The Rocky Road to Menopause- Perimenopause 

Overview  

You’re in your 40s, you frequently experience irregular periods with heavy bleeding, and you frequently wake up sweating at night. You most likely are experiencing perimenopause. As their hormones change in the months or years prior to menopause, which is the end of menstruation naturally, many women suffer a variety of symptoms.   

While perimenopause is a prolonged transitional period, menopause is a specific point in time (peri is Greek for around or near). Although it technically ends a year before perimenopause, it is also mostly referred to as the menopausal transition.  

What is perimenopause?  

Your body begins to transition to menopause during the perimenopause, also known as the menopause transition. Your ovaries start producing fewer hormones during this phase, which makes your menstrual cycle unpredictable or irregular. Your body is currently heading towards the conclusion of its reproductive years.  

You can have perimenopause starting in your mid-30s or as late as your mid-50s. Some people only experience perimenopause temporarily. But for many others, it continues for four to eight years. When your cycles become unpredictable, this period is known as perimenopause.  

Hormonal changes during perimenopause  

Your dropping oestrogen levels are mostly responsible for the hormonal changes you go through throughout the perimenopause stage. Your ovaries produce oestrogen, which is essential for the preservation of the reproductive system. Your oestrogen levels start to fall as you reach perimenopause.   

As oestrogen levels fall, progesterone, another hormone made by the ovaries, is thrown out of equilibrium. Together, these two hormones oversee ovulation and menstruation. During perimenopause, hormone levels frequently change and ride a rollercoaster of ups and downs.  

Your body produces such a low amount of oestrogen during menopause that your ovaries stop producing eggs. You stop getting your menstruation at this point.  

Symptoms  

During menopausal transitions, you could see some subtle and not-so-subtle changes in your body. The duration of these symptoms of perimenopause can vary . 

Mood changes  

Perimenopause might cause depression ,mood fluctuations, irritation. These symptoms could be due to hot flashes that interrupts sleep.  

Loss of bone  

You have a chance of developing osteoporosis, it is a condition that causes weak bones, rises when your oestrogen levels decline because you begin to lose bone more quickly than you can repair it.  

Irregular periods  

The interval between periods could go longer or shorter, your flow could be light or heavy, and you might skip some cycles as ovulation becomes more unpredictable. If the duration of your menstrual cycle consistently changes by seven days or more, you may be in the early stages of perimenopause. You are probably in late perimenopause if it has been 60 days or longer since your last menstruation.  

Hot flashes and sleep problems  

Perimenopause is known for its frequent hot flashes. The degree, duration, and frequency all differ. Hot flashes or night sweats are frequently the cause of sleep issues, though this is not always the case.  

Vaginal problems  

Your vaginal tissues may become less elastic and lubricated when your oestrogen levels drop. If your oestrogen levels are low you could be more susceptible to vaginal problems. 

Decrease in fertility  

If your ovulation is erratic your chance of getting pregnant falls . As long as you are still getting your period pregnancy is still possible. If you want to avoid getting pregnant , use birth control until you haven’t had a period in 12 months. 

Irregular periods  

The interval between periods may be greater or shorter, your flow may be mild to strong, and you may skip some cycles as ovulation becomes more unpredictable.  

Complications  

Period irregularities are a defining feature of perimenopause. The majority of the time, this is normal and of no consequence. However, in the event that:  

• You have to keep changing pads or tampons every two or more hours because of the intense bleeding.  
• Greater than seven-day bleeding  
• Bleeding happens during menstruation.  
• Periods typically last shorter than 21 days.  

These warning signs could point to a reproductive system issue that needs to be identified and treated.  

Risk factors  

Menopause is a typical life stage. However, some women could experience it earlier than others. Factors that increase your chance of getting menopause earlier are  

Treatment for cancer  

Early menopause has been connected to chemotherapy and pelvic radiation therapy for cancer treatment.  

Smoking  

Women who smoke start the menopause one to two years earlier than women who don’t smoke.  

