Perimenopause

Overview

Perimenopause is the time before menopause when your body is getting ready to stop having periods. Perimenopause is sometimes called the menopausal transition.

Women start perimenopause at different ages. You may notice signs, such as your periods becoming irregular, sometime in your 40s. But some women notice changes as early as their 30s or as late as their 50s.

During perimenopause, estrogen — the main female hormone in your body — rises and falls. Your periods may get longer or shorter. You may skip ovulation, which means your ovaries don't release an egg. You also may have symptoms such as hot flashes, trouble sleeping and vaginal dryness.

Once you've gone 12 months in a row without a menstrual period, you've reached menopause and perimenopause is over.

Symptoms

During perimenopause, you may notice changes in your body. Some changes are subtle and others are more obvious. You might have:

• Irregular periods. As ovulation becomes more unpredictable, the time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If the length of your periods is consistently different by seven days or more, you may be in early perimenopause. If you go 60 days or more between periods, you're likely in late perimenopause. If you go 12 months without a period and then start bleeding, talk to your healthcare professional right away. This could be a sign of a health issue.
• Hot flashes. Many people have hot flashes during perimenopause. Hot flashes can vary in how strong they are, how long they last and how often they happen.
• Sleep problems. Trouble sleeping is often due to hot flashes or night sweats, but not always. Changes in sleep patterns can happen in perimenopause even without hot flashes or night sweats.
• Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. Mood changes can happen for other reasons that are not related to perimenopause. For example, people with a history of hormonal mood changes such as premenstrual syndrome, premenstrual dysmorphic disorder or postpartum depression are more likely to have mood changes during perimenopause. People who have had mood disorders in the past, such as depression or anxiety, are also at risk.
• Vaginal and bladder problems. As estrogen levels drop, your vaginal tissues may become drier and less elastic, causing pain during sex. This dryness also can cause burning when you urinate, even if you do not have a urinary tract infection. It also can make you more likely to have urinary or vaginal infections. And you might leak urine more often, need to go more frequently or feel a stronger urge to go.
• Decreasing fertility. As ovulation becomes less regular, it's harder to get pregnant. However, if you're having periods, pregnancy is still possible. If you don't want to get pregnant, use birth control until you've gone 12 months without a period.
• Changes in sexual function. During perimenopause, sexual arousal and desire may change. Some women may not enjoy sex as much, while others enjoy it more. If you are concerned about your sexual health during or after perimenopause, talk to your healthcare professional.
• Loss of bone. As estrogen levels lower, you start to lose bone more quickly than you replace it. This increases your risk of a disease that causes fragile bones, called osteoporosis. People with osteoporosis are at risk of bone breaks.
• Changing cholesterol levels. Less estrogen may lead to changes in your blood cholesterol levels. This can include an increase in low-density lipoprotein (LDL) cholesterol, also called the "bad" cholesterol, which increases the risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol, also called the "good" cholesterol, decreases in many women as they age. Together, these changes increase the risk of heart disease.

When to see a doctor

Some women see a healthcare professional for their perimenopausal symptoms. But others either tolerate the changes or don't have symptoms that bother them. Because symptoms may be hard to notice and can happen slowly, you may not realize they are caused by perimenopause.

If any symptoms of perimenopause bother you, see your healthcare professional.

Causes

Perimenopause is caused by changes in two key female hormones: estrogen and progesterone. As you go through perimenopause, estrogen and progesterone rise and fall. Many of the changes you have during perimenopause are caused by lower estrogen.

Risk factors

Menopause is a natural phase of life. It may happen earlier in some women than in others. For example, in some women it may start early, such as before age 40, or between ages 40 and 45. Certain factors may make it more likely for perimenopause to start at an earlier age, such as:

• Smoking. Menopause happens 1 to 2 years earlier in smokers than in nonsmokers.
• Family history. Women with a family history of early menopause also may go through early menopause.
• Cancer treatment. Cancer treatments such as chemotherapy and pelvic radiation therapy have been linked to early menopause.
• Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause right away. Your ovaries still make estrogen even though you don't have periods. But this surgery can sometimes cause menopause to happen earlier than usual. Also, if you have one ovary removed, the ovary you still have might stop working sooner than expected.

Some health conditions also may make early menopause more likely, such as thyroid disease, rheumatoid arthritis or other autoimmune diseases.

Complications

Irregular periods are common in perimenopause. Most of the time this is nothing to be concerned about. See your healthcare professional if:

• Bleeding is very heavy.
• Bleeding lasts longer than seven days.
• Bleeding happens between periods.
• Periods are usually less than 21 days apart.

These symptoms may mean there's an issue with your reproductive health that needs diagnosis and treatment. If you have gone 12 months without a period and then start bleeding, tell your healthcare professional. You could have a health issue that needs attention.