Understanding the menopause process can take the anxiety out of the experience and help you take charge of your body as you approach your reproductive system’s second act. Ahead, everything you’ve ever wanted to know about perimenopause.
What exactly is perimenopause?
Perimenopause is the phase leading up to menopause, when your ovaries decrease production of sex hormones called estrogen and progesterone. This phase, sometimes called the menopause transition, usually lasts for a couple of years. No matter when you start perimenopause, you’ll likely experience a few physical and emotional changes, including night sweats and hot flashes, in the early phase.Most notably, perimenopause causes changes to your menstrual cycle. At first your periods may be way heavier or more painful than usual. As your ovaries release less estrogen, your periods may become spotty or irregular, with increasingly longer stretches between them. It’s in these longer intervals that you are likely to experience night sweats and hot flashes. (Then, when they go away, look for a period.) It’s also harder to get pregnant as you get older, because your ovaries are releasing fewer quality eggs every month.
While everybody is different, the following signs and symptoms of perimenopause are very common:
- Irregular periods
- Hot flashes
- Night sweats
- Trouble sleeping
- Mood swings
- Anxiety
- Fatigue
- Brain fog
- Breast tenderness
- Weight gain
- Joint or muscle pain
- Brittle hair and nails
- Dry skin
- Dry eyes
- Acne
- Digestion problems
- Loss of libido
- Pain during sex
- Urinary or vaginal infections
- Cramps
In general, women experience more symptoms the closer they get to full-on menopause, kind of like a crescendo.
When does perimenopause start?
Perimenopause can be quite a long process, starting with mild symptoms as early as your mid-30s. Most women report more noticeable manifestations (like hot flashes) by their mid-40s. Menopause usually hits by around age 50.
Perimenopause is considered to be a few years before your period stops, maybe up to five years. It’s also not always linear: You can have perimenopausal symptoms and skip cycles, then go right back into regular cycles.
A few factors can cause menopause to occur even earlier. Anyone who has their ovaries surgically removed will go into menopause right away, without a perimenopausal phase. Having your uterus removed, even without your ovaries, can result in early menopause as well (but probably not by a lot). Cancer medications, such as chemotherapy, and smoking have been shown to affect menopause age. Your race is also a contributing factor: In general, women of color are more like to hit menopause first and can experience worse symptoms.
When does perimenopause end?
Once you go twelve months without a period, you are no longer in perimenopause. Congratulations! You’re in menopause. See ya, PMS.
Can I get pregnant during perimenopause?
Yes! In our mothers’ time, “change of life” babies were the products of unexpected midlife pregnancies. During perimenopause, your cycle may become irregular, making it harder to pinpoint when you could get pregnant. If you’re not looking to add to your family (or to become a mother for the first time), stay on your birth control until you have gone 12 months without your period. By then you’ll be in menopause and won’t have that concern.
I think I’m in perimenopause. Now what?
If you think you’re in perimenopause, start keeping track of your symptoms so you can pick up on patterns and start seeking relief for symptoms that may be bothering you. Your healthcare provider is your best resource for determining what’s going on in your body at any given time. While some doctors order lab tests to pinpoint hormonal fluctuations, your symptoms, age, and personal risk factors are the best indicators of whether you’re experiencing perimenopause.
It’s important to touch base with your healthcare provider during the perimenopause phase for a few reasons. First, a doctor can recommend lifestyle changes and medication to help resolve your symptoms. Hormonal replacement therapy (HRT) was more controversial in the past, but these days the benefits outweigh the risks for many women. If you have severe symptoms that interfere with how you function day-to-day, talk to your provider about hormones.
Women can also find relief from alternative treatments such as acupuncture.
Along with triggering difficult symptoms, perimenopause is also a time of increased health risks. Estrogen plays a pivotal role in your overall health, affecting your cardiovascular system, your bones, and even your mood. Ask your primary care provider or gynecologist about the steps to take in order to protect your health as you get older.
It's not all bad news, we swear!
Perimenopause can be a challenging time, but you don’t have to — and shouldn’t — go it alone. Empowering yourself with knowledge about your changing body and practicing self-care and self-advocacy are paramount in this phase of life. The good news is, many of the lifestyle changes that can keep you healthy long-term can also help keep symptoms at bay — a win-win!
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