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What Is Perimenopause? Signs And Symptoms, And Home Remedies

| Reviewed By Arya Krishnan

Literally, the term perimenopause means "around menopause". It is the time during which a woman's body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is a gradual transition, and no particular test indicates what is happening to the body.

What Is Perimenopause?

Perimenopause or menopause transition is the first stage of menopause that starts 8 - 10 years before menopause. During this stage, a woman will experience some changes in the timing or heaviness in her periods because the ovaries will stop releasing eggs, and they gradually begin to produce less oestrogen [1][2]. As the oestrogen hormones rise and fall, periods grow longer or shorter, and women experience menopause-like symptoms [3].

Women start perimenopause at different ages, some notice the signs in the 40s, but for some women, the changes are evident as early as their 30s. Perimenopause is a natural part of the ageing process. It can last for four years on average, but sometimes only a few months [4].

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When a woman starts perimenopause, the levels of oestrogen will rise and fall unevenly, the menstrual cycles may lengthen or shorten, and one may even begin having menstrual cycles in which your ovaries do not release an egg.

During the final stages of perimenopause, the female body produces less and less oestrogen.

Once a woman goes through the 12 consecutive months without menstruating, that means you have officially reached menopause, and the perimenopause period is over [5].

Let's take a look at the signs and symptoms of perimenopause.

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What Are The Signs And Symptoms Of Perimenopause?

When a woman goes through the menopausal transition, there will be some subtle and evident bodily changes. The first sign of perimenopause is typically a disruption of your menstrual cycle. A woman in this stage can experience the following signs and symptoms:

1. Hot flashes

Hot flashes are common during perimenopause, and the intensity, length and frequency can vary from one woman to the other [6]. Hot flashes can be uncomfortable and come as a sudden wave of heat or warmth often accompanied by sweating, reddening of the skin, and rapid heartbeat. Hot flashes can last from 1 min to 5 mins and are usually followed by a cold chill [7]. About 80 per cent of women will experience some form of a hot flash during perimenopause.

2. Night sweats & sleeping problems

Night sweats are similar to hot flashes but happen during the night [8]. Night sweats can interfere with sleep and cause sleep disturbances. However, in some cases, the cause of sleep disturbances is not understood.

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3. Mood changes

Mood swings and irritability could be due to the sleep disruption associated with hot flashes. In some cases, the mood changes may also be caused by factors not related to the hormonal changes of perimenopause. There is also a risk of depression [9].

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4. Irregular periods

When the ovulation is no longer normal, the length of time between periods may be longer or shorter; the flow can be heavy. At times, you may not even get periods some months [10]. If your period days changes to seven days or more, you may be in early perimenopause. If you have a space of 60 days or more between periods, you are in late perimenopause [11].

5. Lack of sexual desire

A majority of women report having limited sexual arousal or even none. However, it is not the case for everyone because, sexual health experts point out that if you had satisfactory sexual intimacy before menopause, it would likely continue [12].

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6. Loss of bone

During perimenopause, as the oestrogen levels decrease, your bone density will also reduce. Perimenopause can increase your risk of developing osteoporosis [13].

7. Fluctuating cholesterol levels

A decline in the oestrogen levels may lead to fluctuations in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol, increasing the risk of heart diseases [14]. In some women, the high-density lipoprotein (HDL) cholesterol decreases, increasing the risk of heart disease [15].

8. Vaginal problems

When the oestrogen levels reduce, there are chances of the vaginal tissues losing lubrication and elasticity, making intercourse painful (another reason for reduced sex drive in women) [16]. Low oestrogen levels increase the risk of urinary or vaginal infections and urinary incontinence.

Other signs and symptoms of perimenopause are as follows:

• Worse premenstrual syndrome (PMS) before periods [17]

• Breast tenderness

• Weight gain

• Hair changes

• Heart palpitations [18]

Headaches

• Concentration difficulties

• Forgetfulness [19]

• Muscle aches

Urinary tract infections (UTIs)

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What Are The Risk Factors For Perimenopause?

