Information About Perimenopause

What is peri-menopause?
Peri-menopause is an imprecisely defined term to describe the time period and the symptoms that precede menopause. Menopause is defined retrospectively--it is when one year has passed without menses. The average age for menopause is 51-52, but the body starts preparing for menopause years in advance. The biological changes that take place in the seven to eight years prior to menopause (around 45 or so) are referred to as peri-menopause, or menopausal transition. It signals the beginning of decline in estrogen production and childbearing potential (although pregnancy is still a possibility and birth control should be used, as needed).

As a woman's ovaries begin to wind down to the menopausal state, the regular pattern of the menstrual cycle becomes disrupted. Typical peri-menopause periods come closer together than before, initially. This is the very first sign for many women. Later on they come farther apart. After that, the woman may begin to miss months. By this time, she usually has other symptoms and is approaching the average age of menopause. Still, it is not uncommon for women to experience a mixture of normal, short and long cycles during peri-menopause. Bleeding may also become heavier. The frequency of cycles may also decline. These changes may be subtle at first becoming more and more noticeable. It is much like the irregularities of puberty. In fact, it can be thought of as adolescence in reverse.

Pre-menopausal (which simply means "before menopause" and not to be confused with peri-menopause itself) menstrual changes can begin in the 30s. It is normal for periods to become heavier, PMS to increase, and other changes in the cycle to occur. Many women in their thirties fear they are going approaching an early menopause. They are not. These changes are not associated with the major decline and fluctuations in hormone levels of impending menopause. Perhaps the best indicator of peri-menopause are the non-menstrual symptoms.

Peri-menopause, like menopause itself, is much more than the pattern on menstruation. Hot flashes may be the first sign that really gets a woman's attention. They typically begin in the final years of perimenopause, about 1-4 years prior to actual menopause. These are feelings of heat that spread over the body, and usually include a flushed face and sweating. While most uncomfortable at night, hot flashes can appear at any time of the day without warning. Drying and thinning of the vaginal tissues is another. The tissues supporting the pelvic organs lose their elasticity resulting in painful intercourse, or urinary tract problems. Insomnia, irritability, and forgetfulness lead the list of psychological symptoms associated with peri-menopause.

Many women have had their doctors tell them that they are not in peri-menopause, in spite of a host of very obvious symptoms, because they have normal FSH (follicular stimulating hormone), the blood test for menopause. The elevation of FSH is one of the last signs to reveal itself, so a normal level definitely does not mean that a woman is not in peri-menopause. It does mean that there is no concrete test for this and you have to monitor your symptoms and make a judgement call.

Hypothyroid occurs more often in women and in the same age groups as perimenopause. Menstrual irregularities are a major sign in women with thyroid. Fatigue, forgetfulness, and dryness also overlap. But, those with hypothyroidism will feel cold not have hot flashes. Still, flashes come later and the early perimenopause may be confused with it. Simple lab tests can tell a woman for certain.

Low-dose birth control pills have gained popularity as a treatment for peri-menopausal symptoms. They are not for everyone, but work well in many women. Essentially, they work by boosting and smoothing out your own declining and fluctuating hormone levels. Lifestyle adjustments and herbal treatments are also popular.

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