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Premenopause - Perimenopause

Overview, Causes, & Risk Factors

Perimenopause refers to the time before menopause, that is, before a woman stops menstruating completely.

What is going on in the body?

Estrogen levels decrease during perimenopause. The levels gradually decline until a woman stops menstruating. Until then, a woman is in perimenopause. Perimenopause is also called premenopause. Egg production by the ovaries is falling, and estrogen is also diminishing. The production of progesterone also lessens, especially if a woman is no longer ovulating. These hormonal fluctuations vary from woman to woman. Both the amount of hormone produced and the timing of the decline can vary.

What are the causes and risks of the condition?

As women get closer to menopause, the risks of osteoporosis, or bone thinning, and heart disease increase. Lower estrogen levels may be part of the reason that these risks increase.

Symptoms & Signs

What are the signs and symptoms of the condition?

The symptoms vary from woman to woman. Only 30% of women see a healthcare provider about symptoms of perimenopause. The other 70% either don't have severe symptoms, or they get used to them.

Some women may have:

  • chills
  • fatigue
  • frequent urination
  • gastrointestinal problems, such as diarrhea or constipation
  • headache
  • heart palpitations, or feeling a pounding heartbeat
  • hot flashes
  • increased emotions or premenstrual syndrome (PMS)
  • insomnia, or difficulty sleeping
  • muscle pains
  • urinary incontinence, or loss of bladder control
  • vaginal dryness
  • vertigo, or the sensation that the room is spinning
  • About 90% of women have changes in menstruation. The amount of bleeding may increase or decrease. Periods may become longer or shorter and happen more or less often. Some women have severe symptoms. Others have mild or no symptoms. Fertility decreases, but women can still get pregnant. A woman who does not wish to get pregnant needs to use birth control.

    About 60% of women have hot flashes. A hot flash usually comes on suddenly. It feels like heat in the upper body or even the whole body. The woman's upper body or face often turns red or gets red blotches. She may sweat and then shiver as her body returns to a normal temperature. Hot flashes can happen at any time, day or night. The hot flash may last only seconds, or it may last up to half an hour. Hot flashes are a result of decreasing estrogen levels. As estrogen levels decline, the body releases other hormones. These can cause the fluctuations in body temperature.

    Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of perimenopause is usually made by looking at the woman's medical history and supporting symptoms. A blood test can confirm drops in estrogen levels.

    Prevention & Expectations

    What can be done to prevent the condition?

    There is no prevention for perimenopause. All women will go through either a natural or surgical menopause. Women who, for one reason or another, have surgery that removes their reproductive organs earlier in life may not experience perimenopause.

    What are the long-term effects of the condition?

    The long-term effects of perimenopause may depend on any treatments. All hormone replacement therapies have side effects and risks of their own.

    What are the risks to others?

    Perimenopause poses no risks to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    The most common treatment for perimenopause involves the use of oral contraceptives or hormone replacement therapy. The low-dose pills that are available today regulate menstrual flow and frequency. They also can eliminate or reduce hot flashes, vaginal dryness, and emotional and physical symptoms of premenstrual syndrome.

    Dietary changes may also help. Women in perimenopause will benefit from a diet high in calcium, low in fat, and rich in fruits, vegetables, and whole grains. This healthful diet helps prevent osteoporosis, heart disease, and some cancers. It may also help reduce symptoms of perimenopause.

    Exercise helps control weight, improve sleep, and keep bones strong. Exercise also helps with mood swings. Thirty minutes of exercise on most, if not all, days is recommended for everyone.

    What are the side effects of the treatments?

    Side effects of HRT can include headaches, bloating, and irritability.

    Long-term use of hormone replacement therapy may increase the number of women who get breast cancer. If a woman has a family history of breast cancer, menstruated before age 12, or delayed pregnancy, hormone replacement therapy may not be advised. Women who are at higher risk of developing blood clots may also be unable to use hormone replacement therapy.

    The American Heart Association recently issued recommendations about hormone replacement therapy (HRT) in women. For women who have already had a heart attack or have heart disease, it appears that HRT does not protect against having another heart attack or dying from heart disease. The studies that support this information were done with women over 65 years of age. It is unclear if this information also holds true for younger postmenopausal women who take HRT.

    For women who have not already had a heart attack or who do not have heart disease, HRT should not be started for the sole purpose of preventing heart disease. The research is not strong enough to support doing that at this time. Also, it is not necessary for a woman to stop HRT if she is doing well on it.

    Overall, the decision to use HRT should be based upon the proven benefits and risks of HRT. Women should discuss the benefits and risks with their healthcare provider. Together, they can choose the most appropriate course of action.

    What happens after treatment for the condition?

    Most symptoms of perimenopause go away after menstruation ceases. Osteoporosis and cardiac risk factors continue unless estrogen is replaced.

    How is the condition monitored?

    A woman's progression through menopause is monitored in regular gynecological exams, which include pelvic exams and Pap smears. Any new or worsening symptoms should be reported to the healthcare provider.

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