Smoking: Women who smoke have perimenopause one to two years earlier than women who does not smoke.

Cancer treatment: Chemotherapy or pelvic radiation therapy has been associated with perimenopause.

Family history: Women with a family history of perimenopause are more likely to have early menopause.

Hysterectomy: A hysterectomy is an operation to remove the uterus; in most cases, this does not trigger perimenopause/menopause. However, there are chances that the surgery can cause menopause to occur earlier than average.

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Should I Be Concerned About My Perimenopausal Symptoms?

If any of the following applies to you, you must consult a doctor or a gynaecologist immediately.

• Your periods last several days longer than usual.

• Your periods are extremely heavy, or they have blood clots.

• You spot between periods.

• You have spotting after sex.

• Your periods happen closer together (small intervals).

Some of the common causes of abnormal or excessive bleeding during perimenopause include hormone problems, birth control pills, pregnancy, fibroids, blood clotting problems or, in some rare cases, cancer [20].

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How To Manage Perimenopause Signs And Symptoms?

Many women get relief from perimenopause symptoms through lifestyle changes and /or prescription and over the counter (OTC) treatments [21]. In addition, hormone therapy, vaginal oestrogen treatments and antidepressants can help manage perimenopausal symptoms.

Hormone therapy (which comes in pill, skin patch, gel or cream form) can help in relieving perimenopausal hot flashes and night sweats. The doctor may recommend oestrogen, depending on your personal and family medical history. Systemic oestrogen can help prevent bone loss; a common symptom associated with perimenopause [22]. For some, the hormone progestin will be required in addition to oestrogen.

Antidepressants may be prescribed for mood disorders, and certain antidepressants called selective serotonin reuptake inhibitors (SSRIs) might reduce hot flashes [23]. An antidepressant for management of hot flashes can be useful for women who cannot take oestrogen.

Vaginal oestrogen can help treat vaginal dryness; a common symptom associated with perimenopause [24]. The oestrogen can be administered directly to the vagina using a vaginal tablet, ring or cream, which then releases a small amount of oestrogen to be absorbed by the vaginal tissue.

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Home Remedies And Lifestyle Changes For Perimenopause Signs And Symptoms

Adopting healthy lifestyle choices can help manage the symptoms of perimenopause. As studies point out, perimenopause can be managed with some home remedies and lifestyle changes.

Lifestyle changes for perimenopause

• Try to get enough sleep (8 hrs) and maintain a consistent sleep schedule.

• Avoid caffeine (coffee, tea, etc.) before going to bed.

• Avoid drinking too much alcohol, as it can interrupt sleep.

• Be active, as regular exercise can help prevent weight gain, improve your sleep and your mood. Try to exercise for 30 mins every day, and if you can, squeeze in more time for exercise on the weekends.

• Avoid doing any physical activity before going to bed [25].

• Practice stress reduction techniques regularly. You can try meditation or yoga to help promote relaxation and good health and ease the symptoms.

• Follow a healthy diet that is a low-fat, high-fibre diet that is rich in fruits, vegetables and whole grains. Include calcium-rich and vitamin D foods [26].

• Use over the counter, water-based vaginal lubricants or moisturisers to ease the vaginal discomfort.

Here is a list of home remedies that can help manage perimenopause symptoms.

Ginseng: The root of this herb can help soothe hot flashes and improve the quality and duration of your sleep. Ginseng can be consumed as a tea or taken in a capsule form.

Soy: Including more soy-products in your diet can help ease perimenopause symptoms [27]. Soy contains a plant-based oestrogen called isoflavones that can help ease hot flashes, night sweats, and even vaginal dryness. You can get the benefits of soy from soybeans, edamame, tofu, and soy milk.

Vitamin D: As mentioned before, with a lack of oestrogen in your body, you are at an increased risk of developing osteoporosis. This can be avoided by taking a vitamin D supplement, which is also beneficial for boosting your mood [28].

