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Menopause does not happen all at once—it is a transition, and for most women, there is an early stage, called perimenopause, or menopausal transition, which starts before the actual onset of menopause. Perimenopause—peri, Greek for “around” or “near,” + menopause—usually starts between ages 40 and 55, but it can start much earlier. Perimenopause begins with the onset of irregular menstruation and lasts until 1 year after your last period.
During perimenopause, your ovaries slowly stop releasing eggs and producing hormones such as estrogen and progesterone.
This causes the signs and symptoms that people associate with menopause, such as irregular menses, hot flashes and mood swings.
Your periods may be irregular for a while—possibly for years—before menopause. But you can still get pregnant, so you should continue using contraception during this time if you want to avoid an unplanned pregnancy.
During perimenopause, you can have symptoms like menopause, such as hot flashes and mood changes. Your period may go away and come back at unpredictable intervals. Since intermittent ovulation can occur, you can still get pregnant in perimenopause.
For most women, perimenopause lasts two to eight years. You can’t say for sure that menopause has begun until a year has passed since your last period.
In perimenopause and shortly after menopause starts, you may have other changes, such as hot flashes, trouble sleeping, mood swings, and changes to your body, such as vaginal dryness. You may have changes in your sex drive and you may find it hard to focus on what you’re doing or find the right word.
After perimenopause is menopause. Technically, menopause is the specific moment when your periods stop, right after your last period. But of course without the passage of time there is no way for you to know definitively which is your final period. Menopause is confirmed when you have not had a period for a full year.
While these changes are normal and natural, you may feel a bit uncomfortable at times—please seek medical treatment if symptoms persist and become problematic for you.
During perimenopause, your body is preparing for menopause and your estrogen levels may go up and down. All women experience menopause at some point in their lives, typically between the ages of 45 and 55. Occasionally, women can experience premature menopause (onset before age 40). Menopause is a natural stage of the female body brought on by the ovaries’ decreased production of estrogen and progesterone. As estrogen and progesterone levels decrease, the woman no longer ovulates (her ovaries stop making and releasing eggs) and menstruation ceases.
Perimenopause is often self-diagnosed as it’s a natural occurrence of the female body—women who are approaching the menopausal age are expecting the change to occur and are generally familiar with the symptoms.
Gynecologists or general practitioners can also help to determine whether your symptoms are a result of menopause or another condition. Factors he or she may take into account include:
Some women may experience only a few symptoms of perimenopause while others experience many. Symptoms of perimenopause are similar to those of menopause, and may include:
Certain symptoms bother women to differing degrees. One of the main complaints for women in transition is hot flashes—a sudden, temporary sensation of heat experienced by some women during menopause.
The usual treatment for hot flashes and menopause symptoms is hormone replacement therapy, or HRT, though they can also be treated without hormones, using a type of antidepressant known as selective serotonin reuptake inhibitors(SSRIs), such as low-dose paroxetine, or Brisdelle.
Lifestyle changes may also help alleviate hot flashes, depending on your symptoms.
If you suffer from vaginal dryness, you can use a lubricant or moistener, and if symptoms persist, speak with your doctor about a topical estrogen cream.
Some women seek out alternative treatments to manage symptoms. The most commonly used alternative over-the-counter treatments are red clover, black cohosh, and soy supplements. Most controlled studies with these supplements do not demonstrate consistent improvement.
You can also manage these symptoms with lifestyle changes. Exercise and healthy eating make a big difference.
For instance, eating whole grains, fresh produce, and healthy fats can cut your risk of hot flashes by one-fifth.
Too much sugar and saturated fats can increase your risk by almost a quarter.
Other things you can do for yourself include dressing in layers that you can take off if you have a hot flash, decreasing stress, and making sure you get enough sleep.
Though perimenopause symptoms may be disruptive and last several years, there are lifestyle changes you can make that add immeasurably to your quality of life during your transition:
There are ways to treat the symptoms of perimenopause without hormone replacement therapy, though these alternative treatments are not FDA approved, and research is not always clear on effectiveness. Some of these treatments include:
Herbal Medicines. Research has shown that several herbal medicines may be useful in treating many perimenopausal and menopausal symptoms. Before taking natural or herbal products, discuss with your doctor, who will be able to notify you of any health risks and potential interactions with medications. Because natural products can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy. Some findings from this research are highlighted below.
Dietary supplements. Certain dietary supplements can help to restore deficiencies that may occur as a result of decreased estrogen and progesterone production. These include:
Bioidentical Hormone Replacement Therapy. Bioidentical hormone replacement therapy,” or BHRT, is a marketing term that is not recognized by the FDA. It is a term used to describe medications that are prepared in specialized pharmacies. BHRT may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone. Compounded bioidentical hormones are often marketed as natural and safe alternatives to conventional hormone therapy prescription medications. However, compounded formulas are often inconsistent and can vary depending on the batch or the pharmacist. While FDA-approved hormone preparations have been tested for efficacy, purity, safety, and potency, there is a lack of scientific evidence surrounding BHRT and the safety and efficacy of these compounds. As a result, compounded bioidentical hormones are not approved by the FDA. For additional information, see the FDA publication Bio-Identicals: Sorting Myths from Facts.
Acupuncture. Studies have shown that acupuncture, which aims to restore the bodily flow of energy through the insertion of needles into acupuncture points around the body, can help to reduce the severity of hot flashes and night sweats.
As you go through perimenopause, you may want to talk to your health care provider about what is going on. Here are some questions that might be good for you ask:
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