Perimenopause: How To Manage The Change Before The Change
The hormonal shifts of perimenopause can sometimes feel as changeable as the weather. One day there may be sudden heatwaves . The next, cloudy skies .
Women know there’s a forecast for big changes with menopause, which happens around the age of 50 to 52 the average age when our periods stop completely. Yet so much less is said about the stage before menopause perimenopause.
As a result, women often blame stress or age for symptoms actually caused by seesawing sex hormones the fluctuations of oestrogen and progesterone in the years leading up to menopause.
What Are The First Signs Of Perimenopause
Generally, the first sign of perimenopause is irregular periods. Most people will go from having fairly predictable menstrual cycles to unpredictable cycles. A lot of people also experience the most common signs of menopause like hot flashes and vaginal dryness fairly early into the menopause transition.
What Are The Symptoms Of Premature Menopause
Symptoms of premature menopause are often the same as those experienced by women undergoing natural menopause and may include:
- Irregular or missed periods
- Periods that are heavier or lighter than usual
These VMS are a sign that the ovaries are producing less estrogen.
Along with the above symptoms, some women may experience:
- You have undergone chemotherapy or radiation
- You or a family member has an autoimmune disorder such as hypothyroidism, Graves’ disease, or lupus
- You have unsuccessfully tried to become pregnant for more than a year
- Your mother or sister experienced premature menopause
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Can Perimenopause Be Treated
There isnt any treatment to stop perimenopause. Perimenopause is a natural part of life. The cure for perimenopause occurs when your periods stop and you enter menopause.
But your healthcare provider may recommend over-the-counter or prescription perimenopause treatment to help ease symptoms. Your provider may recommend:
- Antidepressants: These medications help with mood swings or depression.
- Birth control pills. These medications stabilize your hormone levels and typically relieve symptoms.
- Estrogen therapy: This treatment stabilizes estrogen levels. You may take estrogen therapy as a cream, gel, patch or swallowable pill.
- Gabapentin : This medicine is a seizure medication that also relieves hot flashes for some women.
- Vaginal creams: Your provider can tell you about prescription and over-the-counter options. Treatment can decrease pain related to sex and relieve vaginal dryness.
Your healthcare provider will discuss the risks and benefits of perimenopause treatment with you and recommend the best option based on your needs. Certain lifestyle changes like eating a healthy diet, light exercise and avoiding foods or activities that trigger hot flashes can also help.
But Theres Some Good News About Memory Loss
Just because brain fog is normal doesnt mean that you cant fight it! Your brains operational efficiency is largely dependent on the amount of oxygen provided to it by your bloodstream. So, whats good for your heart is good for your brain. This means a vigorous program of exercise, a healthy diet, and effective stress management. And work your brain! Crossword puzzles, reading difficult books, and similar brain exercises will maintain your brain function, including your recollection that it was the mayonnaise you were looking for.
Also, your brains unplanned vacation isnt permanent. The brain bounces back after menopause. It adapts to lower estrogen levels, and it compensates.
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Other Drugs Used For Menopausal Symptoms
Despite its risks, hormone therapy appears to be the most effective treatment for hot flashes. There are, however, nonhormonal treatments for hot flashes and other menopausal symptoms.
Antidepressants
The antidepressants known as selective serotonin-reuptake inhibitors are sometimes used for managing mood changes and hot flashes. A low-dose formulation of paroxetine is approved to treat moderate-to-severe hot flashes associated with menopause. Other SSRIs and similar antidepressant medicines are used “off-label” and may have some benefit too. They include fluoxetine , sertraline , venlafaxine , desvenlafaxine , paroxetine , and escitalopram .
Gabapentin
Several small studies have suggested that gabapentin , a drug used for seizures and nerve pain, may relieve hot flashes. This drug is sometimes prescribed “off-label” for treating hot flash symptoms. However, in 2013 the FDA decided against approving gabapentin for this indication because the drug demonstrated only modest benefit. Gabapentin may cause:
Period Could Skip A Whole Month
As mentioned, unless your period skips 12 months in a row, youre still not ready to forever bid farewell to your pads and tampons. Changes in the menstrual cycle after 40 also involve having a period skip a whole month on occasion. This is due to the fact that the production of estrogen at that point in time starts to slow down. This could lead to your body not being able to release an egg, which in turn means no period.
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At What Age Does Perimenopause Begin
Perimenopause begins about eight to 10 years before menopause. It usually starts in your mid-40s, but it can start earlier. Completing menopause before age 40 is called premature menopause. Some medical conditions or procedures cause early menopause. If there is no medical or surgical cause for premature menopause, it’s called primary ovarian insufficiency.
What Causes Perimenopause And When Does It Occur
Perimenopause is a natural part of the aging process. It happens when the ovaries no longer function consistently, which upsets hormonal rhythm and estrogen production, says Dr. Ross. Estrogen is the hormone that governs the female reproductive system, though it also plays a role in protecting other areas of the body, such as the brain, heart, skin and breasts.
