Although premenopause is often used to refer to this time of transition, the proper medical term is perimenopause. Premenopause is the period of time during which women are in their reproductive years, and will continue to have their menstrual cycle.
Perimenopause is characterized by hormonal shifts and physiological changes and as any woman who has been through perimenopause knows, these changes rarely go unnoticed. Rather, perimenopause is often experienced as a time of upheaval in a woman’s life. Though no two women experience perimenopause exactly alike, there are certain characteristic symptoms. Knowing what to expect can help you to prepare and possibly minimize the impact.
Shifting menstrual cycles – the long and the short of it
As estrogen and progesterone levels begin to decline in perimenopause, menstrual cycles can become shorter, lasting less than 21 days, or they can lengthen to 60 days or more. And once your period arrives it may seem to last almost indefinitely, with bleeding that continues for 10 or more days, in some cases leading to anemia. This “never-ending period” phenomenon is a common occurrence, with 77% of women, in one study, reporting at least 3 episodes throughout their menopausal transition.
Though this unpredictable aspect of perimenopause can be frustrating, abnormal bleeding can also mask a serious condition such as cancer. A thorough check up by a medical professional can rule out any underlying disorders unrelated to perimenopause.
Recent research shows that as the ovaries produce less estrogen the pituitary gland responds by secreting more of a hormone called FSH, or follicle stimulating hormone, and it is the increase in FSH that leads to hot flashes. As many as 87% of women experience these sudden flushes of heat and sweating during perimenopause with many reporting them occurring as one of their earlier symptoms.
Whether or how you experience hot flashes seems to depend on a combination of individual genetics, health history, and cultural influences. Recent evidence indicates that the state of your nervous system, which reflects a combination of each of these contributing factors, may be a good predictor of how you experience hot flashes. The timing of onset, severity, and duration of hot flashes may indicate an underlying imbalance in the way the nervous system regulates blood flow which was masked or suppressed in the presence of estrogen and progesterone. In addition, these same imbalances in nerve function are also associated with disrupted sleep, mood, and cognitive function in menopause.
Depression and other adverse mood symptoms are prevalent and affect many women during perimenopause, including some women with no previous history of depression or anxiety. A recent study reported that perimenopausal women experienced symptoms of depression at a rate of four times that of pre-menopausal women.
It’s important to be aware that symptoms of depression can be subtle and may show up as appetite and weight fluctuations, sleeplessness or excessive sleep, agitation, fatigue, decreased concentration, or feelings of worthlessness. Many women report that their struggles with pre-menopausal depression impact their relationships and work lives. Symptoms tend to decline as women progress through the stages of menopause so that by post-menopause the rates of mood disorders settle out at or slightly above those for menstruating women.
As you transition into premenopause, you may find yourself having difficulty falling asleep, staying asleep, or you may find yourself consistently (and frustratingly) awakening well before sunrise. These are all common sleep problems that women in perimenopause describe. Factors that cause or contribute to sleep problems include hot flashes, depression, stress, and unhealthy lifestyle habits. Studies show that sleep problems tend to show up more frequently in the later stages of perimenopause than in the beginning stages. On a positive note, menopause-related sleep problems tend to improve as a woman progresses through the stages of menopause.
Perimenopause brings with it the beginning phases of vaginal atrophy, including thinning, dryness, and decreased elasticity of the vaginal lining due to loss of collagen and changes in the vaginal pH from acidic to less acidic, all related to decreased estrogen levels. Vaginal dryness can lead to irritation and itching and vaginal changes can lead to painful intercourse in the early phases. The urinary system can also be affected, making you more susceptible to urinary tract infections. Unlike other perimenopause symptoms, which improve or resolve as a woman transitions though the various stages of premenopause and menopause, vaginal atrophy symptoms tend to increase and require daily care.