Perimenopause

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Perimenopause is the period of transition from reproductive life, characterised by regular menstruation, to menopause, when menstruation eventually ceases. This period is characterised by a decline in oestrogen, which is an important female hormone involved in menstruation. During this period, menstrual cycle becomes unpredictable, erratic / irregular. This is because ovulation also becomes erratic and unpredictable; but pregnancy is still possible.

What are the symptoms / signs of perimenopause? 

Perimenopause is characterised by the following symptoms, which are also common during menopause:

  1. Irregular menses – Menstrual cycles become less predictable. They may be shorter or longer or a mixture of both. One or two periods may be skipped.
  2. Changes in menstrual flow – Periods may become heavier or lighter than it used to be.
  3. Hot flushes – Sudden feeling of heat inside the body, which spreads across the body like a wave, accompanied by sweating.
  4. Vaginal dryness – This is associated with discomfort during sexual intercourse.
  5. Mood changes – This may involve mood swings, depression etc.

When does perimenopause begin?

The time of onset of perimemopause varies from one woman to another. It may begin as far as ten years before menopause, starting usually around mid 40s.

How long does perimenopause last?

How long perimenopause lasts depends on an individual. While some may experience perimenopausal symptoms for four to eight years, it may last for just few months in others. On the average, it lasts four years.

When does perimenopause end?

Once the period of cessation of menses reaches 12 consecutive months, menopause has set in and perimenopause has ended. At this point, there is no more chance of getting pregnant naturally because ovulation has completely stopped.

What causes perimenopause?

Perimenopause occurs due to decline in oestrogen production from the ovaries. This, in turn, is due to declining number of eggs in the ovaries, leading to declining ability of the ovaries to release eggs. This is a natural process in the reproductive life of a woman.

What other conditions can mimic perimanopause? 

The following conditions may also cause menstrual abnormalities which may coincide with the period of perimenopause. This necessitates the need for medical evaluation for women experiencing such symptoms. They include:

  1. Fibroids
  2. Blood clotting disorders
  3. Use of blood thinners
  4. Miscarriage
  5. Infection of the lining of the womb
  6. A growth projecting from inside the womb (endometrial polyp)

What are the treatment options for perimenopause? 

Being a natural event, not a disease condition, there is no specific treatment to stop perimenopause. However, treatments may be offered to relieve the associated symptoms in women who find them challenging. Such treatments include:

  1. Birth control pills – These help stabilize the hormone levels, thereby relieving the associated symptoms such as hot flushes, menstrual irregularities etc. These pills should be used for limited time, as directed by doctors.
  2. Oestrogen vaginal creams – These may help reduce the pain associated with sex by relieving vaginal dryness associated with low oestrogen level.
  3. Antidepressants – These drugs help to stabilize the mood in those women with mood changes or depression.

Advice for women undergoing perimenopause

  1. Osteoporosis – This is a condition in which bones become less dense and, therefore, more prone to fracture. Therefore, the following medications may be of benefits to these women: calcium, vitamin D and multivitamins. They may also benefit from weight-bearing exercises.
  2. Heart diseases – Women undergoing perimenopause should endeavour to check their blood pressure regularly as well as their cholesterol levels.
  3. Contraception – As women can still get pregnant during perimenopause, though the risk is less than during active reproductive years, women who are not desirous of pregnancy should continue to use effective contraception until menopause sets in. 
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