What Is Perimenopause? What Are Symptoms of Perimenopause?

Mature female friends walking on the beach
Symptoms of Perimenopause. Hero Images / Getty Images

Perimenopause literally means “around menopause” and refers to the months and years (up to 10) leading up to the last menstrual period plus 1 year after the last menstrual period, which defines menopause. Because the symptoms are most intense in the last 2 years of perimenopause, some women think they are in menopause, although they still are having irregular periods. 

Perimenopause is a time of widely fluctuating hormones and the stage when a woman’s menstrual cycle begins to change and become more and more irregular.

Estrogen and progesterone transition from balanced and synchronized to unbalanced and unsynchronized. Because the ovaries contain fewer eggs, they become more resistant to ovulation, which means releasing an egg, so the pituitary gland’s follicle-stimulating hormone (FSH) increases in an attempt to motivate the ovaries to release an egg. Increasing FSH levels determined by a blood test suggest that a woman is in perimenopause.

In 2012 a group of researchers from five countries and multiple disciplines reviewed all the blood tests and markers and symptoms of menopause studies from around the world and came to an agreement on how to define perimenopause. The large study was called STRAW (Stages of Reproductive Aging Workshop). The researchers couldn’t make sense of the information when they tried to define menopause and perimenopause symptoms by age. But when they looked at the onset of menopause as time “0” and then counted both forward and backward by years, suddenly the information lined up.

Perimenopause is defined in that study as the 2 years leading up to menopause, and menopause is defined as 1 year after the last menstrual period.                                                                          

Perhaps you’re hot one minute then pulling on a sweater the next because you’re chilled.

Maybe your thinking is a bit foggy and your mind doesn’t seem as sharp as it once was or all your pants are suddenly feeling a size too small. Do you have heart palpitations? Not interested in sex? Do you urinate more frequently than you used to? Are you 50 years old, give or take a few years? There’s probably nothing “wrong” with you. Your body is transitioning toward menopause.

Most young girls have the “talk” with their mothers or other women about menstruation, sex, and having babies. When a girl gets her period, she learns that she’s fertile and can expect to menstruate every month. On the other end of the age spectrum, women typically don’t have the “talk” with their mothers about menopause and aren’t taught what to expect. And your experience can be very different from those of your friends—either much easier or much more challenging.

For most, perimenopause comes on slowly and without much notice. You have an occasional heart palpitation. You find that it takes you longer to become sexually aroused. You’ve added a few pounds around the middle. Over time, more symptoms crop up, intensify, and become one perfect storm.

For many women, perimenopause and menopause are synonymous with getting old.

Just saying it carries a negative burden. The good news is, the more you understand your estrogen window, the more you will be able to put things in perspective and gain control over your symptoms. That will make you feel both healthier and happier. Another good thing is that most women only get some of the symptoms—almost no one gets them all.

“What is happening to my body and my brain?” Are you a woman who is used to juggling work, social, and family obligations and who once slept through the night and managed your days? Now, do you suddenly find yourself waking up at 4:00 a.m. with heart palpitations or feeling sleepy, anxious, or teary during the day?

Do you sometimes lose focus and have a shorter fuse than you used to? Throw in a few mood swings, headaches, and forgetting where the car is parked and you begin to wonder if something is physically or mentally wrong with you.

Hormonally, perimenopause looks like going through puberty backward, and it brings with it some of the same experiences. During perimenopause, shifting production levels of the hormones estrogen and progesterone cause periods to become irregular and vary in the amount of flow. A woman may have regular periods for 3 months, then none for 6, then periods that arrive regularly for several months, or periods for 6 months, none for 4, then heavy flow or light spotting in-between, and so on. The variables all depend on the individual woman. For the majority of women, perimenopause occurs during their forties, but like everything else on this journey, it may occur earlier or later.

A woman can expect to menstruate from about ages 12 and 1⁄2 to 51, roughly 35 to 40 years. During that time her ovaries have a reservoir of eggs, and some will be released each month throughout her reproductive years to make pregnancy possible. Women usually stop menstruating when they are pregnant or breastfeeding, but during that time their ovaries continue to produce eggs each month, so it doesn’t change the onset of menopause when the last egg has been released. The dwindling number of eggs ushers in irregular hormones and perimenopause.

Common Symptoms of Perimenopause

• Acne
• Anxiety
• Bloating
• Breast tenderness
• Crying
• Decreased libido
• Facial hair
• Forgetfulness
• Frequent need to urinate
• Hair loss or thinning
• Headaches
• Hot flashes
• Interrupted sleep
• Irregular periods
• Mood swings
• Night sweats
• Urinary incontinence
• Vaginal dryness
• Weight gain, especially around the middle

The average length of perimenopause and the most intense symptoms last for 4 years, but again, since everyone is different, that too can vary. Some women have symptoms for 10 years. Occasionally symptoms will last longer. Over time, estrogen levels will drop to pre-puberty levels, periods stop entirely, and it is no longer possible to become pregnant. During perimenopause, estrogen levels plunge and soar like a wild hormonal roller-coaster ride. Instead of estrogen and progesterone levels working together with precision, they work somewhat independently. Progesterone levels don’t typically rise unless the ovary ovulates an egg. Progesterone’s primary role is to stabilize the uterine lining so an embryo can implant (the word progesterone stems from “pro-gestation”), but progesterone also plays a role in a woman’s moods by attaching to the same sites in the brain as the neurochemical GABA, a hormone that helps reduce anxiety. Lower progesterone levels affect women differently, but persistently low levels are believed to play a major role in the mood changes and swings so often experienced by women during perimenopause and menopause.

As uncomfortable and as aggravating as perimenopause can be, know that, like puberty, it is only temporary and will end. The menopausal transition symptoms typically decline significantly 2 years after your last menstrual period, which is 1 year after menopause begins.

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