What to Expect During Perimenopause

Perimenopause and menopause can be both an exciting and challenging time in a woman’s life. It comes at the natural end of ovarian function as the ovaries stop producing hormones, menstrual periods become less frequent, and then stop altogether. Periods are ending (yay!) but along with that, can come sometimes uncomfortable and disruptive symptoms.

Keep in mind that perimenopause and the symptoms you may experience are normal and temporary. By maintaining a healthy lifestyle and working with your doctor, you can manage those symptoms and move into this new phase of life with grace and confidence.

What Is Perimenopause? 

Perimenopause begins approximately four years before actual menopause. Menopause is when a woman goes 12 consecutive months with no menstrual flow. The average age of menopause is 51.5, making the average age of perimenopause 47.

Often, your menstrual cycles get closer together at first, and then further apart. This varies from woman to woman. The common thread is change. However, if you reach menopause before age 40—known as premature ovarian failure—talk to your doctor about possible treatment.

Anatomy and Physiology 101

Before we delve into perimenopause, it’s important to understand the basics of a woman’s physiology and anatomy. This helps clarify what happens to your body during perimenopause.

• Ovaries: Where eggs or follicles are produced that can become a pregnancy if fertilized. Ovaries also produce estrogen and progesterone, the unique hormones of a woman. As a woman reaches her late 30s and 40s, her fertility decreases as the quality and quantity of her follicles diminishes.
• Uterus: Muscular womb where a pregnancy implants and grows. It contracts during labor and cramps during the menstrual cycle. A thin layer of tissue called the endometrium lines the uterus. It responds to the ovaries’ hormones. When no conception occurs during a woman’s monthly cycle, the lining of the endometrium sheds, resulting in menstruation.
• Brain: Contains the pituitary gland, the master gland that directs the ovaries to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH) which trigger ovulation each month. During perimenopause and then menopause, the brain continues to try to get the ovaries to work.

Some women will ask, “Can I have a blood test to see where I am at?” This would be a serum FSH. The problem is that it is not accurate, because it can fluctuate. It can be high when the ovaries are taking longer to make hormone. Then, when the ovary starts to produce some hormone again, the FSH will fall. So, depending on what’s going on at the time you get your blood drawn, it may be high or low.

The Most Common Symptoms of Perimenopause

You may experience a variety of symptoms during perimenopause from mood swings to vaginal dryness, but the two most common are menstrual cycle changes and hot flashes.

Menstrual Cycle Changes

As I mentioned, perimenopause is a time of change in your menstrual cycle and every woman is unique. However, if you begin to have your period every two weeks, it lasts more than seven days, and is very heavy (having to change your product every hour) reach out to doctor for evaluation. Your doctor may recommend an ultrasound to see if any structural issues—like a polyp or fibroid in the uterus or endometrium—could be causing the frequent or heavy bleeding. They may also take a sample of endometrial lining to make sure there is no cancerous or pre-cancerous tissue.

If no issues are discovered, there are several treatment options available:

• A hormonal intrauterine device (IUD) like Mirena releases progestin which makes the endometrium thinner. This results in lighter periods and less flow. Some women become amenorrheic (have no periods) when using the IUD.
• Low dose birth control pill, frequently with a lower dose of estrogen. Women can take the pill up to age 50-51 as long as they don’t smoke, or haven’t had a stroke or blood clot, or an estrogen-related tumor like breast or ovarian cancer. 
• Endometrial ablation is a heat treatment of the endometrium that can reduce or stop bleeding

Vasomotor Symptoms (Hot Flashes)

Eighty percent of perimenopausal women experience vasomotor symptoms, commonly known as hot flashes. Hot flashes are your body’s reaction to having lower levels of estrogen and usually last for about two years. Many women experience sweating or an overall feeling of heat coming from within, which can be a source of embarrassment in work or social situations. When occurring at night, this is often called night sweats and may be disruptive to sleep.

Depending on the severity and frequency of the hot flashes and your medical history, your doctor may recommend hormone replacement therapy or other options.

You Are Not Alone

There are many resources and treatment options that can help you transition through perimenopause and menopause. Don’t suffer in silence. Talk with friends and family, and most importantly, communicate openly with your doctor.