Perimenopause (menopause transition)

Perimenopause is a term that refers to a period in a woman’s life that occurs just before the arrival of menopause. Menopause is a naturally occurring process during which a woman’s menstrual cycle stops entirely. When this happens, she is no longer able to reproduce. Perimenopause is the time during which a female’s body begins to transition into menopause, and it is also referred to as the menopausal transition. The starting age for menopause varies from woman to woman, and so the age when perimenopause begins also varies. Signs that the body has entered perimenopause include irregular menstruation, changes in estrogen levels, and a decrease in ovulation. Women may also experience menopause-like symptoms such as hot flashes, vaginal dryness, and sleep issues. The transition from perimenopause to menopause is complete when a woman has gone twelve months without having a menstrual period.

Background

Menstruation is a monthly process during which blood and other substances shed from a woman’s uterus and are discharged through the vagina. The menstrual cycle, also known as a period, first occurs during adolescence and continues to occur on a monthly basis for several decades. A female’s very first period is referred to as her menarche. When menarche occurs, a female can become pregnant because ovaries begin producing oocytes, or immature egg cells. The menstrual cycle helps a woman’s body prepare for pregnancy. It is controlled by the hormones estrogen and progesterone. These hormones make the eggs in a woman’s ovaries mature during the menstrual cycle. Once an egg is matured, it travels outside of the ovary and is ready to be fertilized by a male sperm cell. This process marks the starting point of sexual reproduction. By the time the egg is ready for fertilization, estrogen and progesterone have also created a thick and spongy layer around the uterus. This layer is meant to provide cushioning for fertilized eggs at the beginning of pregnancy. If fertilization by a sperm cell does not occur, the lining breaks down and eventually flows out of the body. This cycle then begins again, repeating each month until a pregnancy occurs.

When a woman reaches a certain age, her body’s menstrual activities become irregular and her ovaries stop producing eggs for reproduction. After a prolonged period in which a woman has not had a menstrual cycle for twelve months, she is said to have entered menopause. Menopause usually occurs in a woman’s forties or fifties, with the average age being about fifty-one. Some women enter menopause at earlier or later ages, however. Menopause is a natural biological process that eventually occurs in every woman and marks the period in a woman’s life in which she can no longer bear children. A woman’s ability to become pregnant diminishes as she grows older. This is because every woman only has a finite amount of oocytes that may develop into mature eggs. As the number of oocytes is depleted, hormone levels in the ovaries decrease, specifically estrogen and progesterone levels.

Several years before a woman enters menopause, a period known as perimenopause signals the coming changes. A number of physical changes and symptoms marks perimenopause, and it is commonly referred to as the menopausal transition because the body is readying itself for menopause. Perimenopause usually begins when a woman is between forty and fifty but can begin earlier in some women. This phase can last anywhere from six to ten years.

Overview

A variety of symptoms signal the start of perimenopause in women. These symptoms can range from subtle to obvious. Irregular periods are a major symptom of perimenopause. Ovulation becomes less predictable, and the time between each menstrual cycle begins to vary. Menstrual flow can be light to heavy, and sometimes a woman may skip a monthly period entirely. Continued changes lasting seven days or more in the length of the menstrual cycle may indicate perimenopause. Breaks in menstrual cycles that last for sixty days or more are usually clear signs of late perimenopause.

Perimenopause can also cause symptoms such as sleep problems and hot flashes. Hot flashes usually last anywhere from a few seconds to several minutes and can cause a flushing of the skin, rapid heartbeat, sweating, or shivering. They are caused by reduced levels of estradiol, an estrogenic hormone. Hot flashes that occur at night and lead to sweating are often called night sweats. Hot flashes and sleep problems usually arise in tandem, as hot flashes and night sweats can disrupt sleep. Sleep issues can occur without hot flashes or night sweats, however.

Perimenopause is also responsible for mood swings, which can include general irritability or more severe mood issues, such as an increased risk of depression. These symptoms can be exacerbated by hot flashes and sleep disturbances. Mood changes may also result from societal stressors unrelated to the hormonal changes of perimenopause.

Hormonal changes during perimenopause can also lead to vaginal and urinary issues. A decrease in estrogen levels can diminish the natural lubrication of the vaginal canal, leading to vaginal dryness and diminished elasticity. This can make sexual intercourse painful and can affect a woman’s level of sexual arousal and desire. Diminished estrogen can also increase a woman’s risk of vaginal or urinary infections. Thinning urinary tissue can also make it difficult to control urinary output, leading to incontinence.

As hormone levels continue to fluctuate, ovulation becomes irregular and decreases a woman’s ability to conceive. Pregnancy remains possible in women as long as they continue to menstruate, however irregularly. Once periods have stopped for twelve straight months, childbearing is no longer possible. Hormone changes can also affect a woman’s bone health. A decrease in estrogen levels makes it difficult for bone tissue to regenerate as quickly as in youth, leading to an increased risk of osteoporosis, a disease that weakens bone density. Other physical problems arising from hormone changes associated with perimenopause include increases in low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, and a decrease in high-density lipoprotein (HDL) cholesterol, or “good” cholesterol. This can increase a woman’s chance of heart disease.

A number of methods can be used to ease the symptoms of perimenopause. Hormone replacement therapy is a common treatment. Vaginal estrogen can also be administered to the vagina to ease dryness. Some doctors prescribe antidepressants to help with mood swings and reduce the occurrence of hot flashes

Bibliography

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