What is perimenopause?

August 19, 2010 By Joel Sorosky, M.D.

Wouldn't it be great if one day a woman awoke to find her period had ended just like that? No hot flashes, no mood swings, no erratic vaginal bleeding. While that happens in rare cases, for most women, menopause, or the cessation of menstruation, is preceded by a transition called perimenopause.

Although no two women experience perimenopause in exactly the same way, the onset of any of these symptoms is a sign that a woman's childbearing years are coming to an end.

Menstrual irregularities. For women who could always predict the onset of their periods, unexpected bleeding is a telltale sign of perimenopause. Not only may their periods begin arriving haphazardly, they may also be longer or shorter, lighter or heavier, or perhaps more painful than usual. If you notice your periods becoming irregular, start keeping a diary. This will help you notice any new patterns in your cycle and also help your healthcare provider determine what kind of treatment, if any, may be appropriate.

Hot flashes. During perimenopause, the body begins to taper off estrogen production. In response, the pituitary gland releases bursts of luteinizing hormone. The trouble is, these “bursts” may make a woman feel as if she's on fire for anywhere from a few seconds to a few minutes. Her face, neck and chest may redden, and her body temperature may rise several degrees. During the night, hot flashes may cause excessive perspiration. If you're bothered by hot flashes, dress in layers (natural fibers are best) so you can remove a layer when necessary. Try to avoid stress, keep active and eat well-balanced meals. It might help to keep a hot-flash diary to identify triggers, such as alcohol or specific foods. If hot flashes continue to disrupt your life, talk to your healthcare provider about treatment options. Some women find that eating foods rich in vitamin E (sources include wheat germ, nuts, whole grains and vegetable oil) and soy products helps take the heat off.

Vaginal dryness. Less estrogen causes the vulva and vagina to become less elastic. Vaginal tissues also become drier and thinner, which may cause burning and itching. As a result, perimenopausal women may experience some discomfort, possibly even bleeding, during intercourse. A water-based lubricant may help relieve this discomfort, or your healthcare provider may prescribe an estrogen cream.

Inform your healthcare provider when you experience these or other changes. Although perimenopause will be the likely reason for them, he or she can rule out any underlying abnormal conditions. In addition, now is the time for you and your healthcare provider to begin discussing ways to make your perimenopausal years and beyond smooth and healthy.

Now that you know

Slowly but surely, menopause is coming—and there's no turning back. But perimenopause can give you time to evaluate some aspects of your health:

The onset of perimenopause is a clearer indicator of what stage of life your body is at than your chronological age. It's a time to start evaluating your bone health and your heart health and find out what steps you should be taking to offset or prevent changes.

Perimenopause may prompt you to make reproductive choices.

Knowing menopause is on the way can help you prepare emotionally for the transition to postmenopause.

Joel Sorosky, M.D., is chief of Obstetrics and Gynecology at The Hospital of Central Connecticut.