Perimenopause has a major effect on estrogen, the main female hormone. Levels will be in flux during perimenopause, rising and falling in uneven cycles. That will make menstrual cycles shorten or lengthen, and in some cases, ovulation may not occur.
Other symptoms include vaginal dryness, hot flashes and sleep problems. While a woman can still become pregnant during these stages, it becomes more difficult. Once women have gone 12 consecutive months without a menstrual period, perimenopause ends and menopause begins.
Because it is a gradual transition, there is no test available to indicate perimenopause, and some of its signs can happen for other reasons. Some doctors will check thyroid levels to make sure the changes are not attributable to problems with that gland.
What Doctors Look for to Diagnose Perimenopause
Doctors will usually look for the following:
· Menstrual irregularity – The flow can change from heavy to light, the length of time may change and there may be some skipped periods. A persistent change – one in which there are seven days or more in the length of the cycle – can be a sign of perimenopause. If there’s a 60-day gap or more between periods, it’s a sign of perimenopause in the later stages.
· Hot flashes – These incidents of uncomfortable warmth appear during perimenopause and will vary in length, intensity and frequency. They may disturb sleeping patterns or cause night sweats in some women.
· Mood changes – Women may experience irritability, mood swings and increased depression during perimenopause, but some symptoms may be attributed to a lack of sleep caused by hot flashes and hormonal changes.
· Vaginal and bladder issues – As estrogen levels dip, vaginal tissues lose lubrication and some of their elasticity. This often results in painful intercourse, and lower estrogen levels may lead to vaginal infections or urinary tract issues, including urinary incontinence caused by lost elasticity.
· Decreased fertility – If ovulation changes, so, too, does the ability to conceive. While pregnancy is still possible while undergoing perimenopause, it will become more difficult.
· Changes in sexual function – Arousal and desire can be affected by perimenopausal issues.
· Bone loss – An increased risk of osteoporosis, which causes bone loss faster than replacement levels, is a risk of perimenopause. The afflicted may be more prone to broken bones.
· Cholesterol level changes – An increase in low-density lipoprotein cholesterol (bad cholesterol) and high-density lipoprotein (good) cholesterol can happen because of the changing estrogen levels. These changes can increase the risk of heart disease.
Potential Causes of Perimenopause
There is nothing wrong with entering perimenopause -- it’s part of the natural cycle of a woman’s life. Although there are no definitive studies linking any one action or inaction to its onset, there are several factors that medical professionals believe may hasten its appearance at an earlier age.
These include:
1) Smoking – Some studies have shown that menopause begins one to two years earlier in smokers than non-smoking women. That would mean perimenopause arrives earlier.
2) Family history – We are all a product of the genes passed down through the centuries by our ancestors. If early-onset perimenopause symptoms run in the family, it’s more likely to occur in a relative who shares many of the same genes.
3) Cancer treatments – The cure is often worse than the disease in some instances, and that’s true of cancer. Chemotherapy and pelvic radiation treatments have been linked to early menopause, and thus are likely to start the perimenopausal symptoms earlier as well.
4) Hysterectomy – A procedure to remove the uterus and not the ovaries is not linked to menopause because the ovaries still produce estrogen. For unknown reasons, the surgery can cause menopause to begin earlier.
Should You See a Doctor?
Most women don’t visit the doctor for perimenopausal symptoms, either because the symptoms are not severe enough to warrant a visit; because they simply tolerate the changes as part of a normal life cycle; or because they don’t notice the subtle changes going on.
Irregular periods are part of perimenopause and usually are not a concern. However, there are circumstances when a doctor’s visit is warranted. These include when a menstrual cycle is extremely heavy (a change of tampons or pads every few hours); the cycle lasts longer than a week; when bleeding occurs between periods; and when the cycle speeds up to less than 21 days apart.
All of these factors may or may not signal a problem with the reproductive system and warrant a doctor visit to check for any underlying conditions. However, if any conditions seem abnormal about the perimenopausal period, it is best to have a doctor’s confirmation that all is well.
Treatments for Perimenopause
There are some hormone treatments available that may ease perimenopausal symptoms.
These include:
1) Hormone therapy – Estrogen treatments are available via skin patches, pills or creams that may ease some of the symptoms of perimenopause and/or menopause, including night sweats and hot flashes. Dosage levels will depend on medical history, family background and whether the woman still has a uterus, but doctors typically prefer a lower dose to start.
2) Vaginal estrogen – This can be applied topically as a cream or taken orally. This provides a small dose of estrogen, which can ease vaginal dryness, urinary symptoms and painful intercourse issues.
3) Antidepressants – Selective serotonin reuptake inhibitors (SSRIs) can help reduce menopausal hot flashes. This is typically used if estrogen can’t be taken or if there is a mood problem.
4) Neurontin – A drug called gabapentin is used for seizures, but one of its off-label uses is reducing hot flashes. If a woman is unable to undergo estrogen therapy or has a history of migraines, gabapentin is useful.
In addition to medications, a healthy diet, more frequent exercise, use of over-the-counter lubricants, and stress reduction techniques like meditation or yoga can help with perimenopausal symptoms.