different women face menopause closure at different ages, right?

Menopause coach Emily: Absolutely, we’re all going to get a different variation on it, just as I mean, we’re all different, aren’t we? It’s, you know, it stands to reason. There’s one thing I just quickly want to say; I’m very aware of the time. Sorry, we’re getting a diagnosis; I put that in inverted commas because it isn’t an illness. So we don’t get a diagnosis. But if you want to access help for your systems, feel symptoms. So blood tests are best used to rule out thyroid problems, certain minerals, and deficiency issues. So, yeah, self-advocating and learning what your body’s telling you. Seems to be just the best way to get that help.


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