Perimenopause: Changes And Symptoms To Expect
You recently blew out candles to celebrate your 45th birthday, and now youre dealing with hot flashes, irregular periods and vaginal dryness. Welcome to perimenopause, the time in your lifeusually in your 40swhen hormones shift as you approach menopause.
We define menopause clinically by the fact that a person has stopped menstruating for at least one year, says UNC Medical Center OB-GYN Rachel Urrutia, MD. Perimenopause is the time leading up to that, and its characterized by hormone levels that are starting to change.
Perimenopause can last 10 to 12 years, but the worst symptoms are usually in the five years leading up to menopause. Menopause happens when the ovaries no longer have eggs to expel and so ovulation stops. Because ovulation stops, the production of estrogen and progesterone is greatly decreased.
Perimenopause: Rocky Road To Menopause
What are the signs of perimenopause? You’re in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, you’re going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause that is, the natural end of menstruation. Menopause is a point in time, but perimenopause is an extended transitional state. It’s also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause .
Your Pms Can Feel Even Worse
All those hormonal ups and downs that start at 40 can do a number on your mood and emotions before your period begins. As the hormones fluctuate more dramatically, those women who have mood symptoms with their periods tend to see more fluctuations in those moods, says Dr. Dunsmoor-Su. Some women get very depressed as the hormonal fluctuations become more significant.
If you find yourself becoming significantly depressed, dont be afraid to reach out to your doctor. Anti-depressants are very helpful in this kind of depression, and if left untreated, it can become very severe during the menopausal transition, she says.
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Should I Be On Birth Control During Perimenopause
Yes. If you do not want to become pregnant, you should use birth control during perimenopause. Even if you are getting your period every few months, you are still ovulating those months. Since its not possible to predict when you are ovulating, you should use birth control until you havent gotten a period for at least 12 months.
When Does Menopause Usually Happen
Menopause happens when you have gone 12 months in a row without a period. The average age of menopause in the United States is 52. The range for women is usually between 45 and 58.2 One way to tell when you might go through menopause is the age your mother went through it.3
Menopause may happen earlier if you:
- Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.4
- Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who dont smoke.5
Certain health problems can also cause you to start menopause earlier.
Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our Early or premature menopause page.
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Is Increased Period Pain Normal
So, what can happen, if your periods start to get closer together or last longer, is that you can end up getting low in iron. Low iron levels can cause quite a few health issues, so this is something that you really need to watch if you’ve had more than a couple of periods that go on for a little bit longer, or are a little bit heavier, than normal.
The problem is that when you start to miss periods, all that’s happening is that your oestrogen is not getting high enough each month to trigger a period. But there is still a build-up in the lining of the uterus, and once that releases when you have a period, which can cause a lot of spasms and can give you a lot of cramping and pain as well.
The problem is, here, that other symptoms can be a factor as well. When your oestrogen levels start to fall, this could be when you start missing periods. Lower oestrogen levels can also increase your pain perception so you may feel more pain than what you would normally.
The other thing that can happen here is that, as your oestrogen starts to change, it can affect your absorption of magnesium. This is especially true if you’re not getting enough magnesium in your diet already! Then low magnesium will contribute to stomach cramping and that will include the uterine cramping when you get a period.
When To See A Doctor
Speak with your healthcare provider if youre experiencing any of these:
- Abnormal length of period
- Bleeding with intercourse
While these are common during perimenopause and usually not a cause for concern, its best to keep your doctor in the loop and notify them of any changes. Anytime youre unsure or concerned about perimenopause symptoms, speak with your doctor.
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Your Cramps Could Become More Painful
Well this sucks: Even though your periods might come less frequently or might be lighter than before, youll still experience those gut-churning crampsand they might actually be worse. Cramps can get worse in the beginning of perimenopause due to the closer and stronger surges of estrogen and progesterone, says Dr. Gupta. The good news, however, is that as you close in on menopause, your flow shows up less often and is lighterhence, less cramps, she says.
What Do You Need To Know About The Menopause
The menopause is the natural process women go through as they reach a certain age and signals the point when a womans monthly periods have come to an end.
Although reaching the menopause technically means you have had your last ever period, we often use this phrase to describe the lead up to your periods stopping. Periods rarely just stop suddenly, many women experience irregular periods for some time. This might include heavier, more painful periods or lighter, less frequent ones these patterns can go on for a number of years. Every woman is different but you are generally considered to be fully through the menopause after not having a period for at least two years.
