Perimenopause is a term that often confuses many women. It is commonly referred to as the “time around menopause,” but it is much more than just a prelude to the end of menstruation. Perimenopause is a transitional phase in a woman’s life that can span several years, typically beginning in a woman’s 40s but sometimes starting earlier. During this time, a variety of physical and emotional changes occur as the body prepares for menopause, the point at which menstruation permanently ceases.
What is Perimenopause?
Perimenopause refers to the years leading up to menopause, during which a woman’s body undergoes hormonal fluctuations as it transitions from the reproductive years to a post-reproductive phase. It is characterized by changes in menstrual cycles, hormone levels, and the onset of symptoms like hot flashes, sleep disturbances, and mood swings.
Perimenopause can begin anywhere from age 35 to 50, but for most women, it starts around their 40s and lasts anywhere from 4 to 10 years before reaching menopause. Menopause itself is defined as the point when a woman has gone 12 consecutive months without a menstrual period. The average age for menopause in the New Zealand is 51 (National Institute on Aging, 2020).
During perimenopause, the ovaries gradually produce less oestrogen and progesterone, two key hormones that regulate the menstrual cycle and support fertility. This hormonal imbalance is responsible for many of the symptoms associated with perimenopause.
What Are the Common Symptoms of Perimenopause?
Perimenopause can affect every woman differently, and the severity and type of symptoms can vary. Some women may experience only mild discomfort, while others may face more significant changes. Here are some of the most common symptoms:
1. Irregular Menstrual Cycles
One of the hallmark signs of perimenopause is a change in menstrual cycles. Periods may become heavier or lighter, more frequent or less frequent, and they may last longer or shorter. Some women may skip periods altogether or experience prolonged cycles. These changes occur as the body adjusts to fluctuating levels of oestrogen and progesterone (Worsley, 2014).
2. Hot Flashes and Night Sweats
Hot flashes are sudden feelings of intense heat that spread through the body, often accompanied by sweating and sometimes a flushed appearance. Night sweats are hot flashes that occur during sleep and can disrupt rest. Both are common during perimenopause and are thought to be related to changes in oestrogen, which affect the body’s temperature regulation (Freeman et al., 2001).
3. Sleep Disturbances
Many women in perimenopause experience difficulty sleeping, often due to night sweats, but also because of changes in hormone levels that affect the sleep-wake cycle. Sleep disturbances can lead to fatigue, irritability, and difficulty concentrating (Maki et al., 2011).
4. Mood Changes
Mood swings, irritability, and increased anxiety or depression can also be common during perimenopause. These mood changes are often attributed to fluctuating hormone levels, as well as the emotional toll of adjusting to the physical changes that come with perimenopause (Kuehner, 2017). For some women, perimenopause can trigger or exacerbate mental health conditions like anxiety and depression.
5. Vaginal Dryness and Sexual Changes
Lower oestrogen levels can lead to vaginal dryness, making sex uncomfortable or painful. This is a common symptom of perimenopause, and some women may also notice a decrease in sexual desire (Kingsberg et al., 2019).
6. Memory and Concentration Issues
Many women report difficulties with memory and concentration during perimenopause, often referred to as “brain fog.” Hormonal changes can impact cognitive function, leading to forgetfulness or difficulty concentrating. However, these symptoms are typically temporary and improve after menopause (Sherwin, 2012).
7. Physical Changes
Other physical changes that may occur during perimenopause include weight gain, especially around the abdomen, changes in skin elasticity, and thinning hair. These changes are partly due to the decline in oestrogen levels, which affects fat distribution, skin health, and hair growth (Gambera et al., 2016).
How Long Does Perimenopause Last?
Perimenopause typically begins in a woman’s 40s but can sometimes start in the mid-30s. The duration of this phase varies, lasting anywhere from 4 to 10 years, with most women experiencing an average of about 7 years. The transition ends when a woman has gone 12 consecutive months without a period, marking the arrival of menopause. It is important to note that perimenopause is a gradual process, with hormone levels fluctuating over time.
How Can You Manage the Symptoms of Perimenopause?
