What You Need to Know about Perimenopause

The beginning and ending stages of a woman’s menstrual cycles get a lot of attention in our society. We know the signs of puberty in our tween and teen years, and we know the symptoms of menopause in midlife. But there is a transition phase in our menstrual cycle that does not get as much attention – it’s called perimenopause and it may come as a surprise to many women.

Symptoms of perimenopause can vary greatly, so it is often challenging for providers to diagnose. This can lead to a confusing and frustrating time for women. That’s why we’ve mapped out what you need to know about perimenopause and what you can do to help manage your symptoms. We hope that learning more about this topic will help you feel more comfortable about what you may be going through. And remember, your Women’s Health Connecticut provider is here to guide you and answer any of your questions.

What is perimenopause?

Perimenopause is a natural process caused when your ovaries gradually stop producing eggs. It typically occurs in the early 40s but may begin as early as the mid-30s, well before a woman officially enters menopause. On average, perimenopause can last from 4 to 6 years, but can also last for 10 years or more. It ends after a woman has gone 12 months without having her period (menopause).

How perimenopause affects your period

Perimenopause begins when periods are still reasonably regular, but the menstrual cycle length may shorten slightly and there may be some stretches of irregular bleeding. This is due to the fluctuation of estrogen levels and low progesterone (female hormones). As women get older, some of their eggs may not be as healthy and progesterone levels may be unpredictable. So, the uterus lining may start to fall out early or intermittently. If the egg isn’t released at all, the lining of the uterus never gets ready for pregnancy and may grow enough to start bleeding instead of falling out. This usually causes more painful flow and more blood clotting.

The normal balance between estrogen and progesterone is key to making you feel “normal”, so you may feel quite differently during these times. But even during perimenopause, some cycles, controlled by a healthy egg, may be completely normal so the symptoms may be intermittent. And sometimes, estrogen levels, which come from the ovary, may fluctuate, with drops leading to hot flashes.  

Signs of perimenopause

There are two stages of perimenopause, early and late. Early perimenopause typically begins when a woman is 35 to 42 years old. Late perimenopause generally begins at 45 to 50 years of age. Since a woman’s hormones levels can fluctuate during perimenopause, it may be tricky for your doctor to make a diagnosis.

Symptoms of perimenopause may include (not all women experience symptoms):

• Heavy flow – imbalanced hormone levels can lead to a heavier flow.
• Disrupted sleep - middle of the night waking, having trouble falling asleep, waking early
• Mood changes - new or increased feelings of anxiety, irritability or depression
• Night sweats and hot flashes - a change in hormone levels can cause changes in our internal thermostat
• Sore breasts - erratic estrogen levels can cause breast tenderness to occur
• Headaches – premenstrual headaches can begin or increase during this time
• Weight gain – the relatively high estrogen (as compared to lower progesterone) of early perimenopause makes gaining weight more likely
• Cramps – often times, cramps that once occurred in your 20s have returned
• Shorter cycles – slightly shorter cycles by an average of 27 days
• Low libido – lack of interest in sex is common
• Vaginal dryness – this can be caused by the decline in estrogen levels
• Brain fog – memory issues or being forgetful

Perimenopause treatments

Not every woman needs to be treated, but if perimenopause symptoms are bothering you excessively, your Women’s Health Connecticut provider can work with you to recommend treatment options to help ease symptoms. Some options may include birth control pills, vitamins, or herbal supplements. Life style changes such as being on a healthy diet, not smoking or drinking alcohol, getting enough rest and staying at a healthy weight can also help. 

For more information about perimenopause, please contact your Women’s Health Connecticut provider. 

Additional Resources