Dr. Kimberly McMorrow, OB/GYN at Virginia Physicians for Women, shares some insights on the transitional period before your last period, including timing, symptoms, and treatment.
We’ve all heard of menopause: the end of periods! No more cramping, no more tampons or pads, no more need for birth control. It sounds so magical. We wish it were that simple, but it doesn’t just happen overnight. There are a lot of changes your body goes through as it makes this transition from pre- to post-menopausal. This is perimenopause: the transitional years leading up to the end of menstruation.
If you’re in or approaching your forties, you might be wondering what to expect and how to prepare for perimenopause. Here’s a little guide to when it might start, what symptoms you might experience, and how we can help you through it.
When does perimenopause start and how long does it last?
The perimenopause years typically start in your 40s but may start as early as your 30s. It begins about four years before menopause, when the estrogen that your ovaries make starts to fluctuate. That’s why you’ll probably notice changes in your menstrual cycle first.
Menopause has officially occurred (and perimenopause has come to an end) when your ovaries have stopped making estrogen and your periods have naturally stopped. It’s diagnosed when you’ve gone 12 consecutive months without a menstrual period (for no other reason). On average, women reach menopause at age 51. Menopause that occurs between age 40 and 45 is considered early menopause. Menopause that occurs before age 40 is called premature menopause.
What factors affect the age you reach menopause?
If your mom and most of the women in your family experienced menopause around the same age, whether that was early, late, or right on average, you can generally expect to follow suit. That’s not always the case, though, and other factors can come into play besides family history.
Smoking can cause early or premature menopause because it causes damage to your ovaries. Chemotherapy and pelvic radiation can cause you to experience menopause earlier than you otherwise would have as well. Ovarian surgery (for example, to treat endometriosis) can also take a toll on healthy ovarian tissue and cause menopause to occur earlier than usual.
Some things that don’t impact the age at which you experience menopause: age at first period, pregnancy, breastfeeding, hormonal birth control methods, and ethnicity.
What are the first signs of perimenopause?
The first signs of perimenopause are usually changes in your menstrual cycle. These changes can be variable. It’s possible for cycles to become longer or shorter than normal, and the flow can be heavier or lighter than you’re used to. Some women skip their periods altogether. These changes are very common symptoms of perimenopause, but you should still alert your provider since abnormal bleeding could be a sign of a problem.
What are the most common symptoms of perimenopause?
Other than menstrual changes, common symptoms include hot flashes, difficulty sleeping/insomnia, night sweats, vaginal dryness, mood changes, and fatigue. Some women have no symptoms and some have very mild symptoms. It’s also possible to have very severe symptoms.
How are perimenopause symptoms treated?
We treat menstrual changes similar to how we treat menstrual problems throughout a woman’s life. Treatments include hormonal management such as birth control pills, the Mirena IUD, or progestins. Sometimes we control heavy menstrual bleeding with tranexamic acid to help your blood clot. In severe cases, sometimes surgery is necessary.
For hot flashes and sleeping disturbances, we may consider starting hormone therapy, a trial of antidepressants, or herbal supplements such as black cohosh. Vaginal dryness is typically treated with lubricants and topical estrogen, though some women find relief with ThermiVa if these more common options don’t help.
For women with severe insomnia and mood swings associated with perimenopause, antidepressants can be very helpful. Some antidepressants are marketed to treat multiple symptoms associated with perimenopause like hot flashes and mood lability. Adding counseling to this regimen can also be helpful for mood changes associated with perimenopause. And check out Dr. Santosh’s blog post, How Women’s Hormones Can Affect Their Sleep – and Tips for Improving It! to learn ways to combat sleep difficulties associated with perimenopause.
How can I prepare for perimenopause?
First of all, it’s important to exercise and follow a healthy diet as you enter this phase. Having good lifestyle habits can often help minimize the symptoms of perimenopause.
It’s also helpful to talk about perimenopause with your mom and sisters, since the perimenopause experience tends to run in the family. Sometimes hearing about a family member’s experience can help you learn when perimenopause might start, what symptoms you might experience, and to what degree.
Your women’s health provider can help!
We also encourage you to talk to your doctor about what to expect as well as seek their help as you begin to experience symptoms. While many of the symptoms above are a normal part of the perimenopausal transition, it can be difficult to tell which symptoms could be signs of a problem. Symptoms can also just be a pain to deal with, and you might want some medical assistance when it comes to managing them.
Your doctor has helped so many women through these changes. They will do their best to help you find the treatment and relief you need so that you can enjoy this next stage of life. The good news is many patients report feeling pretty wonderful once they’ve made it to the other side!
Dr. Kimberly McMorrow is an OB/GYN at Virginia Physicians for Women. She sees patients at VPFW’s Koger Center and Prince George offices and delivers babies at Johnston-Willis Hospital.
