Premenopause (Perimenopause) - What is it and how does it manifest itself?

Menopause isn't just about missing your period and possibly experiencing hot flashes. Before a woman's body truly enters menopause, it goes through many other changes, including the symptoms of perimenopause.

Premenopause or perimenopause refers to a state of transition of the body towards menopause, which marks the end of the fertile period in a woman's life. Find out everything you need to know in this article, because no matter your age, it's for your own good to understand your body.

What is premenopause?

Perimenopause is the time when your body begins to transition into menopause. It can start as early as your mid-30s or as late as your mid-50s, but it usually starts 3 or 4 years before a woman's body actually enters menopause, but in some cases, it can happen as early as 10 years before.

During this transition, the ovaries produce fewer hormones, which makes the menstrual cycle irregular. However, an egg is released during this time, so a woman in the transition to menopause can still get pregnant. At this point, the body is moving toward the end of its reproductive years.

Other physical changes and symptoms may occur as the body adjusts to different hormone levels. Officially, perimenopause ends and menopause begins after 12 consecutive months without menstruation.

Symptoms & signs: How does perimenopause manifest itself?

The symptoms of perimenopause, the age at which it starts, and how long it lasts vary from woman to woman. No one can say exactly what you will experience, but here are some of the most common symptoms:

• Hot flushes
• sensitive breasts
• dry, thinning skin
• hair loss or thinning hair
• bone fragility
• severe premenstrual syndrome
• changes in cholesterol levels
• reduced sexual desire (libido)
• fatigue
• irregular menstruation
• vaginal dryness and, consequently, discomfort during sex
• decreased fertility
• involuntary urine leakage when coughing or sneezing
• urge incontinence - an urgent need to urinate more often
• mood swings or disturbances
• sleep problems
• difficulty concentrating
  

How long does perimenopause last?

The age at which perimenopause begins can vary significantly from one woman to another. Signs can appear around the age of 40, but some women notice these changes after the age of 35. On average, perimenopause lasts 3-4 years, but it can last just a few months or it can last as long as 10 years.

Perimenopause is a transitional period that ends in menopause. Basically, menopause means that menstruation has stopped. When you have not had a menstrual period for 12 months, you have officially reached menopause.

The menstrual cycle in premenopause

During perimenopause, estrogen levels (the main female hormone) fluctuate irregularly, rising and falling continuously. This can cause menstrual cycles to be longer or shorter, but there can also be menstrual cycles when the ovaries do not release an egg (do not ovulate). In addition, you may experience symptoms similar to menopause, such as hot flashes, sleep disturbances, and vaginal dryness, but don't worry, there are many treatments available.

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Ovulation & pregnancy in premenopause

Although fertility decreases during perimenopause, it's good to know that your ovaries are still functioning during this time and releasing an egg, just like they always do. As long as you're menstruating, pregnancy is possible.

If you don't know how to calculate ovulation yet, it's the perfect time to read our article on Fertile Period . Here you will find numerous methods for calculating your ovulation period and we will also answer questions you didn't know you had before.

Causes & Risk Factors - Why does perimenopause occur?

The causes of perimenopause are not numerous. During this transition period to menopause, estrogen and progesterone production begins to fluctuate, rising and falling. Many of the changes a woman goes through during perimenopause are actually a consequence of low estrogen levels.

Menopause is a natural stage in a woman's life, but sometimes it can occur earlier than expected. Some evidence suggests that certain risk factors influence the onset of perimenopause more quickly, including:

• smoking
• family history
• oncological treatment (cancer treatment through chemotherapy or radiotherapy of the pelvic area)
• hysterectomy

Premenopause, menopause & post-menopause - What's the difference?

Each of these stages represents a gradual change, which usually occurs over several years.

Premenopause or perimenopause occurs in a woman's fourth decade of life, but can sometimes occur after age 30. Symptoms may become more pronounced as menopause approaches. Typically, a woman enters perimenopause 3-4 years before menopause and this period ends 12 months after the last menstruation.

Menopause means that the ovaries no longer release eggs, and estrogen production drops substantially. Symptoms of premenopause can continue after menopause. Most women enter menopause between the ages of 40 and 58, with the average age being 51. Want to know more about the subject? Discover everything about Menopause in our article dedicated entirely to the causes, symptoms and treatment specific to this period.

Postmenopause is the stage after menopause. During this time, symptoms may increase due to decreased estrogen production. However, in general, a woman will experience less intense menopausal symptoms.

Premenopause treatment

There are several types of treatments that can help relieve premenopausal symptoms. What is important, however, is to consult with your gynecologist or a specialist doctor to achieve the results you want and to use the right solutions for you.

Hormonal treatment in premenopause

Hormone therapy is helpful for some women.

