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Menopause

Updated 03 September 2020

Understanding perimenopause, the lead-up to menopause

Although perimenopause often overlaps with menopause, there is a difference.

  • Perimenopause is the lead-up to menopause, but when it occurs differs from person to person
  • The symptoms are often similar to menopause
  • As perimenopause occurs, periods may become more irregular 

Menopause is a normal life event that all women experience as they age. The menopause and the menopause transition (the period leading up to menopause) is a distinct transitional life phase with its own particular health issues.

Menopause technically refers to a woman’s very last period. The terms pre- and perimenopause are used to describe the stages that lead up to menopause and are often used interchangeably by doctors.

Some doctors use the term “premenopause” to refer to any stage before a woman’s first and last period. The prefix “pre” means “before” and “peri” means “near” or “close”. Technically, any woman can be premenopausal, but perimenopausal is the correct term when a woman is close to menopause.

When does perimenopause occur?

Perimenopause commonly occurs three to four years before a woman transitions to menopause, but can start as early as ten years before menopause.

Perimenopause usually occurs during a woman’s 40s, but can occur during her 30s.

What distinguishes perimenopause from menopause?

During perimenopause, the ovaries still release eggs, but oestrogen levels start to drop significantly. At this stage, it’s possible for women to start experiencing menopausal signs such as hot flushes and sleep disturbances, but there is still a menstrual cycle and it’s possible to conceive.

According to Cleveland Clinic, it is possible for periods to start becoming more irregular during the perimenopausal phase, but of your period is absent for longer than 12 months, you are no longer perimenopausal, but menopausal. If you are on medication or have medical conditions that normally affect your period, it might be difficult to distinguish between stages.

What are the signs of perimenopause?

As oestrogen levels start to drop during perimenopause, experts agree that the main sign of this stage is irregular periods, because of declining ovarian function.

Because of declining oestrogen levels, there are other signs that are similar to menopause. These include:

  • Hot flushes and night sweats
  • Decreased sex drive
  • Vaginal dryness
  • Sudden heavy periods as the uterine lining becomes thicker because of less progesterone
  • Sudden mood changes
  • Sleep disturbances  

What can be done about perimenopause?

According to Harvard Medical School, there are several treatments that can relieve some symptoms. It is always best to discuss any treatments or concerns with your gynaecologist or doctor.

  • Discuss a low-dose oral contraceptive with your gynaecologist to help with hormonal irregularities. Not only do they regulate heavier bleeding and thin the lining of the cervix, but also supress erratic mood swings.
  • Newer generation antidepressants like venlafaxine, or some serotonin reuptake inhibitors such as fluoxetine can relieve severe hot flushes if hormone therapy or oral contraceptives are not an option.
  • Vaginal oestrogen as a cream or gel can help vaginal dryness.

READ | Medication might be the reason behind postmenopausal weight gain

READ | How to deal with hot flushes

READ | Brain fog during menopause is real 

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