Menopause is defined as the time when a woman has ceased having her period for a full year. But the five to ten years leading up to menopause—referred to as perimenopause since the 1990s—is a hazier concept. During this time, which often begins when a woman is in her mid-40s, hormone levels change, leading to changes in menstrual cycles and a range of other symptoms. The interval between periods can fluctuate (longer or shorter cycles can occur) and the amount of menstrual flow may become heavier or lighter. Ovulation becomes more erratic, and periods may be skipped altogether.
There is no definitive lab test to indicate the onset of perimenopause. Rather, as women transition toward menopause, they may experience hot flashes, night sweats, sleep disturbances, and vaginal dryness. Mood swings, anxiety, forgetfulness, headaches, joint pain, gastrointestinal reflux, and diminished libido may also occur—but aging and other medical conditions can contribute to those symptoms.
Although changing periods are characteristic of perimenopause, abnormal bleeding can signal other gynecologic conditions. You should see your primary-care doctor or gynecologist if you have excessive bleeding, bleeding between periods, or bleeding after intercourse, to rule out a serious condition.
It’s well known that a woman’s risk of heart disease increases after menopause, but there is some evidence that the risk starts to rise during perimenopause. For example, in a large study of Norwegian women, age 40 to 54, total cholesterol, triglycerides, and the ratio of total to HDL (“good”) cholesterol increased as the women went from premenopause to perimenopause to postmenopause. And it’s also possible that decreasing hormone levels during perimenopause can accelerate bone loss, increasing the risk of osteoporosis.
Perimenopause is usually assessed by a woman’s symptoms rather than by blood tests. While an elevated FSH level in the blood can help some doctors to “diagnose” lowered estrogen levels characteristic of perimenopause, the test fluctuates greatly during the menstrual cycle. It only gives a snapshot of the level on a given day. Saliva tests are not reliable or meaningful, either. These tests won’t influence treatment options. On the other hand, checking blood sugar, cholesterol, and thyroid levels is reasonable to do during this time of life.
Options for relief
Medications such as oral contraceptives or low-dose hormone therapy may help control hot flashes and irregular bleeding, but the risks may outweigh the benefits for some women. Certain non-hormonal medications, such as low-dose antidepressants, may also be an option for severe hot flashes. And there are strategies for managing hot flashes that don’t involve drugs, such as paced breathing, mindfulness meditation, and cognitive-behavioral therapy.
If you’re at high risk for osteoporosis, yourdoctor may recommend a bone density test. You should also talk to your doctor if you have other symptoms that are distressing to you, such as trouble sleeping or depression. Lifestyle changes,including relaxation techniques, may help some symptoms.
Keep in mind, also, that though a woman in perimenopause is less likely to conceive naturally, birth control should be used if you do not want to become pregnant. Missing a period, particularly early in perimenopause, can occasionally indicate a pregnancy.
An invitation to healthier habits
Perimenopause is a good time to take stock of your overall health. If you haven’t already done so, make sure that your cholesterol, blood pressure, blood sugar, and thyroid hormone levels are within normal limits.
Be sure to eat a healthy diet and consider taking calcium and vitamin D supplements. Other supplements used by some women include black cohosh, Dong Quai, Evening Primrose Oil and flaxseed. Enjoy regular exercise, including weight-bearing activities such as running or hiking and weight lifting. And if you smoke, now is an especially good time to quit.
Using this time of life to establish healthy habits is the best way to improve how you feel and prepare you for a healthy menopause.
Also see Cooling Hot Flashes, Without Drugs.