Perimenopause: A Time of Transition

Perimenopause is the time in a woman’s life when her body makes the transition between having monthly menstrual periods and entering menopause, the permanent end of her reproductive ability. Menopause is defined as the time when a woman has not had any menstrual periods (including spotting) for 12 months.

Irregular periods are common during perimenopause, but you should see your health care provider if:

• Menstrual bleeding is very heavy or comes with clots

• Menstrual bleeding lasts longer than seven days

• You have spotting or bleeding between periods

• You bleed from the vagina after sex

As your body ages, your ovaries release fewer eggs, hormone levels decrease and fertility decreases and eventually disappears. These perimenopausal changes begin around age 45, but can begin as early as age 35. Perimenopause can last a few months or a few years. It can produce symptoms, some of which may be unpleasant. While this is a natural process, each woman’s experience is different.

Facing the change

• If you are having periods, even if they are irregular, you can get pregnant. Talk to your health care provider about your options for birth control.

• Mood changes. Changing hormone levels don’t lead directly to altered moods or irritability, but many women in midlife do experience mood changes. Simple ways to cope with moodiness include talking with friends or making time to relax every day. Talk with your health care provider if you have sad moods that are prolonged or severe.

• Hot flashes. Hot flashes occur possibly because of declining hormone levels. It helps to avoid hot flash triggers such as high temperatures, spicy food, alcohol and caffeine. Also, try dressing in layers you can remove.

• Vaginal dryness. Lower estrogen levels can result in less vaginal lubrication, making sex uncomfortable. Try using an over-the-counter vaginal lubricant to improve the comfort of intercourse. Regular sexual activity can also help you avoid discomfort and dryness.

• Sleep changes and night sweats. It’s common to wake up at night soaking from sweat followed by chills. You may also have trouble getting back to sleep or have insomnia. Wear cool pajamas to bed and keep an extra pair on hand for when you wake up. Avoid caffeine and try relaxation exercises to help reduce sleep disturbances.

Diet and exercise can help

Frances McGill, M.D., an obstetrician-gynecologist in New York City, notes that eating a healthy diet and living an active lifestyle can ease perimenopausal symptoms.

“Exercise is important because it releases endorphins, which have a ‘feel-good’ effect,” Dr. McGill says. In terms of your diet, cutting back on fat, excess alcohol and caffeine also helps your body remain on an even keel. These steps also can help prevent weight gain.

The hormone debate

Until recently, hormone therapy (HT) was thought to be a fairly safe treatment for easing menopausal symptoms. A study by the Women's Health Initiative, part of the National Institutes of Health, was stopped in 2002 when it found that HT increased the risk for breast cancer and heart disease.

“The Women’s Health Initiative surprised us all,” Dr. McGill says. “I think most surprising was that in relatively healthy women, there was an increase in heart disease and stroke.”

Despite these findings, HT can be suitable for short-term relief of severe menopausal symptoms. Talk with your health care provider about whether short-term HT is right for you.