Women start perimenopause at different ages. In your 40s, or even as early as your 30s, your may start noticing the signs. Your periods may become irregular — longer, shorter, heavier or lighter, sometimes more and sometimes less than 28 days apart. You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help ease these symptoms.
Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause, and the perimenopause period is over.
During the perimenopausal period some subtle — and some not-so-subtle — changes in your body may occur. Some things you might experience include:
Menstrual irregularity. As ovulation becomes more erratic, the intervals between periods may be longer or shorter, your flow may be scanty to profuse, and you may skip some periods. Early perimenopause is defined as a change in your menstrual cycle length of more than seven days. Late perimenopause is characterized by two or more missed periods and an interval of 60 days or more between periods.
Hot flashes and sleep problems. About 65 to 75 percent of women experience hot flashes, most commonly during late perimenopause. The intensity, duration and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes erratic even without them.
Mood changes. Some women experience mood swings, irritability or increased risk of depression during perimenopause, but the cause of these symptoms may be sleep disruption caused by hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.
Vaginal and bladder problems. When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen levels may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you're having periods, pregnancy remains a possibility. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months.
Changes in sexual function. During perimenopause, sexual arousal and desire may change. But for most women who had satisfactory sexual intimacy before menopause, this will continue through perimenopause and beyond.
Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis.
Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.
When to see a doctor
Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don't experience symptoms severe enough to warrant attention. Because subtle symptoms may come on gradually, you may not realize at first that they're all connected to the same thing — fluctuating levels of estrogen and progesterone, another key female hormone.
If you do experience symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your doctor.
All the best,