How To Recognize Perimenopause

Understanding that the prefix "peri" means "around" helps explain the meaning of perimenopause. Perimenopause is the time around menopause, both the years leading up to menopause and then the first year or so after. Here is some information that will help you to recognize perimenopause:

  1. Hormone Levels. During perimenopause, your hormone levels are all over the map. Estrogen and progesterone levels, which used to shift predictably, begin to rise and fall unevenly.

  • Onset and Duration. Both the age at which perimenopause begins and its duration are variable. For many women, perimenopause begins in their forties though some women begin to notice changes in their thirties or not until their fifties. Perimenopause begins from 2-8 years before menopause. You are considered to have reached menopause after one full year without a menstrual cycle.
  • Effects on Menstrual Cycle. Shifting hormone levels can either lengthen or shorten your menstrual cycle and increase or decrease your flow of blood. You may begin to skip some periods as ovulation becomes less regular. As ovulation becomes less predictable, lower levels of progesterone can create periods that are heavier in flow and last longer.
  • Hot Flashes. Approximately three-quarters of all women experience hot flashes during perimenopause. See How To Understand Hot Flashes for more on this topic.
  • Sexual Changes. Intercourse may become painful as vaginal tissues lose their elasticity and natural lubrication. Some women experience a decrease in sexual arousal and desire.
  • Urinary Incontinence. Urinary incontinence may occur or worsen as tissue tone is lost.

  • Frequency of Infection. Low estrogen levels can contribute to more frequent vaginal or urinary tract infections.
  • Sleep Changes. Sleep can be interrupted by hot flashes or the night sweats that can accompany hot flashes. Shifting hormone levels can also contribute to sleeping problems.
  • Mood Swings. Some women experience mood swings, irritability or depression during perimenopause which can be exacerbated by changes in sleeping patterns.
  • Ability to Conceive. As long as you continue to menstruate, you may still become pregnant. However, as ovulation becomes less predictable, your chances of conceiving lessen.
  • Cholesterol. Levels of low-density lipoprotein (LDL), or the "bad" cholesterol, may increase due to declining estrogen levels. Additionally, levels of high-density lipoprotein (HDL), or the "good" cholesterol, may decrease. These two changes in cholesterol both increase the risk of heart disease.
  • Osteoporosis. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis.
  • Though many of these changes listed sound like symptoms, many women experience menopause as a powerful change of life and see perimenopause as nature's way of preparing women for that change. PubMed's "Positive aspects of menopause: a qualitative study" provides a starting point for reflection upon perimenopause's many positives.


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