What is perimenopause?

Perimenopause refers to the transitional period of time before menstruation actually stops, which is marked by changes in the menstrual cycle, along with other physical and emotional symptoms. Perimenopause can actually last up to 10 years and during this time the following processes are occurring within a woman's body:

• ovaries release eggs less regularly
• ovaries gradually produce less estrogen and other hormones
• fertility decreases
• menstrual cycles shorten, there are fewer ovulations, and more cycle irregularity
• circulating levels of estrogens and progesterone are markedly reduced
• androgen (androstenedione) is reduced
• testosterone decreases

What causes perimenopause and perimenopausal symptoms?

Perimenopause is caused by the declining function of the ovaries. Ovulation may become erratic and then stop altogether. The menstrual cycle length and flow may become irregular as much as 10 years before the final menses (last menstrual period).

As fluctuations of hormones occur, symptoms result from the changing levels of estrogen and progesterone in the body. At times, estrogen levels may be higher, which may trigger symptoms similar to premenstrual syndrome (PMS). At other times, the estrogen levels may decrease, which may trigger hot flashes or night sweats. This fluctuation of estrogen levels may be interspersed with normal menstrual cycles during perimenopause. Research studies demonstrate that perimenopausal women show varying patterns of hormonal fluctuations. No two women will experience perimenopause in the same way.

What are the symptoms of perimenopause?

The following are the most common symptoms of perimenopause. However, each woman may experience symptoms differently. Symptoms may include:

• mood changes
• changes in sexual desire
• difficulty in concentrating
• headaches
• night sweats
• hot flashes
• vaginal dryness
• sleep disturbances
• joint and muscle aches
• extreme sweating
• frequent urination
• similar symptoms as experienced with premenstrual syndrome (PMS)

The symptoms of perimenopause may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for perimenopause:

Specific treatment for perimenopause will be determined by your physician based on:

• your age, overall health, and medical history
• current symptoms
• your tolerance for specific medications, procedures, or therapies
• your opinion or preference

More and more physicians are treating perimenopausal symptoms. These treatments may include:

• low-dose birth control pills (to keep hormone levels more constant)
• antidepressants (to stabilize mood swings)
• progesterone (to treat premenstrual syndrome, or PMS, symptoms)

Other lifestyle changes your physician may recommend include the following:

• Add soy and flax to your diet.
• Exercise regularly.
• Take vitamin E.
• Identify what triggers hot flashes (i.e., coffee, tea, etc.) by keeping a diary or record - to help reduce their likelihood.
• Discuss other herbal treatments such as ginkgo biloba, Evening Primrose Oil, and black cohosh (which may have some effectiveness in relieving certain symptoms), with your physician.

Some of the same suggestions used for coping with hot flashes in menopausal women may also be helpful for perimenopausal women. Consult your physician for more information.