Article by Rachel Cady, MD, Welia Health Women’s Health and OB/GYN provider
While everyone talks about menopause symptoms, it is perimenopause, or the menopause transition (MT) that is usually the most symptomatic for women. Perimenopause begins with menstrual cycle irregularities and ends following one year of absent menses. The average age of perimenopause is 47, and the average age of menopause is 51-52 year old. MT lasts about 4-8 years, but tends to be longer in smokers and in those with earlier symptom onset.
Common perimenopause symptoms
Below are the most common symptoms you’ll experience during perimenopause:
- Menstrual cycle changes
- Hot flashes
- Vaginal/vulvar dryness with painful sex
- Poor sleep
- Weight gain
- Difficulty concentrating and concerns about one’s memory
- Mood changes, depression and anxiety
Menstrual cycles vary depending on if ovulation (release of egg) occurred. About 25% of menstrual cycles in the perimenopause are ovulatory. Ovarian follicle aging progresses in the perimenopause. Progesterone and estrogen levels are extremely variable, which changes bleeding patterns.
Very heavy bleeding or bleeding in between periods are abnormal, and you should schedule a visit with your clinician. Cycles in early perimenopause are 7 or more days shorter, while cycles in the late perimenopause are at least 60 days apart.
Hot flashes that occur during the perimenopause are the result of a narrowing in the brain’s thermoregulatory center. This area of the brain is estrogen sensitive. When estrogen levels decline, the body is not able to accommodate as quickly. Therefore, skin redness, sweating, sometimes anxiety, and waking up at night result. About 75% of women report hot flashes with the average duration of about 5-7 years.
Metabolism goes down about 25% for perimenopausal women, which commonly results in weight gain. Most women have no idea this is going to happen, and are therefore not prepared.
So, what other things do you have to look forward to during MT?
- Bone loss starts in perimenopause.
- Risk factors for heart disease increases in the MT, including high blood pressure and high cholesterol.
Okay, so those weren’t really “things to look forward to.” But I can tell you something good!
Being prepared helps lessen symptoms
The latest-and-greatest data clearly shows that by being proactive, planning ahead, being open to treatment options, and being prepared, you can help yourself be healthier in the postmenopause.
Women on average are living one third of their lives postmenopause. The New York Times recently referred to perimenopause as “The Puberty of Midlife,” and most importantly, the conversation is not being heard enough.
Women are hungry for accurate information pertaining to health. Perimenopause is not “doomsday.” By recognizing what is normal, understanding common symptoms and their causes/treatments, and having a preventive/proactive mindset, you can largely lessen these symptoms. Perimenopause remains a wonderful time to check in with your clinician to help in this process.