Perimenopause

Perimenopause means the time period during which a woman’s body makes its natural transition toward permanent infertility called menopause. Perimenopause is also called the menopausal transition. Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40’s. But some women notice changes as early as their mid-30’s. The level of your estrogen the main female hormone rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg. Treatments are available to help ease these symptoms. Once you’ve gone through 12 consecutive months without a menstrual period, you have officially reached menopause, and the perimenopause period is over.

Symptoms
During the perimenopausal period some subtle and some not so subtle changes in your body may occur. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you’re likely in late perimenopause. Many women experience hot flashes during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them. Some women experience mood swings, irritability or increased risk of depression during perimenopause, but the cause of these symptoms may be sleep disruption caused by hot flashes. However, as long as you’re having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you’ve had no periods for 12 months. During perimenopause, sexual arousal and desire may change.
Treatment
Drug therapy is often used to treat perimenopausal symptoms. Systemic estrogen therapy which comes in pill, skin patch, gel or cream form remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms. An antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.