(Updated November 2008)
Perimenopause is the period of time before menopause when a woman’s body changes. Perimenopause is a normal transition in a woman’s life. Although each woman’s experience can be different, most women experience a decreased ability to become pregnant, and irregular and sometimes heavy menstrual periods.
When does perimenopause occur?
Perimenopause can last from two to ten years. It occurs before menopause. Menopause usually occurs between the ages of 45 and 55.
How will I recognize perimenopause?
Possible changes you might expect during perimenopause include:
- Changes in menstrual cycle
- Vaginal dryness
- Decreased bone density
- Unpredictable breast tenderness
- Skin changes
Changes in menstrual cycle
The most common early sign of perimenopause is a change in your menstrual cycle. Often, the amount of time between bleeding becomes shorter and the bleeding becomes heavier. You should talk to your health care professional (doctor, nurse practitioner, physician assistant, midwife) if you are experiencing heavy vaginal bleeding, long intervals of spotting, or have gone more than two months without a period.
Variations in breast tenderness or fullness are common in all women throughout the menstrual cycle and pregnancy. During perimenopause, you may be unable to predict breast tenderness or fullness as your cycle changes. Any lumps in your breast or fluid leaking from the nipple should be evaluated by your health care professional.
Will I experience emotional changes?
During mid-life, emotional swings can occur in everyone, both men and women. They are often about issues such as children leaving home, parents growing older, or career changes. They are not usually due to hormonal changes that come with perimenopause.
Hormonal shifts during perimenopause can cause sleep disturbances. Lack of sleep can lead to fatigue and a decreased sense of well-being. Hormonal shifts can also cause mood swings, similar to what some women experience during a menstrual cycle, only less predictable.
Should I still use birth control?
It is possible to become pregnant during perimenopause. Most women in their early to mid 40s still ovulate regularly and are at risk for an unintended pregnancy. The medical risks associated with pregnancy increase a lot during this time in a woman’s life. To avoid unintended pregnancy, contraception is an important part of health planning.
Low-dose birth control pills are one option during perimenopause. Low-dose birth control pills can correct irregular bleeding, help with hot flashes and night sweats, and reduce the risk of ovarian and uterine cancer. They can also serve as a transition to hormone therapy after menopause.
Contraceptive hormonal implants, transdermal patches, or injectables may also offer other health benefits. The intrauterine device (IUD), including the hormone-releasing IUD, can be a good method during this time. Male and female condoms, cervical caps, the sponge, the diaphragm, and spermicides can also be good contraceptive options. Condoms (both male and female) can also help you reduce the risk of contracting a sexually transmitted infection.
No one method is perfect for every person, so talk to your health care professional to find out which method is best for you. If unprotected sex should occur, emergency contraception is always an option Visit www.not-2-late.com for more information about emergency contraception.
Will my sex life change?
Most women do not experience major changes in their sex lives during perimenopause. You may notice more vaginal dryness. This is your body’s normal response to a decreased level of the hormone estrogen. Your health care professional can discuss the options available to deal with vaginal dryness, such as use of over-the-counter lubricants. Once you reach menopause, you may also want to discuss a prescription hormone therapy or vaginal estrogen cream to help alleviate vaginal dryness.
Some women experience a decrease in sexual desire during perimenopause or after menopause. This may be due to a number of different factors that are not physical. If you experience a loss of sexual desire which concerns you, there are a number of hormonal treatments available that can help. Consult your health care professional on available options.
What therapies can help?
Menopausal hormone therapy is considered safe for healthy women in the first five years after menopause. Menopausal hormone therapy is recommended only as a short-term treatment of moderate to severe symptoms such as hot flashes or night sweats. Long-term use of menopausal hormone therapy is not usually advised as it may increase risk of heart disease and breast cancer for some women. Consult with your health care professional to balance the benefits and risks of hormone therapy to make the best decision for your health and well-being.
A number of alternative therapies—in the form of herbal supplements, special diets, and exercise and relaxation techniques such as yoga and meditation—have shown promise and are gaining popularity among women in perimenopause.
There are also a number of herbal remedies that may help some women with perimenopausal symptoms. However, the majority of these herbs and supplements have not yet been adequately studied, researched, or regulated, and there is no assurance about the content of the products.
What else should I do to maintain my health?
Perimenopause is a good time to plan for a vigorous, healthy second half of your life. That means establishing a healthy lifestyle, which includes activities such as regular weight-bearing exercise, a healthy diet, and stopping smoking. If you are not already maintaining a healthy lifestyle, now is a good time to start.
See your health care professional to schedule a regular mammography and blood tests that will screen for diabetes and high lipids (cholesterol). Without these tests, diabetes and high cholesterol can go unchecked for long periods of time and damage your body without symptoms. Early treatment can prevent major complications later in life. You may also want to consider a bone density test, which is recommended for women under 65 who have one or more risk factors for osteoporosis. Risk factors include a close relative with osteoporosis, smoking, and a slender build.
For more information about perimenopause, please ask your health care professional, or contact:
- Association of Reproductive Health Professionals (ARHP)
Sex & A Healthier You program: www.sexandahealthieryou.org
- The North American Menopause Society (NAMS)
About Audrey Kelly, PharmD