While perimenopause can bring about challenging symptoms, there are several strategies that can help women manage this transition and improve their quality of life. Here are some tips for managing perimenopause:
1. Diet and Nutrition
Maintaining a balanced diet rich in whole foods can help manage symptoms like hot flashes, weight gain, and mood swings. Focus on:
High-fibre foods: Whole grains, fruits, and vegetables can help manage weight and support digestive health.
Calcium and Vitamin D: These nutrients are important for bone health, which can be affected by lower oestrogen levels.
Phytoestrogens: Foods like soy, flaxseeds, and legumes contain plant compounds that have a similar effect on the body to oestrogen and may help balance hormone levels.
2. Exercise
Regular physical activity can help improve sleep quality, reduce stress, and support weight management. Activities like walking, swimming, yoga, or strength training can also help reduce the frequency and severity of hot flashes (Stahl et al., 2011).
3. Stress Management
Since perimenopause can exacerbate feelings of anxiety and irritability, incorporating stress-reducing techniques such as mindfulness, meditation, or breathing exercises can be helpful. Cognitive behavioural therapy (CBT) has also been shown to improve mood and reduce anxiety during this time (Liu et al., 2013).
4. Sleep Hygiene
Establishing a good sleep routine is crucial for women experiencing sleep disturbances during perimenopause. This includes keeping a consistent bedtime, avoiding caffeine or alcohol close to bedtime, and creating a cool, comfortable sleeping environment to help manage night sweats. Minimising the use of screens before bedtime and exposing yourself to the morning sunlight can help to balance your circadian rhythm and to have a more restful sleep.
5. Herbal Medicine
Herbal medicine can have many benefits for managing perimenopause symptoms. Some herbs contain compounds that can help balance hormones, reduce inflammation, and support overall health during this transition.
References
Freeman, E. W., Sherif, K., & Rickels, K. (2001). Hot flashes: Epidemiology and physiology. The American Journal of Medicine, 111(11), 129S-135S. https://doi.org/10.1016/S0002-9343(01)00847-9
Gambera, A., Davis, S. R., & Diamond, M. (2016). The effect of menopause on skin, hair, and vaginal health. Maturitas, 91, 10-13. https://doi.org/10.1016/j.maturitas.2016.05.006
Kingsberg, S. A., & Wysocki, S. (2019). Managing sexual dysfunction in women with menopause. Obstetrics and Gynecology Clinics of North America, 46(4), 579-590. https://doi.org/10.1016/j.ogc.2019.07.002
Kuehner, C. (2017). Why is depression more common among women than among men? The Lancet Psychiatry, 4(2), 146-158. https://doi.org/10.1016/S2215-0366(16)30263-2
Liu, X., Huang, Z., & Wang, H. (2013). Cognitive behavioral therapy for depression in women with perimenopausal symptoms: A systematic review. Menopause Review, 30(6), 182-188. https://doi.org/10.1097/GME.0b013e318295d846
Maki, P. M., Rubin, L. H., & Berman, A. J. (2011). Sleep disturbance in women at midlife: A critical review of the literature. Journal of Women’s Health, 20(4), 455-463. https://doi.org/10.089/jwh.2010.2510
National Institute on Aging. (2020). Menopause. National Institutes of Health. https://www.nia.nih.gov/health/menopause
North American Menopause Society. (2020). The 2020 position statement of the North American Menopause Society on hormone replacement therapy. Menopause, 27(2), 161-182. https://doi.org/10.1097/GME.0000000000001513
Sherwin, B. B. (2012). Cognitive changes in perimenopause and menopause: The role of estrogen. Journal of Clinical Endocrinology and Metabolism, 97(1), 1-7. https://doi.org/10.1210/jc.2011-1747
Stahl, J., Manson, J. E., & Sowers, M. (2011). Physical activity and menopausal symptoms: A review of the evidence. Maturitas, 68(4), 299-306. https://doi.org/10.1016/j.maturitas.2010.10.006
Worsley, R. (2014). The menopause transition: A clinical guide. Australian Family Physician, 43(7), 471-475.