As long as you have ovaries, you are fair game for premenopausal symptoms, Dr. Ross adds. While these hormonal changes most often begin between the ages of 40 and 55, she says there are some people for whom perimenopause will occur earlier in life. According to Dr. Ross, these include:
- Breast cancer patients undergoing chemotherapy
- Cigarette smokers
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Hot Flashes & Night Sweats
Hot flashes and night sweats are common symptoms of perimenopause and menopause, with over 85% of women reporting hot flashes. Hormone changes affect your bodys internal thermostat. A hot flash feels like a wave or sensation of heat across your face, neck, and chest. It can last for several minutes. Hot flashes can happen a few times a day, a few times a week, or less often.
Hot flashes that happen at night are called night sweats, which can cause women to wake up drenched in sweat and disturb sleep. Women are more likely to report hot flashes at night.
What Fsh Level Means Perimenopause
FSH is a hormone produced by the pituitary gland the gland located at the base of your brain. It stimulates the ovaries to release an egg during ovulation. Testing your FSH level can help confirm menopause has started. A consistently high level of FSH can indicate menopause. However, FSH tests can be misleading because during perimenopause your hormones rise and fall erratically. Certain medications, like birth control pills or hormone therapy, interfere with hormone levels and will affect the results of any hormone tests. Overactive thyroid and high prolactin can also alter those results.
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Your Pms Can Feel Even Worse
All those hormonal ups and downs that start after 40 can affect your mood and emotions before your period begins. “As the hormones fluctuate more dramatically, those women who have mood symptoms with their periods tend to see more fluctuations in those moods,” said Dr. Dunsmoor-Su. “Some women get very depressed as the hormonal fluctuations become more significant.”
If you are becoming significantly depressed, don’t hesitate to reach out to your healthcare provider “Anti-depressants are very helpful in this kind of depression, and if left untreated, it can become very severe during the menopausal transition,” Dr. Dunsmoor-Su said.
Why Am I Gaining Weight During Perimenopause
The shift in hormones slows down your metabolism. Its very common for women in perimenopause to gain weight once their estrogen levels start to decline. Maintaining a healthy diet and regular exercise can help prevent weight gain during the transition to menopause.
A note from Cleveland Clinic
Perimenopause is the transition to menopause. During perimenopause, you may start having menopause-like symptoms, such as hot flashes, mood swings or vaginal dryness. Most perimenopause symptoms are manageable. But if you need help managing symptoms, medications and other treatments are available. Perimenopause ends when youve had no period for a full year. At that point, you enter menopause.
Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.
References
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Looking At The Bright Side
Treating acne can take a long time. For many women, breakouts dont go away for at least 2 months after starting treatment. However, the bright side is that hormonal changes do not last forever. Eventually, hormones even out, and so do symptoms. For more information about perimenopause symptoms and hormonal acne, speak with a healthcare provider.
What Are Periods Like During Perimenopause
Your body is producing less of the hormones that help you ovulate, so your periods can become irregular. Your menstrual cycle could become longer or shorter than usual. Your bleeding could also be heavier or lighter than normal. Some people also notice a change in their premenstrual syndrome symptoms.
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Problems With The Master Gland
The pituitary gland is a small structure located at the base of the brain. It is known as the “master gland” because it produces several hormones that affect many bodily processes and other endocrine glands. Hormones produced by the pituitary gland include prolactin, growth hormone , thyroid-stimulating hormone , luteinizing hormone , adenocorticotropin , and follicle-stimulating hormone . The pituitary gland also releases antidiuretic hormone and oxytocin. A pituitary gland tumor is the most common kind of pituitary disorder. They are usually benign . Sometimes these tumors secrete more or less of hormones made by the pituitary gland. Other tumors don’t secrete anything. Some pituitary tumors produce symptoms because they grow large enough to affect the functioning of the pituitary gland or surrounding brain structures.
Your Circadian Rhythm Is Off
The pineal gland is a small endocrine gland that is located in the brain. It produces melatonin, which affects circadian rhythm and the levels of other hormones in the body. A pineal cyst is a disorder of the pineal gland that may not produce any symptoms. If the cyst is large, it may produce symptoms including water on the brain , headache, eye problems, and vision problems. Large pineal cysts that cause problems usually affect women who are in their second decade of life.
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Is Early Menopause The Same As Perimenopause
No, perimenopause is a stage where your estrogen levels drop down effecting your menstrual cycle among other things. It starts almost a decade before your menopause.Menopause is the end of menstrual cycle. If it happens to women younger than 45 years, it is called early menopause. It is the phase where a woman does not get menstrual periods for at least 12 months.In simple words, perimenopause is the beginning of the end and early menopause is the end.
Keeping An Active Sex Life
Menopause can reduce a persons sex drive and lead to vaginal dryness, but it also removes the need for birth control. For some, this can make sex more enjoyable.
Having sex often can increase vaginal blood flow and help keep the tissues healthy.