Alongside the often irregular periods, many women often experience a whole number of symptoms in the lead up to the menopause as oestrogen begins to drop, this can be anything from hot flushes to joint pain.
On this page I give a quick overview of what the menopause involves and specifically the effects it can have on the menstrual cycle. Visit A.Vogel Talks Menopause for more in-depth information and video blogs from our menopause expert Eileen.
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Hormonal Causes Of Severe Pain During Irregular Periods
The pain associated with irregular periods is usually caused by fluctuations in hormone levels, particularly estrogen and progesterone. During menopause, estrogen and progesterone as well as some other hormones, are created in the body in less stable, consistent amounts. These fluctuations can cause a number of other menopausal symptoms as well, such as hot flashes, night sweats, and vaginal dryness.
Can I Get Pregnant If I Am In Perimenopause
Yes, you can still become pregnant. You may be less likely to get pregnant during perimenopause, but it’s still possible. As long as you have a period, you can still get pregnant. If you want to expand your family during this time, speak with your healthcare provider about your health, fertility and possible fertility treatment options.
When your periods are irregular, you may be more likely to get pregnant unexpectedly. If you dont want to expand your family at this age, continue using birth control until your healthcare provider tells you its safe to stop. Continue to practice safe sex to prevent sexually transmitted diseases throughout your life.
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Menopause Symptoms Can Feel Like Pms
Some women develop symptoms of Premenstrual Syndrome for the first time or have more acute levels of their normal PMS. These symptoms can be physical, psychological, or emotional. Most of us will have had some level of PMS during the second half of the monthly cycle over the years. Symptoms may have been getting stronger during your 30s and 40s, approaching menopause. Most common symptoms are irritability, aggression, tearfulness, mood swings, breast pain and fluid retention.
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Menopause Might Not Be The Cause
Heres a curveball: Your symptoms may not be due to menopause at all. Dr. Evans says, Just like Freud blamed mothers for everything, we tend to blame our ovaries and uterus for everything. But menopause isnt always to blame.
Many symptoms mimic the signs of menopause but there might be other causes. In midlife, there are plenty of factors affecting womens physical and mental health. Some of those can mimic the signs of menopause.
For example, juggling work, kids and aging parents can contribute to anxiety and depression. Weight gain, which is often blamed on menopause, has more to do with an aging metabolism. Thyroid disorders can mimic menopause as well. And though its not the norm, pseudo-hot flashes have even been caused by chronic sinus infections, Dr. Evans says.
Bottom line: Dont write off discomfort as, Well, I guess this is my life now. You dont need to live with uncomfortable symptoms, whatever the cause. See your doctor to figure out whats going on and how best to manage it.
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To Avoid Constipation And Increase Your Natural Gut Bacteria
- High fibre Eat lots of high fibre foods
- Alcohol Drink alcohol only in moderation
- Water Drink plenty of water
- Eat fermented foods such as sauerkraut, Kimchi and and Kefir. But do start slowly and build this up, I overdid it when I first started taking these and ended up with uncomfortable side effects like bloating.
- Psyllium husk The powder or capsules are both excellent.
- Chia seeds I have chia seeds each day in my oatmeal.
- Kiwi fruit If your stomach tolerates it, Kiwi fruit is great for constipation. 1 or 2 a day will help keep your regular.
Period Changes During Menopause
So, yes, the peri-menopause is when your periods start to change as you approach the menopause. At this point, your periods can become closer together, they can become longer, they can become heavier, or they can do the complete opposite they can start to miss, they can get further apart or they can get lighter. You might even find you’re only having one period every three months or so.
Both of these are kind of normal, if you like, but they can affect how you feel and also cause a lot of pelvic discomfort.
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When Does Menopause Occur
Most women reach menopause between 45-55 years of age, and the average age for women in Australia to reach menopause is 51-52 years. Some women will have a later menopause, at up to 60 years of age, especially if there is a family history of late menopause.
Menopause sometimes occurs earlier than expected as a result of cancer treatment, surgery or unknown causes. This is discussed further in ‘Causes of menopause’.
