Definition of Perimenopause

Perimenopause is a natural process of aging that serves as a transition between a woman's fertile years and menopause, when menses cease. It is marked by hormonal shifts that cause several changes in the body. Perimenopause affects all women, but may present mild symptoms in some, while other women may experience significant discomfort.

Effects

• The first sign of perimenopause is a change in menstrual cycles. Periods may become irregular, infrequent, heavier or lighter---there is no set pattern to the change, only a difference from what the woman normally experiences. Perimenopause also causes hot flashes and night sweats. Insomnia is common, as are mood swings, decreased libido and vaginal dryness. Some women may experience none of these symptoms, or symptoms may be mild. When menses occur, symptoms typically subside.

Time Frame

• Perimenopause is a process that lasts for several years before giving way to menopause. Timing is not influenced by the age of first menses, ethnicity, childbearing or use of birth control. Perimenopause takes two to eight years and lasts for a year after the final menstrual cycle. It occurs in late middle age, with 51 years of age being average. However, some women notice perimenopausal changes as early as their 30s and 40s.

Estrogen and Progesterone

• Estrogen and progesterone levels are in flux during perimenopause, impacting their normal synergistic function in the body to cause the majority of perimenopause symptoms. Estrogen levels may vary wildly, causing mental fog, vaginal dryness, bone density loss (which can contribute to osteoporosis), rising cholesterol levels and an increased risk of heart disease. Missed ovulation during perimenopause results in decreased progesterone, which has effects similar to changes in estrogen.

Other Hormones

• Other hormones affected by perimenopause include testosterone, thyroid, cortisol and follicle-stimulating hormone. Testosterone may rise or fall. Increased levels cause pattern baldness, deepening of the voice or acne. Decreased testosterone results in fatigue, low sex drive, incontinence and weight gain. Low thyroid levels produce fatigue and weight gain. A drop in cortisol also results in fatigue. Rising follicle stimulating hormone (FSH) levels indicate how close a woman is to menopause.

Medical Treatment

• Traditional treatment of perimenopause involves taking low-dose birth-control pills or taking estrogen and progesterone supplements. The exact treatment will depend on the lab values of hormones affected by perimenopause. While these treatments are effective, some women taking hormone supplements may increase their risk of blood clots or breast cancer. Because symptoms of perimenopause disappear during menstrual cycles, hormone therapies should be discontinued during that time and then resumed once symptoms reappear.

Alternative Medicine

• Black cohosh, vitex (chaste berry) and dong quai are among the wide variety of herbs used to treat perimenopause (see Resources for links to additional information). Nutritional supplements like vitamins E and B and L. Arginine or L. Glutamine are sometimes suggested to reduce symptoms. However, there have been few clinical studies proving the efficacy of herbs or vitamins to safely manage symptoms of perimenopause.