Perimenopause: What It Is and How to Know You're Going Through It

Perimenopause is also sometimes referred to as the menopause transition, for what will become obvious reasons.

This time frame can best be explained as a transitional period from reproductive years to menopause, explained Sarah de la Torre, M.D., an OB-GYN with an emphasis on lifestyle medicine with Seattle Reproductive Medicine.

During the transition, a variety of symptoms can occur, including:

• Premenstrual symptoms getting more intense
• A lighter or heavier flow
• Your cycle suddenly developing a new timetable of its own

How and why is perimenopause different from menopause or even premenopause? What are its symptoms? How can you tell if you're in this specific stage versus another?

Premenopause, perimenopause, menopause, postmenopause

"Peri" is a Greek prefix that means about or around. Perimenopause, then, translates to around menopause, which includes the years leading up to it. Menopause is diagnosed when you've experienced a full year of no menstrual cycles.

The average age at which women enter menopause in the United States is 51, according to Mayo Clinic.

Perimenopause could start at any age, but it typically occurs during a woman's 40s, de la Torre explained, though some women experience it in their 30s. Like menopause, perimenopause can affect each individual differently and cause a range of symptoms that vary in severity.

The transition may begin a few years before a person's last menstrual cycle and typically lasts anywhere from four to eight years.

Premenopause describes the duration between someone's first period and the onset of perimenopause. After menopause, when a person has not experienced a period in at least a year, comes the period known as postmenopause.

While perimenopause does impact fertility, someone actively menstruating has a chance of becoming pregnant, though those chances diminish over time. Due to that slight possibility, using birth control during perimenopause is recommended if pregnancy is not in the plans.

Once you reach menopause, you no longer ovulate, meaning pregnancy is not possible naturally.

Both perimenopause and menopause can be naturally occurring transition periods, but certain conditions might accelerate the sudden onset of menopause. Most commonly, these factors include medical interventions, such as removing both ovaries, chemotherapy and radiation. Under these circumstances, someone might not experience perimenopause and instead skip to menopause.

Other risk factors, such as smoking, family history and a hysterectomy (when the uterus and ovaries are removed), can cause early onset of perimenopause.

Why does perimenopause occur?

Menopause is a natural and normal occurrence that marks the transition from fertility to infertility. The ovaries stop producing eggs, and female hormone production decreases.

"During our reproductive years, our bodies are making lots of estrogen, the main female hormone, and we're fertile," de la Torre said. "During perimenopause, our estrogen levels begin to decline, and many women will experience symptoms related to this, as well as decreased fertility."

The levels of the sex hormones progesterone and estrogen drop during perimenopause. Estrogen helps with fertility and vaginal lubrication, and progesterone helps to prepare the uterine lining for a fertilized egg. Both are produced mainly by the ovaries.

What are the symptoms of perimenopause?

Perimenopause can cause the onset of multiple emotional, physical and sexual changes.

"Because estrogen plays an important role in numerous body systems, the symptoms of perimenopause can vary widely," de la Torre said. "First, periods tend to become irregular because ovulation becomes less consistent. Second, women in perimenopause may experience hot flashes, which feel like a rush of heat to the body, sometimes paired with flushing and sweating. The intensity, length and frequency of hot flashes can vary."

She pointed to a third symptom: changes in sexual function. These include painful sex due to less vaginal lubrication and changes in libido. They occur because of changes in estrogen levels.

While a doctor's visit for perimenopause may not be required, severe discomfort caused by its symptoms could warrant a visit.

"With any health concerns, it's always best for women to consult their physician and have a candid conversation," de la Torre explained.

She listed the following symptoms that people may experience during perimenopause:

• Dryness
• Hot flashes
• Night sweats
• Mood changes
• Changes in sexual desire
• Headaches and migraines
• Oral health issues
• New or increased allergies
• Difficulty concentrating/memory lapses
• Dizziness
• Weight gain
• Breast changes
• Digestive health issues
• Fatigue
• Osteoporosis/osteopenia
• Irregular heartbeat
• Irregular periods
• Stress incontinence
• Tight muscles and joint pain
• Tingling limbs and restless legs syndrome

How do you know you're experiencing perimenopause?

Perimenopause has different stages. Specific symptoms, such as shorter and less regular menstrual cycles, can indicate which stage someone might be experiencing.

Early-stage perimenopause can include changes in the menstrual cycle or surges in estrogen. Late-stage perimenopause usually occurs between the ages of 40 and 50 when the menstrual cycle slows significantly and the time between periods increases.

About six months before menopause, estrogen levels drop substantially. Other symptoms, such as sleep disturbances and hot flashes, may also increase during late-stage perimenopause.

A doctor typically makes the diagnosis through a few considerations, including age, menstrual history and other presenting symptoms. Usually, they do not need to run tests and can make the diagnosis through symptoms alone.

'More than ever, women are speaking up about their experiences, and doctors, innovators and women everywhere are finding solutions.'

Perimenopause marks the beginning of what is a significant life change for some people. Talking about these changes can help ease the emotional components of menopause-related transformations.

"Because of a lack of information and open dialogue, perimenopause can be an intimidating stage of life for many women, but it doesn't have to be," de la Torre said. "More than ever, women are speaking up about their experiences, and doctors, innovators and women everywhere are finding solutions. I believe that perimenopause can be a time to pause and focus on your overall health. It can be a time for self-care, self-discovery and self-love."

Perimenopause isn't a disease that needs medication. Some people might seek treatment, but not everyone may experience symptoms as severely. However, solutions now exist for the symptoms that affect women's quality of life, de la Torre said. Treatments for symptom relief include hormone therapy. Your provider may also recommend lifestyle changes such as diet, stress-reduction techniques, antidepressants, adjustments to improve sleep such as limiting caffeine intake, and using lubrication for sex.

Are some unusual symptoms that might be tied to perimenopause bothering you? It may be time to talk to a doctor.

If you don't have a doctor you see regularly, first of all, you should find one. Fortunately, telehealth makes it easy to connect with a healthcare professional who can answer your questions and evaluate your situation. Many physicians offer video visits, which are a good way to see a doctor quickly since a lot of them have same-day appointments. Giddy telehealth is an easy-to-use online portal that provides access to hundreds of healthcare professionals whose expertise covers the full scope of medical care.