Perimenopause: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

The term "perimenopause" refers to the time when your reproductive years come to an end and your body naturally shifts to menopause. The menopausal transition is another term for perimenopause.

The perimenopause affects women at varying ages. Sometime in your 40s, you may start to notice symptoms of an approaching menopause, such as irregular menstruation. However, for other women, the alterations start in their mid-30s.

During perimenopause, your body's amount of estrogen, the primary hormone for women, varies irregularly. Menstrual periods may start if your ovaries fail to release an egg or ovulation. On the other hand, your cycles can get longer or shorter. Other possible menopause-related symptoms include hot flashes, insomnia, and dry vagina. 

Some therapies can help to ease these symptoms. Once you have gone 12 months without having a monthly cycle, the perimenopause stage comes to an end. You are regarded as having entered menopause at that point.

Causes Of Perimenopause

During perimenopause, your body produces increasing amounts and decreasing amounts of progesterone and estrogen, two important female hormones. The decrease in estrogen is the primary cause of many of the changes that take place during perimenopause.

Also Read: Amenorrhea: Causes, Symptoms, Risk Factors, Diagnosis, Treatment And Complications

Symptoms Of Perimenopause

During the menopausal transition, there may be certain subtle and not-so-subtle bodily changes. You might run into:

• Irregular Periods: As ovulation becomes more irregular, you may experience fluctuations in the time between periods, light to high flow, and skip some cycles. If there are regular variations in your menstrual cycle of seven days or more, you may be in the early phases of perimenopause. If sixty days or more have passed since your last menstrual cycle, you are most likely in the late stages of perimenopause.
• Problems with sleep and hot flashes: The perimenopause is when hot flashes usually occur. The regularity, length, and degree are different. Though they are not always the reason, hot flashes, and night sweats are often the source of sleep problems.
• Emotional changes: Mood swings, irritability, or a higher risk of depression might happen during perimenopause. The inability to sleep due to heat flashes may cause these symptoms. Mood swings can be caused by several things besides the hormone changes linked to perimenopause.
• Problems with the vagina and bladder: When estrogen levels fall, your vaginal tissues may become less pliable and lubricated, which can make sexual activity painful. Furthermore, if your estrogen levels are low, you can be more vulnerable to urinary or vaginal infections. Having trouble urinating could be exacerbated by loss of tissue tone. 
• Reduced fertility: The less frequently you ovulate, the lower your chances of becoming pregnant. Yet, as long as you are menstruation, pregnancy is still conceivable. Until you haven't had a period for a full year, use birth control to avoid getting pregnant.
• Modifications in sexual behavior: Perimenopause may cause changes in arousal and desire for sexual activity. Perimenopause and beyond are likely to be marked by fulfilling sexual relationships, nonetheless, if this was the case before menopause.
• Loss of bone: Osteoporosis, a disorder that causes brittle bones, is more likely to occur in people with reduced estrogen levels because the bone breaks more quickly than it grows back.
• Adjusting the cholesterol level: Decreased levels of estrogen can lead to adverse changes in blood cholesterol, like an increase in low-density lipoprotein (LDL) cholesterol, commonly referred to as the "bad" cholesterol, which increases the risk of heart disease. Additionally, women are more likely to develop heart disease as they age due to a drop in high-density lipoprotein (HDL), also known as the "good" cholesterol.

Also Read: Cholestasis Of Pregnancy: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Risk Factors Of Perimenopause

Menopause is a normal life stage. But it might happen to some women sooner than to others. Although the evidence is not always conclusive, some factors may raise your likelihood of entering perimenopause earlier in life. Among these factors are:

• Smoking: One to two years before non-smoking women, smokers experience the onset of menopause.
• History within the household: If early menopause runs in the family, women may experience it early in life.
• Cancer therapy: Treatment for cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.
• Hysterectomy: A hysterectomy, which removes your uterus but leaves your ovaries in place, usually does not cause menopause. Even when you are not menstruating, your ovaries are still producing estrogen. However, menopause may begin earlier than usual as a result of this type of surgery. Additionally, if you have one ovary removed, the other ovary may stop working earlier than expected.

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Diagnosis Of Perimenopause

The perimenopause is a gradual transition that happens over time. The diagnosis of perimenopause requires the use of multiple tests or indicators. Your doctor will consider various criteria, including your age, symptoms, menstrual history, and physical changes.

Some doctors may recommend testing to determine your hormone levels. With the possible exception of evaluating thyroid function, which may change hormone levels, hormone testing is rarely necessary or beneficial to evaluate perimenopause.

Also read: Vaginal Agenesis: Causes, Symptoms, Diagnosis, Treatment and Complications

Treatment Of Perimenopause

Following are some of the treatment options for perimenopause:

• Hormone therapy: The most effective remedy for hot flashes and night sweats associated with perimenopause and menopause is still systemic estrogen therapy, which comes in the form of pills, skin patches, sprays, gels, or creams. Depending on your medical history, both personal and familial, your doctor may recommend estrogen at the lowest dosage necessary to treat your symptoms. If your uterus is still intact, you'll need progestin in addition to estrogen. The presence of estrogen in the body can help prevent bone loss.
• Estrogen: Estrogen can be directly applied to the vagina using a vaginal ring, cream, or tablet. The small amount of estrogen released during this treatment is absorbed by the vaginal tissue. It can help with certain bladder problems, discomfort during sexual activity, and certain vaginal dryness.
• Antidepressants: Menopausal hot flashes may be lessened by several antidepressants that belong to the selective serotonin reuptake inhibitor (SSRI) medication class. For women who are unable to take estrogen due to medical reasons or who require it for mental health concerns, an antidepressant may help manage hot flashes.
• Gabapentin: Authorized to treat seizures, gabapentin has also been demonstrated to lessen hot flashes. This medication can help migraineurs as well as women who are medically unable to take estrogen therapy.
• Fezolinant: Menopausal hot flashes can be treated with this medicine as an alternative to hormone therapy. It works by blocking a brain circuit that helps regulate body temperature.

Before deciding on a course of therapy, discuss your options with your doctor and weigh the pros and dangers of each. Review your options annually as your needs and the range of treatments available may vary.

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Complications Of Perimenopause

Period irregularities are one of the primary indicators of the perimenopause. Generally speaking, this is normal and shouldn't raise any red flags. However, speak with your doctor if:

• The bleeding is so bad that you have to change tampons or pads every hour or two for two or more hours.
• More than seven days go by while bleeding
• Bleeding occurs in between periods.
• Periods typically occur less than 21 days apart.

These kinds of symptoms may point to a reproductive system problem that requires diagnosis and treatment.

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