Perimenopause

September 21, 2011

The term perimenopause is defined as that time about or around menopause. Internationally, the Council of Affiliated Menopause Societies has used the term climacteric to describe the phase during the aging of women marking the transition from the reproductive phase to the nonreproductive state. Generally, it is recommended that perimenopause and climacteric be used synonymously and to represent the transition from the reproductive stage to 12 months following the final menstrual period. This term is also often referred to as the menopause transition.

Perimenopause generally starts in a woman’s early 40s when increasing symptoms may develop. The most frequent symptoms are menstrual cycle irregularities, vasomotor symptoms (hot flashes), sleep disturbances, and less frequently vaginal thinning and dryness. The response to symptoms is impacted by psychological, social, and cultural influences, but the most significant initiator of symptoms in the perimenopause is related to the declining or changing levels of estrogen and progesterone, produced from the ovary. As the menopause transition is a normal process, there is a disinclination to call the effects “symptoms,” but these can be quite severe and need medical intervention. There are potential long-term effects from the hormonal changes (see Menopause).

Our current knowledge about the perimenopause is limited to few studies, but what is known in terms of changes through the perimenopause are listed as follows:

  1. Declining fertility. The ability to reproduce declines rapidly between the ages of 35-38 and onwards. Fertility beyond age 45 is much less frequent.
  2. Changes in the menstrual cycle. The menstrual cycle changes are the most frequent symptoms reported by women in the premenopause. These include heavier flow (menorrhagia), reduced flow (oligomenorrhea), more frequent menstruation (polymenorrhea), and ultimately loss of menstruation (amenorrhea).
  3. Vasomotor symptoms. The most frequent symptom after menstrual cycle changes relate to vasomotor symptoms. The hot flash, which is a feeling of sudden transient warmth that may spread across the face or the entire body, usually followed by a sensation of perspiration and possible shivering, is frequently a problem. The vasomotor symptoms may last a few months or several years, but usually disappear spontaneously. The best therapy remains some form of estrogen or estrogen plus progestin therapy.
  4. Sleep disturbances. Changing or declining estrogen levels have a negative impact on the quality of Rapid Eye Movement (REM) sleep. REM sleep is an important component of normal sleep. Disrupted sleep patterns can be exacerbated by night sweats (hot flashes during the night). A result of poor sleep is morning fatigue, irritability, complaint of reduction in short-term memory, and minor depression.
  5. Urogenital changes. Thinning of the vaginal lining with increasing susceptibility to infection or to painful intercourse is not usual prior to cessation of menses and the presence of a low estrogen level.
  6. Urinary complaints. There is very little evidence to suggest any impact of the perimenopause on urinary stress incontinence (leaking bladder). However, there may be an increase of urgency or the sensation of the need to urinate immediately.
  7. Central nervous system changes. There is no direct evidence of any major central nervous system change in terms of direct causation of perimenopause with increased depression, loss of cognition, or headache, although indirect evidence has been presented.
  8. Sexuality. There is evidence that sexual activity decreases with age in both sexes and problems of sexual desire and sexual arousal may be related to declining ovarian estrogen and androgenic hormones.

The perimenopause represents a good opportunity for a complete health evaluation, identification of risk factors for development of future medical problems, screening for early evidence of existing problems, and commencement of a proactive preventive health program.

SEE ALSO: Fecundity, Libido and desire, Menstrual cycle disorders, Menstruation, Oligomenorrhea

Suggested Reading

  • North American Menopause Society. (2002). Menopause core curriculum (2nd ed.). Cleveland, OH: Author.

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