Wild yam: Wild yam has been shown to have potential estrogenic activity, while it is not as effective as other remedies for perimenopause, researchers say that wild yam supplements may mimic the effects of oestrogen on your body [29].

• Some of the other less common home remedies for perimenopause are black cohosh (North American herb), French maritime pine bark extract and dong Quai (Chinese herb).

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The Difference Between Premenopause And Perimenopause

Premenopause and perimenopause are often confused with each other.

Premenopause is when you have no symptoms of perimenopause or menopause. During this, you will still have periods (irregular/regular) and is considered to be in the reproductive years. When a woman reaches the premenopause stage, there will be no noticeable changes in your body [30].

Perimenopause is when you start to experience symptoms of menopause, such as changes in your period cycle, hot flashes, sleep disturbances and mood swings.

How Long Does Perimenopause Last?

Normally, the average length of perimenopause is four years, but for some women, this stage may last only a few months or continue for ten years. And perimenopause ends when a woman has gone 12 months without having her period.

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On A Final Note…

Be aware of any potential interactions of herbal supplements before you try any remedy. Perimenopause is nothing but a natural process, where your body is preparing you to the next stage in your life. It is completely normal and natural. Talk to you gynaecologist if you have any doubts or concerns.

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Frequently Asked Questions

Q. What is the first sign of perimenopause?

A. Irregular periods are often the first noticeable symptom for a woman in perimenopause.

Q. What can I expect during perimenopause?

A. Perimenopause can last anywhere from one to 10 years. During this time, the ovaries can function erratically, and the hormonal fluctuations may bring about a range of changes, including hot flashes, night sweats, sleep disturbances, and heavy menstrual bleeding.

Q. How does perimenopause make you feel?

A. Mood changes are common and often occur around the time of perimenopause and menopause when the hormone levels are decreasing. You may experience mood swings, either high or low mood, or anxiety, crying spells and irritability.

Q. What age is normal for perimenopause?

A. The average age of menopause is 51, and perimenopause symptoms typically begin about four years before your final period. Most women start to notice perimenopause symptoms in their 40s.

Q. Do breasts grow during perimenopause?

A. Yes, it is common for breasts to get bigger or smaller or to change in shape during perimenopause as the hormonal fluctuations are dramatic and unpredictable.

Q. Can a woman have an orgasm after menopause?

A. Although perimenopause-related hormone changes and vaginal changes can dampen arousal around midlife can also affect women's enjoyment of sex and the ability to achieve orgasm, there are ways you can get out of it.

Q. What vitamins should I take for perimenopause?

A. You can take calcium and vitamin D supplements.

Q. How does perimenopause affect periods?

A. Perimenopause can make your periods suddenly irregular. When you are in perimenopause, hormone changes become more erratic, leading to unpredictable bleeding patterns.

Q. How do I get rid of perimenopause belly?

A. Regular exercise and a watchful diet can help reduce perimenopause belly. Your routine can include aerobic exercises, like swimming, walking, bicycling, and running, as well as resistance or strength training.

Q. Can you lose weight during perimenopause?

A. Yes. While it can take longer to lose weight, it is not impossible.

Q. Can perimenopause make you feel crazy?

A. The hormonal changes of menopause, combined with its side effects, can have a significant impact on your mood. It is completely normal to experience mood swings, sadness, and even rage during this time.

Q. Does perimenopause make you tired?

A. Yes, fatigue during perimenopause due to the changes in the levels of hormones like oestrogen, progesterone, thyroid hormones, and adrenal hormones can make you feel extremely tired.

Q. Does perimenopause cause weight gain?

A. The hormonal changes of menopause might cause weight gain around your abdomen than around your hips and thighs. However, perimenopause alone is not the cause for the weight gain, but lifestyle and genetic factors as well.

Arya KrishnanEmergency Medicine
MBBS
Arya Krishnan
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