When To Get Help
As always, you know your body best, and you should never hesitate to get professional help if you think you need it. If you experience any of the following, you should consult your doctor right away:
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My Experience Of Periods Changing Prior To Menopause By Aisling Grimley Founder My Second Spring
“At 47 I missed my period one month and thought I might be pregnant as I also experienced some hormone surges that reminded me of pregnancy. I had some red rage moments and very tender breasts.
During the following 5/6 years of perimenopause, I went through times of having regular monthly periods in my classic pattern for a few months. Then I might skip up to 6 months only to have periods return to normal again. During the gaps with no period, I sometimes had PMS like symptoms and mild cramps when I reckon I should have had a period. Sometimes my cramps were very painful, at other times I had no pain at all. My last periods were quite light and I never experienced flooding but I know it is very usual to have one or two very heavy periods before they stop altogether.
At 53 I had my last period and I am now period-free for 15 months so I declare myself to be in The Menopause!” Aisling
Why Am I Gaining Weight During Perimenopause
The shift in hormones slows down your metabolism. Its very common for women in perimenopause to gain weight once their estrogen levels start to decline. Maintaining a healthy diet and regular exercise can help prevent weight gain during the transition to menopause.
A note from Cleveland Clinic
Perimenopause is the transition to menopause. During perimenopause, you may start having menopause-like symptoms, such as hot flashes, mood swings or vaginal dryness. Most perimenopause symptoms are manageable. But if you need help managing symptoms, medications and other treatments are available. Perimenopause ends when youve had no period for a full year. At that point, you enter menopause.
Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.
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What Is Perimenopause Or The Transition To Menopause
Perimenopause , or the menopausal transition, is the time leading up to your last period. Perimenopause means around menopause.
Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly. During this transition, your ovaries make different amounts of the hormones estrogen and progesterone than usual.
Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.
How Often Do I Need To See My Doctor After Menopause
You should still see your healthcare provider for routine gynecological care even though you arent menstruating. This includes Pap tests, pelvic exams, breast exams and mammograms. You should continue to schedule annual wellness appointments. Since you are at an increased risk for osteoporosis, providers usually recommend bone density screenings as well. Talk to your healthcare provider to determine how often you should make check-up appointments based on your health history.
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Other Causes For Period Changes
The regular monthly period is not the only reason why people may bleed.
Because a persons periods are often irregular during perimenopause, they should pay extra attention for any abnormal symptoms particularly as some uterus-related conditions are more common during and after perimenopause.
People may bleed because of:
- Endometrial atrophy. Low estrogen in perimenopause and menopause can cause the tissue of the uterus to get very thin, which can cause irregular bleeding.
- Uterine polyps. These are benign growths that can grow inside the uterus and cervix. Polyps do not always cause symptoms, but some people notice bleeding after sex.
- Endometrial hyperplasia. Hormonal shifts can cause the lining of the uterus to thicken in perimenopause. When the body has too much estrogen without enough progesterone, this thickness may cause bleeding. Bleeding is its most common symptom. Endometrial hyperplasia is treatable but can increase a persons risk of cancer.
- Uterine Cancer. Uterine cancer happens when abnormal or atypical cells progress into cancer. Though rare, it generally presents with heavy bleeding or postmenopausal bleeding.
Perimenopause is not a disease and does not require treatment. It can, however, increase peoples risk of developing certain diseases. Moreover, the menstrual cycle can change for reasons other than perimenopause.
Anyone experiencing changes in their menstrual cycle should see a doctor for a diagnosis.
You Might Start Skipping It Here And There
Dont freak out if your period goes entirely MIA one month. A skipped period is the first sign of deteriorating egg quality, says Dr. Dunsmoor-Su. Some months, the eggs just don’t reach a point where they release, and so a period gets missed. Remember: Youre not in menopause until you go a full year without a period, so skipping a month doesnt necessarily mean you can toss all your pads and tampons.
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Your Periods Could Become Less Frequent
Before you reach menopause, your body goes through perimenopause, a transition time between normal periods and full menopause , which can last one to five years, says Rebecca Dunsmoor-Su, MD, an ob-gyn in Seattle. Perimenopause is a time thats characterized by irregular menses, which are usually more spaced out. As your hormones start to fluctuate, it can lead to scanter, lighter periods, adds Adeeti Gupta, an ob-gyn and founder of Walk In GYN Care in New York City.