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What is perimenopause?

There has not been an agreed-upon definition of perimenopause, causing challenges for those of us who need and want to understand what we are going through! Often when people talk about being in menopause or talk about going through menopause, they are talking about perimenopause.  The International Menopause Society (IMS) has advocated for us to use The World Health Organization definition below. 

Perimenopause: the period immediately before the menopause when the endocrinological, biological, and clinical features of approaching menopause commence and the first year after menopause. 

A woman is premenopausal from her first period until she enters perimenopause or the menopausal transition. The changes that occur in perimenopause are best defined as declining levels of hormones, fluctuating levels of hormones, a change in the length of cycles, and unpredictably of the production of eggs. Menopause is defined as occurring when you have not had a period after 12 months. After that, you are considered post-menopausal.

What happens During Perimenopause?

  • Your hormone levels of estrogen and progesterone are dropping and will fluctuate wildly.
  • You might experience irritability, mood swings. Many women have symptoms of depression. 
  • Hot flashes are quite common with perimenopause. The length, frequency, and intensity of these vary for each woman.
  • Night sweats and flushing

Women gain an average of 2–5 pounds during perimenopause.

  • Sleep problems, usually caused by hot flashes but also experienced without them. We aren't sure why. 
  • Ovulation, and therefore periods become more unpredictable. Menstrual flow can either be lighter or heavier than normal. 
  • Your sex drive may decrease and/or become unpredictable or you may have painful sex.
  • Declining estrogen levels can cause increased bone loss which increases a woman’s risk for osteoporosis. 
  • Decreasing hormone levels also impact cholesterol so you may suddenly have high cholesterol for the first time. 
  • Because hormones play a role in brain function many perimenopausal women complain of memory and concentration problems.
  • Weight gain is also a common symptom
  • Symptoms of PMS can worsen or get better
  • You might experience an increase or decrease in urinary tract infections

Some women also experience some less common symptoms such as :

  • Hair loss
  • Heart palpitation
  • Acne
  • Breast tenderness or reduction in breast tenderness
  • Migraines
  • Aching Joints
  • Dry Skin

Doctors believe the hypothalamus, responsible for temperature regulation, is made more sensitive by the fluctuation of hormones and is responsible for hot flashes. 

Perimenopause and Vasomotor symptoms (VMS)

Sixty to eighty percent of women experience vasomotor symptoms during perimenopause. For some they are minimal and for some, they are much more intrusive. 

Vasomotor symptoms are:

  • hot flashes- a sudden sense of heat that can occur in the head face or chest or neck.
  • flushing- a change in the color of your skin, like blushing, that usually accompanies a hot flash.
  • night sweats -waking up sweating in the night sometimes accompanied by drenched sheets and closed.

 In 2015 a North American Menopause Society panel found that cognitive behavioral therapy and hypnosis were significantly effective in treating hot flashes.

I honestly had never heard of perimenopause until recently when seeing patterns in my female clients of this age group. I don't think I ever hear my clients talk about it either, however it seems that the impact of perimenopause on our moods, our stress level, our weight, and our sleep and appetite and our concentration is pretty profound. It lasts an average of 2-5 years but for some, it can last for up to 10 years! If you are between the ages of around 35 and 51 changes and challenges you may be experiencing in these areas may be due to perimenopause. For women, hormonal changes can be worse than those of adolescence. 

Additionally, many of us who have children, aging parents and are in the workforce are in the midst of tremendous life stress. The timing couldn't be worse. 

Perimenopause is worse than menopause, and there is some reason to think that things get better after perimenopause. For example, 60 percent of women state that they have memory problems during the menopause transition but during post-menopause, women report these levels to return to normal( 2009).

About 18% of women in early perimenopause and 38% of those in late perimenopause experience symptoms of depression.

About 18% of women in early perimenopause and 38% of those in late perimenopause experience symptoms of depression

Depression and Anxiety in Perimenopause

Most physicians don't get training in perimenopause, and middle-aged women aren't generally a priority in medicine. Yet, women who have a history of depression and anxiety are very vulnerable to episodes at this time, especially those who are sensitive to hormonal fluctuations. Many physicians will not screen for depression and anxiety in their patients during perimenopause,but they should.The environmental stressors typical to midlife for women, including weight gain so common for us, paired with life circumstances are a perfect storm. It's important to know that if you have mood symptoms of anxiety and depression you may need professional help.  Perimenopause like postpartum, pregnancy, and adolescence is a time of great vulnerability for women. 

Please click here to learn more about depression and perimenopause.

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Lovejoy, J. (1998). The influence of sex hormones on obesity across the female life span. Journal of Women’s Health, 7, 1247–1256. doi:10.1089/jwh.1998.7. 1247

American academy of neurology; menopause transition may cause trouble learning. (2009, Jun 10). Elder Law Weekly Retrieved from http://nclive.org/cgi-bin/nclsm?url=http://search.proquest.com/docview/208902417?accountid=13217

As Menopause Nears, Be Aware It Can Trigger Depression And Anxiety, Too. (n.d.). NPR.Org. Retrieved March 11, 2020, from https://www.npr.org/sections/health-shots/2020/01/16/796682276/for-some-women-nearing-menopause-depression-and-anxiety-can-spike

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