Perimenopause, the first stage of Menopause

When can Perimenopause start?

Perimenopause can begin in some women in their 30s, but most often it starts in women ages 40 to 44. Women who have had their a hysterectomy or ovary removed may experience symptoms earlier.

Common Symptoms:

Irregular Periods: This is one of the first signs of perimenopause. You may notice that your periods occur closer together or further apart. Due to reduced progesterone levels, the endometrium's growth regulation diminishes, potentially leading to a thicker uterine lining prior to shedding, resulting in significantly heavier menstrual periods. Additionally, conditions such as fibroids (non-cancerous growths on the uterine wall) and endometriosis (the displacement of endometrial tissue to other pelvic regions), both influenced by estrogen, may exacerbate and cause increased discomfort.

Hot flashes and sleep disturbances: Perimenopausal women commonly experience hot flashes of varying intensity, duration, and frequency, often disrupting sleep patterns. Mood changes, including irritability and increased risk of depression, may be linked to sleep disturbances or other factors unrelated to hormonal fluctuations.

Vaginal and bladder issues: Diminished estrogen levels during perimenopause can lead to vaginal dryness, reduced elasticity, and painful intercourse. Additionally, lower estrogen levels may increase susceptibility to urinary or vaginal infections and contribute to urinary incontinence due to loss of tissue tone.

Declining fertility: As ovulation becomes irregular, fertility decreases, although pregnancy remains possible as long as periods occur.

Sexual function changes: Perimenopause may bring alterations in sexual arousal and desire, though women who enjoyed satisfying intimacy before menopause typically maintain it through perimenopause and beyond.

Bloating: may occur more frequently in perimenopause than during menopause or postmenopause. During perimenopause, your hormones are changing rapidly. That can lead to higher levels of estrogen. Estrogen causes your body to retain water, which can lead to bloating.

Menopause is a normal part of life, just like puberty. Many women may notice changes in their bodies before and after menopause.

The transition usually has three parts:

  1. Perimenopause
  2. Menopause
  3. Post-Menopause

Changes usually begin with perimenopause. This can begin several years before a woman’s last menstrual period. Menopause comes next, the end of the menstrual periods. After a full year without a period, menopause is over. Post-menopause follows menopause and lasts for the rest of a woman’s life. The average age for the last period is 51. Some women, however, have the last period in their forties, and some have it later in their fifties (1). For many women, this process is a smooth transition and goes unnoticed with no symptoms, but for others this seemingly normal part of life is not normal for them at all.

National Institutes of Health – National Institute on Aging, “Menopause.” http://www.nia.nih.gov/health/publication/menopause.

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