Perimenopause is that period before the onset of menopause. For some women, perimenopause can last as long as 3-4 years until the ovaries stop releasing eggs all together. During this time of “menopause transition,” the ovaries produce less estrogen and many patients begin to have menopause symptoms.
Irregular periods in your 40s may be a sign of perimenopause and rarely some patients may start this transition in the mid-30s. While the average age of menopause is 52, the perimenopausal transition time frame and the symptoms that are experienced can vary greatly. Perimenopause ends when you have gone a complete year (12 months) without a menstrual cycle.
During a normal menstrual cycle, both estrogen and progesterone levels rise and fall. Most of the symptoms of perimenopause are due to the variation in baseline estrogen levels. It is the fluctuations of these hormones and their impact on the body that produces the wide range of symptoms. While checking blood hormone levels can help guide treatment, the diagnosis of perimenopause can be made based upon your symptoms alone.
The severity and age at which you experience symptoms varies. Smoking, family history, history of cancer treatment or a previous hysterectomy may contribute to experiencing perimenopause at an earlier age.
Symptoms can include:
There are many over the counter treatments options and supplements that are aimed at treating mild symptoms such as vaginal dryness, loss of lubrication and hot flashes. For some women, these options may provide relief. When symptoms are unresponsive however or when they are severe prescriptions options are also available.
Hormone replacement therapy is a very popular treatment for perimenopause and menopause symptoms. A low dose birth control is one simple option. The “pill” suppresses the ovary and therefore reduces the fluctuations in estrogen and progesterone levels. Estrogen pills, patches and creams are often very effective at relieving hot flashes, night sweats and the more severe symptoms that women experience. Estrogen can also help prevent bone loss. Oftentimes when long term treatment is pursued, a progestin may be prescribed as well.
There are many routes for delivering hormone replacement and sometimes localized treatments are better for certain symptoms. For example, vaginal estrogen is often used to relieve vaginal dryness. Vaginal estrogen may used directly in the vagina in the form of a tablet, ring or cream. Other symptoms that can be improved can also include painful intercourse, chronic discharge and irritation and some urinary symptoms.
Increased irritability, mood swings and even depression can occur during perimenopause. Aside from improving mood symptoms and sleep disturbance, certain antidepressants may actually help with hot flashes and may be useful in situations where estrogen is contraindicated due to certain medical conditions or a history of breast cancer.
There are many options for management of symptoms. Some women respond better to certain regimens than others. For women who require prescription medications the lowest effective dose for the shortest duration is what is oftentimes preferred. Be sure to set up a consultation to see which options might be best for you.
While some degree of menstrual irregularity can be common during perimenopause, there can be other more serious causes that must also be ruled out before initiating any form of treatment. It is especially important to make an appointment for further evaluation if you experience any of the following symptoms:
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Your Doctors of Capital Women’s Care
Rockville and Silver Spring, Maryland