Graphic with the female gender symbol styled as a clock with a line chart below

Ugh. Menopause. It’s the often-bemoaned part of aging that all women experience – usually in their early 50s – that signals the end of the body’s ability to reproduce. But it’s not something that happens overnight. In fact, it starts years before in a sort of limbo phase known as perimenopause. That’s right, ladies, if you’re edging close to your 40s and thought you had at least another decade until the stereotypical hot flashes begin, that’s not necessarily true.

The science behind perimenopause breaks down to this: Hormone production gradually changes as the body transitions to – and ultimately results in – menopause. Eventually, the ovaries no longer release eggs and menstruation stops. Menopause is officially marked by going one year without a period. In the United States, it occurs on average around 50 to 51 years of age.

For perimenopause, “the ovary creates sex steroid hormones of estrogen, progesterone and androgens in a regular fashion until about age 37 – this may vary by a few years. The internal ovarian responses create less feedback to the brain and the follicle stimulating hormone begins to increase. This leads to subfertility, less regular cycles and lack of ovulation,” explained Dr. Amy Miller, an OB-GYN with Summerville Women’s Care.

She likened perimenopause to a jalopy: “It runs for a bit, breaks down, then goes again. Then it breaks down again. It’s a slow decline.”

Some red flags are irregular cycles – both the interval between menses or the length of flow may change. Women also may experience fertility decline and vasomotor symptoms such as sweating, palpitations, anxiety and uncomfortable flushes in the head, chest and face. Those symptoms can last six to 10 years beyond the start of menopause.

Graphic showing stages of menopause - Pre-Teen = Premenopause, 35-45 = Perimenopause, about age 51 Menopause, older = Postmenopause. The last regular period is at the end of the premenopause stage and the last period begins the menopause stage.

While some women may not exhibit many uncomfortable symptoms, others experience even more in the one to two years before their last period.

“Women may experience sleep disturbance – which leads to irritability, lack of concentration and moodiness – also vaginal itching, painful intercourse and bladder urgency,” Dr. Miller said. “More than half of women experience significant symptoms, and up to 15% describe them as debilitating.”

Perimenopause is generally only diagnosed for patients who are experiencing these uncomfortable symptoms regularly.

Treatment options vary, though common methods for treating hot flashes, mood swings and night sweats include hormone replacement therapy, birth control pills and even some over-the-counter options, according to Dr. Stan Ottinger of Charleston OB-GYN.

“Of course your provider can determine the best treatment for your body, but, for patients who only experience the occasional night sweats, we often suggest over-the-counter options like black cohosh, Estroven® or Remifemin. If it’s more-than-occasional hot flashes, I prescribe them the similar medications that we use for treating PMS or PMDD,” he said.

Hormone replacement therapy often is prescribed to stop irregular bleeding, using estrogen and progesterone – or just estrogen if you’ve had a hysterectomy – to regulate your body cyclically. Today, hormone replacement therapy is easily incorporated with pills, creams, patches and more.

“There is a slightly higher risk of breast cancer and blood clot risks,” Dr. Ottinger added. “Some people may not be good candidates for it, but, most of the time, the benefits outweigh the risks.”

While the benefits of hormone replacement therapy include managing symptoms of perimenopause and menopause, both doctors cautioned against the long-term use of those hormones. Dr. Miller explained that estrogen – or lack thereof – affects the function of organs in different ways, and the relationship between the levels of those hormones and the body’s organs at various ages and stages of life is still under the microscope. For example, estrogen can improve mood swings and be beneficial for those in their late 40s and early 50s, and it can also aid in preventing osteoporosis. Later treatments may play a role in the risk of strokes and dementia for older patients. Estrogen levels at certain ages have also been linked to cardiovascular disease and breast cancer, so, while hormone replacement therapy can be beneficial, you should always consult with your physician first.

“The main takeaway from perimenopause and menopause is that it is common – every woman has to go through it. Symptoms and levels of tolerance can vary, so, if you’re experiencing some, go to your provider and talk about it. Some people are afraid to ask a question, but we can do things to help people,” Dr. Ottinger continued. “Come in for an exam and tell us everything is not OK. This is something that can be easily addressed.”

By Anne Shuler Toole

INFOGRAPHIC: Perimenopause by the Numbers
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