Hysterectomy  

Typically, menopause is not brought on by hysterectomies that only remove the uterus but leave the ovaries in place. Your ovaries continue to produce oestrogen even when you are no longer menstruating. However, such a procedure can result in menopause starting earlier than usual. In addition, removing one ovary may cause the remaining ovary to stop producing eggs earlier than intended.  

Family background  

Women who have experienced early menopause in their families may do so again.  

Health risks associated with perimenopause  

Menopause, which occurs immediately following perimenopause, is accompanied by health hazards. Your bones’ ability to last is significantly influenced by oestrogen. The inside of your bones becomes less dense and more brittle when you have osteoporosis.  

This increases your chance of breaking a bone. Your doctor might advise taking a multivitamin, taking calcium supplements, getting additional vitamin D, or doing more weight-bearing workouts.  

Heart disease and other cardiovascular health issues are also more common in menopausal women.  

Diagnosis  

Perimenopause is a procedure, a change that happens gradually. You cannot tell if you are in perimenopause by relying solely on one test or indication. Your age, previous menstruation history, and any symptoms or physical changes you’re noticing are just a few of the factors your doctor will take into account.  

Some doctors may test your hormone levels. Hormone testing, however, is rarely required or helpful to assess perimenopause other than to examine thyroid health, which might alter hormone levels.  

Treatment  

Hormone treatment  

The most effective treatment for perimenopausal and menopausal hot flashes and night sweats is still systemic oestrogen therapy, which can be administered as pills, skin patches, sprays, gels, or creams. Your doctor may suggest oestrogen in the lowest dose required to relieve your symptoms, according to your personal and family medical history. You will require progestin in addition to oestrogen if your uterus is still present. Oestrogen in the body can stop bone loss.  

Vaginal oestrogen  

The vagina can get oestrogen directly by a vaginal pill, ring, or cream. Only a tiny quantity of oestrogen is released during this procedure, and the vaginal tissue absorbs it. Vaginal dryness, discomfort during sexual activity, and some urinary symptoms can all be helped by it.  

Antidepressants  

Menopausal hot flashes can be reduced by a subset of antidepressants that is selective serotonin reuptake inhibitors (SSRIs). Women who need an antidepressant for a mood condition or who are unable to take oestrogen may find relief from hot flashes with an antidepressant.  

Gabapentin  

Gabapentin has been demonstrated to help lessen hot flashes, in addition to being approved to treat seizures. Women who suffer from migraines and are unable to take oestrogen therapy can benefit from this medication.  

Fezolinetant  

Menopause hot flashes can be treated with this medication without the use of hormones. It functions by obstructing a brain circuit that aids in controlling body temperature.  

Managing perimenopause symptoms at home  

Making these healthy lifestyle decisions may help reduce some perimenopause symptoms and encourage excellent health as you get older.  

Ease vaginal discomfort  

Use water-based vaginal lubricants that are available over-the-counter (Astroglide, K-Y Liquid, etc.) or moisturisers (Replens, Vagisil Prohydrate, etc.). If you are a woman who is sensitive to glycerin, look for goods without it because it might burn or irritate them.  

Eat well  

A nutritious diet is more essential than ever because of the risk of osteoporosis and heart disease rises throughout this time. Adopt a low-fat, high-fibre diet full of fresh produce, whole grains, green vegetables and fruits. Include foods high in calcium. If caffeine and alcohol tend to cause heat flashes, stay away from them.  

Consult your physician to determine the best type and dosage of calcium supplements for you to take. Take suggestions from your doctor if you should take calcium supplements as well, and if so, what kind and how much. You should also inquire about your need for more vitamin D, which aids calcium absorption.  

Physical activity  

Regular physical activity helps prevent weight gain, enhances sleep quality, and improves mood. Try to work out for at least 30 minutes most days of the week, but not immediately before bed.  

When should I call my doctor?  

You should consult your doctor if your perimenopausal symptoms are severe or are affecting your quality of life. They might be able to provide you with assistance or suggest a course of action to lessen the severity of your symptoms.  

Summary  

The transitional phases of perimenopause and menopause signal the end of your reproductive years. However, keep in mind that not all characteristics are bad. You can pass through these periods more easily and with a little bit more freedom if you use all of the treatments that are accessible.  

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