It’s more than likely that you’ll have heard of menopause, but what about perimenopause?
Like puberty, menopause is a natural transition in your cycle that’s marked by hormone changes and officially starts 12 months after your last period. However, your period doesn’t just stop overnight. The transition into menopause can last years. This is known as perimenopause.
The average age to experience menopause is between 45 and 55. However, perimenopause can begin anytime between your 30s and 50s. During this time, you’ll continue to have a period, but your ovaries start to produce less estrogen, meaning your cycle may become irregular.
Any change to your menstrual cycle can be unsettling. So, from hot flashes to irregular periods, a menopause specialist talks to Flo about what to expect when you experience perimenopause. While everyone who has a period will go through perimenopause, that doesn’t mean that you have to go through difficult symptoms without medical support.
As mentioned above, perimenopause simply describes the transitional process into menopause.
The two important hormones to highlight in perimenopause are progesterone and estrogen. Estrogen plays a key role in your cycle. Your estrogen levels rise just before ovulation to trigger your ovaries to release an egg. Shortly following ovulation, your progesterone levels also rise to prepare your body for pregnancy. They then dip again before your period if the egg isn’t fertilized.
When you enter perimenopause, the amount of estrogen produced by your ovaries decreases. This can lead to irregular periods and your progesterone levels being thrown off. For many people, perimenopause isn’t a straightforward process, and you might have a regular cycle one month and then a particularly long or short one the next. It can be helpful to monitor your cycle at this time with a period tracker like Flo.
Lubna Pal, professor of obstetrics, gynecology, and reproductive sciences at Yale University, explains that irregular periods are often the first sign of perimenopause for many people.
She explains, “You could notice your cycles becoming a little bit shorter. You used to be 28 days. Now they’re 25 to 21 days. That may be the earliest clinical manifestation and the first sign of perimenopause.”
It’s important to note that even as your cycles become irregular, you can still get pregnant during perimenopause. So you should still consider using contraception if you don’t want to have a baby.
Monitoring your cycle and symptoms can be tough because no two bodies are the same. That means people can experience symptoms differently and at very different times.
Generally speaking, there are two main stages of perimenopause:
The early transition: This is when you start to notice irregularities in your cycle. On average, people reach this milestone when they’re around 47. However, this isn’t the case for everyone, and if you start to notice irregularities in your cycle, you should reach out to your health care provider.
The late transition: You may have identified that your cycle is getting increasingly longer (up to 60 days). The gaps between your periods will continue to get longer until your period stops altogether. The average age to experience the late transition in perimenopause is 49.
Like puberty, there’s no set time for your body to enter perimenopause. Some people start the transition in their 30s, while other people won’t experience perimenopause until their late 40s or 50s. If your period stops completely before the age of 40 and you’re not on hormonal contraception, then you should reach out to your health care provider. Menopause before 40 is premature ovarian insufficiency and may be indicative of other health conditions.
Once you start to notice the symptoms associated with menopause, it can be difficult to know how long they’ll last. For some people, the transition can last a year, while for others it can last much longer.
“Some women may start feeling some hot flashes occasionally here and there by their mid to late 40s,” Pal explains. “Symptoms peak within the first year of menopause. The average time for symptoms to persist is around four and half years, but in a handful of women, it can continue for a decade.”
Research has attempted to establish whether there are any factors related to how early you may transition toward menopause and how long your symptoms will last.
One study found that lifestyle factors like smoking and a history of heart disease could be linked to early natural menopause. Pal says that having your periods stop before the age of 40 would be considered early menopause.
Another study reported that there could be links between the age you experience menopause and the age your mother experienced menopause. However, there’s currently limited research into this.
There are a number of signs and symptoms associated with perimenopause. Some people only experience a couple of them; others have all of them.
Suddenly feeling extremely hot, anxious, or flushed? Hot flashes are one of the most common symptoms associated with menopause and perimenopause. It’s estimated that around 75% of women will experience them at some point.
They occur because as your estrogen levels decrease, your body’s thermostat (hypothalamus) becomes increasingly sensitive to temperature changes. “Hot flashes are very common, but not everyone suffers from them. Some women might have a flash occasionally versus five or seven times a day,” Pal explains.
Studies have highlighted that Black women are more likely to report feeling hot flashes. Similarly, people with a higher body fat percentage are more likely to experience hot flashes.
Night sweats are common and can happen for a multitude of reasons. However, when you’re going through perimenopause, the sweats can be caused by a decrease in your estrogen levels. They happen for the same reason that you might experience hot flashes during the day: Your hypothalamus is more sensitive.
Some studies show a link between menopause and fatigue because as your hormones fluctuate, it can cause your energy levels to dip. You might also be more tired because you’re struggling to sleep at night — insomnia is a common perimenopause symptom.
Estrogen doesn’t just play a crucial role in your menstrual cycle. As your estrogen levels drop during perimenopause, the tissue of your vulva and the lining of your vagina may become thinner. This means that during sex, you may produce less discharge, leaving you feeling dry and uncomfortable. This is called vulvovaginal atrophy.
“This discomfort relates to the changes in vaginal tissue that happen when estrogen starts to go. And if sex is less frequent, the discomfort can get worse,” says Pal.
Perimenopause might not just impact your physical health. Research has highlighted that due to the change in hormone levels, you may be more prone to feeling low or depressed when you start to transition toward menopause.
Tiredness, difficulty sleeping, forgetfulness, brain fog, and trouble concentrating are all perimenopause symptoms that can affect your mental health. In fact, one study highlighted that this is a time when people could be at a heightened risk of depression or low moods. The symptoms associated with perimenopause and a lack of understanding surrounding the transition were highlighted as critical triggers.
Experts have also noted that you may be more susceptible to experiencing low moods during perimenopause if you’ve experienced depression in the past. If you’re at all worried or are feeling down, reach out to your health care provider. They should be able to offer you support and be a listening ear.
As perimenopause is a natural transition, there is no treatment to stop it from happening. However, your health care provider may recommend over-the-counter or prescription treatment to help you manage your symptoms.
- Antidepressants to help with low moods or depression
- Supplements containing calcium, vitamin D, vitamin E, or omega-3 can help with managing night sweats, hot flashes, and maintaining bone density.
- Birth control pills to stabilize fluctuating hormone levels and improve symptoms related to a decrease in estrogen
- Hormone replacement therapy can balance out levels of estrogen and progesterone.
- Hormonal or non-hormonal vaginal creams or lubricants to help remedy vaginal dryness
Pal suggests that any treatment plan should have you, the patient, at its center. So, if your medical professional recommends a treatment to you that you’re unsure of, then don’t be afraid to ask questions.
Unless you’re taking contraception, you will still be able to get pregnant while taking treatment to manage perimenopause symptoms. You should speak to your health care provider about family planning while talking about treatment options. If you don’t want to have a baby, then taking birth control pills may be a good option for you. However, hormone replacement therapy can’t prevent pregnancy, and if you still get your period, then you’ll need to use birth control.
While the symptoms associated with perimenopause are common, the way you seek treatment and what works for you might be entirely different from that of your friends and loved ones.
It’s important to remember that perimenopause is a stage of life that every woman and person who has a period will pass through at some point. But that doesn’t mean every experience of it will be the same, especially when it comes to perimenopause symptoms. They’re often as individual as our cycles.
The symptoms associated with perimenopause can be challenging, so we’d recommend having open conversations with friends and family, along with your health care provider so that you have the support in place that you need. Remember: You don’t need to suffer in silence with perimenopause symptoms. There are things your health care provider can do to help.
Written by Courtney Goudswaard