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What is Perimenopause?

Signs and Symptoms to Look For

All of a sudden, you feel the onset of warmth in your face, neck, and chest. Your best friend suggests that it might be a hot flash. “A hot flash?” you say, “I’m way too young to be going into menopause.”

In the United States, menopause occurs naturally on average at age 51, with a typical age range between 45 and 55. Clinically, women aren’t considered menopausal until they have had twelve consecutive months without a period. What many women don’t realize is that there are several years before menopause that are defined as perimenopause, or a time of life when a woman’s body undergoes changes in preparation for menopause.

Perimenopause symptoms typically surface in your forties, but sometimes they may occur as early as your thirties. Perimenopause can last as little as two years or as long as ten. Pregnancy is still possible during perimenopause, and birth control is recommended until one year has passed since your last menstrual cycle.

Throughout perimenopause, your ovaries will begin to make less estrogen and progesterone, which can lead to changes in your menstrual periods. Cycles may become longer or shorter, heavier or lighter, and more or less frequent. Eventually, your ovaries will stop making enough estrogen to thicken the lining of the uterus and your periods will stop.

In addition to irregular menstrual cycles and hot flashes, other symptoms of perimenopause include night sweats, sleep disturbance, vaginal dryness, painful intercourse, decreased libido, mood swings, headaches, weight gain, and heart palpitations. The symptoms and length of perimenopause vary from woman to woman. While it is common to follow in your mother or sister’s footsteps as to the timing of menopause, symptoms experienced can also be very different from one family member to the next.

While perimenopause and menopause cannot be prevented, there are ways to ease the symptoms and steps you can take to reduce your risk of long-term problems. As always, diet and exercise play a vital role in keeping symptoms at bay. Avoid caffeine, alcohol, and spicy foods and opt for a diet rich in fruits, vegetables, beans, soy, flaxseed, and fish oils. Supplement your diet with calcium and vitamin D. Exercising regularly during perimenopause and menopause can decrease hot flashes, prevent weight gain, and help with depression and sleep disturbances. In addition, it can be helpful to seek emotional support from family and friends, as well as from a professional counselor, if needed. Practice deep breathing exercises or try yoga, tai chi, or meditation. Dress lightly, wear layers, and keep your bedroom cool. Finally, regular sexual intercourse and the use of vaginal lubricants or moisturizers can help keep the genital area healthy, reducing vaginal dryness and a decline in sexual function.

As you enter perimenopause and menopause, the need for an annual visit to your OB-GYN remains very important. Regular visits will help you stay up-to-date on age-appropriate screenings and allow for evaluation of possible abnormalities. If menopausal symptoms are disruptive to your life, you and your health care provider can determine the treatment option that is right for you. There are many options to choose from including oral contraceptives, progestin therapy, endometrial ablation, herbal products, and hormone therapy that can provide relief. The right option for you will depend upon the severity of your symptoms, your overall health and family history, and your preference.

Kristin P. Schraa, MD, is a gynecologist at Virginia Women’s Center. She enjoys caring for women of all ages and has particular interest in adolescent health, reproductive issues, and perimenopause. She lives in Mechanicsville with her husband and two young boys.
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