Some tips for maintaining sexual health and activity during menopause include:
- staying physically active
- avoiding tobacco products, recreational drugs, and alcohol
- taking the time to become aroused, which will improve lubrication
- doing Kegel exercises to strengthen the pelvic floor
It is worth remembering that, while a woman cannot become pregnant once menopause starts, it is still important to use barrier protection during penetrative sex to protect against sexually transmitted infections.
Often, sexual partners will be getting older and may be experiencing menopause at the same time. They, too, may be feeling a drop in sex drive. Opening up about any concerns can help both partners feel better and explore new forms of intimacy.
Menopause is a stage in life, not an illness. Most women experience natural menopause during midlife. However, surgery and other factors can cause menopause to start earlier.
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How Do Hormones Work
When women begin entering menopause, estrogen, the female hormones, decrease while androgen increases. This increase in androgens can lead to acne and other problems. However, there are other lifestyle factors that can play a role in acne risk. Genetics, stress, and sleep problems can all lead to increased breakouts.
Hormonal Imbalance And Fatigue
Fatigue is a common symptom that may have many potential underlying causes. Just as too little progesterone can make it hard to sleep, too much progesterone can make you more tired. Another common hormonal imbalance that causes fatigue is low thyroid hormone levels . This condition is easily diagnosed with a blood test. If your levels are low, you can take prescription medication to bring your levels back up to normal. Regardless of any hormone imbalance that may exist, practice good sleep hygiene to optimize your sleep. This involves going to bed and waking up at the same time every day, even on the weekends. Avoid alcohol, caffeine, and exercise from the late afternoon on to avoid interfering with sleep. Establish a relaxing nighttime routine to give your body the message that it’s time for sleep. Take a warm bath, sip a cup of chamomile tea, or listen to relaxing music.
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Menopause Symptoms At Age 45
Around the age of 45, many women enter pre-menopause and start to notice the first signs that menopause is coming. For some women, the symptoms are mild and short-lasting. For others, menopause symptoms can be disruptive and long-lasting.
Some of the earliest signs of menopause may include:
Changes to your period
Period changes are usually the first signs of menopause. For example, your period may start to happen every 6-8 weeks. Or you may miss a couple months before it comes back again. You may also have a heavier flow or a lighter flow from time to time.
That said, its important to know you can still get pregnant during perimenopause. So, continue to use birth control in the lead up to menopause as you normally would. Also, if youve missed your period and youre not sure whether perimenopause has started, consider taking a pregnancy test as a first step.
Mood changes
As your hormone levels change, you may find yourself feeling more irritable, anxious, sad or forgetful than usual. Your sex drive can also decrease or increase.
These changes are very typical as your body approaches menopause. So be kind to yourself, practice self-care and ask for help if youre having trouble.
Sleeping problems
You may find it difficult to fall asleep, or you may wake up in the middle of the. Sleep trouble can contribute to a persistent feeling of tiredness, which can also affect your mood.
What Are The Hormonal Changes During Perimenopause
The hormonal changes you experience during perimenopause are mostly caused by declining estrogen levels. Your ovaries make estrogen, which plays a vital role in maintaining the reproductive system. Once you enter perimenopause, your estrogen levels start to decrease. As estrogen decreases, it throws off the balance with progesterone, another hormone produces by the ovaries. These two hormones together are responsible for ovulation and menstruation. Its common for hormone levels to fluctuate during perimenopause to go up and down like a rollercoaster.
When you reach menopause, your body makes so little estrogen that your ovaries no longer release eggs. At this point, you stop having your period.
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What Influences Appetite And Weight
When Estrogen Drops, Hunger Increases
Fluctuating hormones, including a decrease in estrogen levels during a woman’s monthly cycle, may trigger mood changes in some women. Some females may reach for comfort foods that are high in fat, calories, sugar, and salt in an effort to feel better. Sadly, eating these foods backfires and makes women feel worse. Sodium increases water retention and bloating. Sugar, excess fat and calories will lead you to pack on the pounds. Falling estrogen levels also affect leptin, a hormone that inhibits hunger. Combat hormonal weight gain by adopting a healthy diet and exercise plan. Stick to lean meats, healthy fats, complex carbs, whole grains, and fresh fruits and vegetables to help prevent PMS and encourage healthy blood sugar levels and weight loss.
How Is Premature Menopause Treated
The symptoms and health risks of premature menopause, as well as the emotional issues that may result from it, can be managed with the methods similar to those used for natural menopause. Women dealing with infertility that is brought on by premature menopause may want to discuss their options with their doctor or with a reproductive specialist.
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Changes In Premenstrual Syndrome And Changes In Mood Overall
Premenstrual syndrome, the condition that occurs in the days before a womans period, can become more severe during the perimenopausal phase. People in the perimenopause phase can also experience problems like depression, irritability, and feelings of stress or anxiety. People who have experienced mood disorders throughout their life are more likely to experience these problems during perimenopause.
Vaginal Dryness And Discomfort
Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex. Also, if the skin breaks, this can increase the risk of infection.
Atrophic vaginitis, which involves thinning, drying, and inflammation of the vaginal wall, can sometimes occur during menopause.
Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.
Learn more about atrophic vaginitis here.
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