• Systemic estrogen therapy (in the form of pills or tablets, patches, gels or creams) is considered the most effective treatment option to relieve hot flashes and night sweats, common symptoms in premenopause and menopause.
• Depending on the woman's medical history and health status, the doctor may recommend (very) low doses of estrogen to relieve symptoms. If necessary, she may also prescribe progesterone in addition to estrogen therapy.
• Another hormonal treatment that your doctor may recommend is a progesterone cream, which helps if vaginal dryness occurs and, in addition, offers protection against premenstrual syndrome.
• Another hormonal treatment used in premenopause is oral contraceptives. If your menstrual bleeding is irregular and you don't want to get pregnant, a good option is birth control pills with a low dose of hormones. Since ovulation is suppressed, menstrual flow and periods are regulated, hot flashes disappear, and vaginal dryness is reduced.
• There are also vaginal estrogen treatments that can be used to relieve symptoms of premenopause. These are products that can be inserted into the vagina to relieve vaginal dryness and pain that a woman feels during sex.

Antidepressant treatment for perimenopause

Some antidepressants can reduce some of the symptoms of menopause, such as hot flashes. Such treatment is usually recommended for women who, for some reason, cannot take estrogen.

Natural treatment for premenopause

If you consult your doctor, he or she will recommend the right treatment for you. Natural options include:

• for bone health - calcium and vitamin D
• in case of low libido - the doctor may prescribe a testosterone supplement
  

Sometimes a few lifestyle changes are also welcome, such as:

• a healthier diet
• light physical exercise
• avoiding foods or activities that cause hot flashes

Before deciding on any form of treatment, talk to your doctor about your options, as well as the risks and benefits of each option. This way, you can make the right decision for you.

Tests & Analysis - Diagnosing Premenopause

Only a specialist can diagnose premenopause, following the patient's symptoms. Most often, a blood test helps determine hormone levels, but it is important to remember that their levels are variable during this period.

We are all different, and this means that some women endure symptoms without much effort, while others seek medical attention when symptoms set in. However, it is always recommended to consult a doctor if unusual symptoms appear or if their intensity increases sharply.

Premenopause complications

The first sign of perimenopause is usually irregular periods. Most of the time, this is normal for this time of your life. However, don't delay seeing a doctor if:

• the bleeding is heavy - you have to change the tampon every 1-2 hours
• bleeding lasts more than 7 days
• bleeding occurs between menstrual periods
• Menstruation frequently occurs at intervals of less than 21 days
  

These situations may mean that you are facing a more serious problem with your reproductive system. For diagnosis or treatment, it is essential to consult a doctor.

DON'T FORGET! Premenopause symptoms should not affect your daily routine or well-being, so see a doctor if you are concerned about these aspects.

Helpful tips for managing premenopause

Perimenopause brings with it a series of changes in a woman's body, mainly influenced by variations in estrogen levels. Therefore, to improve the quality of life in premenopause, it is important to take care of yourself and you may want to follow some of our tips:

• It helps you to exercise (low-intensity), at least 30 minutes every day
• quit smoking
• get enough rest and try to create a regular sleep schedule
• avoid drinking alcohol and reduce caffeine consumption
• try to reach a body weight that satisfies you and maintain it constant
• include calcium in your diet
• ask your doctor if you should take a multivitamin supplement
• if low libido is affecting your intimate life, seek help from a therapist (with or without a partner)

Frequently asked questions

Still have questions? We'll answer a few more now.

Can you get pregnant during premenopause?

Since your ovaries are still releasing eggs during premenopause, yes, you can get pregnant! For a contraceptive method that's right for you, consult your gynecologist.

Why do breasts hurt during premenopause?

During perimenopause, the levels of estrogen and progesterone in the body fluctuate unpredictably, and this is responsible for the breast pain associated with menopause. It is not unusual to notice that your breasts enlarge, shrink, or change shape during this period.

Are contraceptives recommended in premenopause?

Contraceptives can only be recommended by a specialist doctor and in some cases, yes, they are even used as a form of treatment during the premenstrual period.

At what age does perimenopause set in?

Perimenopause occurs at different ages, but it is usually possible for the first signs to appear around the age of 40. On average, menopause occurs around the age of 51.

How long does the perimenopause period last?

The perimenopause period can last a few months or even a few years, but usually lasts for 4 years. It ends when 12 months have passed since the last menstrual period, and then menopause begins.

How can you manage hot flashes in premenopause?

Many women manage hot flashes through simple techniques and methods, including: wearing clothing in layers (so you can dress/undress depending on how you feel), drinking ice water at the onset of a hot flash, and wearing cotton underwear and clothing (increased comfort overnight).

Can perimenopause be prevented?

Perimenopause cannot be prevented, but it can be delayed.

Always seek the help of a qualified doctor when making decisions regarding your health. Take care of yourself and everything will be fine!