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What are the key areas of health affected during Perimenopause?

What can you expect during Perimenopause? 

What treatments can you try to help relieve symptoms?


During perimenopause, you may have difficulty falling pregnant, but you are not yet infertile. If you postponed pregnancy until your career was well established or for other reasons, you can still become pregnant, but may require assistance from a fertility expert. Irregular periods are a clue that you may be sub-fertile. No periods mean you are infertile.

Menstrual Irregularities

Perimenopausal menstrual changes can include skipped menstrual periods or periods can last significantly longer. Your flow can change, and generally become either heavier (menorrhagia) or irregular and infrequent (oligomenorrhea). Iron deficiency anemia from excessive blood loss causes chronic fatigue, withdrawal, cognitive problems and irritability. You may find you struggle at work or home because you have difficulty concentrating when your anemic blood cannot deliver sufficient oxygen to the brain and cells of the body.

As the ovaries become less efficient, you may not produce an egg each and every month. Anovulatory cycles that do not produce an egg usually result in heavy periods, often with pain (dysmenorrhea). Your likelihood of having an anovulatory cycle is only 2% to 7% during your peak fertility (mid-20’s to mid-30’s), but jumps to 33% percent of cycles in women over 50.

One in every five hysterectomies is performed as a treatment for menorrhagia. 
Three of the most bothersome menstrual irregularities in perimenopausal women are:
1. Menorrhagia, which means heavy bleeding more than 80 ml per cycle, or 16 soaked sanitary pads per cycle. Menorrhagia is serious because it eventually leads to iron deficiency anemia.

  1. Metrorrhagia, which means irregular uterine bleeding between expected menstrual periods
  2. Menometrorrhagia, which means heavy and irregular uterine bleeding. The woman with menometrorrhagia bleeds excessively during her expected menstrual period and also at irregular intervals, usually around two weeks apart, instead of the normal cycle of 28 – 35 days.
    About 10% of all fertile women world-wide develop menorrhagia. In Australia, menorrhagia affects 5.1% of women and dysmenorrhea (painful periods) affects 29%. In the UK, 7 women in every 1,000 have menorrhagia. In the USA, 10 million women have menorrhagia.
    Women with menorrhagia, metrorrhagia, or menometrorrhagia commonly develop anemia from excessive blood loss – iron tablets, injections or infusions are often required. An often recommended course of action by some doctors is hysterectomy (removal of the uterus). Generally, these collective problems occur due to low progesterone production.
    They may also occur due to:

Benign (non-cancerous) uterine tumors, called fibroids (see www.understandinguterinefibroids.com)
Endometriosis (the womb’s lining grows outside the uterus) (see www.understandingendometriosis.com)
A gynecological cancer
A genetic bleeding disorder, like von Willebrand’s disease

Sleep, Headaches and & Cognition changes

You may develop night sweats and disturbed sleep from low progesterone and varying estrogen levels during perimenopause. Insomnia is common. You may not achieve deep slumber, and probably awaken feeling tired.

During the day, your fluctuating hormones may create hot flashes, depressive feelings and irritability. Low progesterone levels lead to lack of concentration, mood changes and poor short term memory.
Migraine headaches begin or worsen because hormones affect blood vessels in the head. Combined with your lack of restful sleep, these fluctuations can leave you tired to the point where your usual high performance degrades. Low progesterone and varying levels of estrogen is the underlying cause of most of these symptoms.

Tissue Changes

You could leak urine when you cough, sneeze or laugh. You may have more bladder infections as your urethra becomes less flexible and more easily damaged, due to hormonal deficiency. Your vagina is more prone to itchy yeast infections (candidiasis).

Your bones may thin out (osteoporosis). Consequently, your joints and back may ache.

You may feel a sensation like ants crawling over your skin, called formication. Your skin may thin, dry out, and become inelastic.
Your chances of developing heart and blood vessel diseases increase.

You will lose muscle mass and your fat distribution will concentrate in your abdomen. Expect your waist to thicken, whereas in your prime childbearing years your weight probably concentrated around your hips and thighs. Your metabolism slows, leading to weight gain, even though you stick to your usual diet.
Decreased sexual desire

Your interest in sex may diminish (low libido, lack of arousal, diminished desire, poor aoursal or absence of orgasm) and you may develop a dry vagina, so that intercourse is painful or irritating (dyspareunia). A less resilient vagina is more easily traumatized by penetrative sex. You may have difficulty achieving an orgasm. You may feel too tired for sex due to chronically disturbed sleep, lack of the hormone testosterone and iron deficiency due to menstrual irregularities.

When can I expect perimenopause?

You will probably have at least some perimenopausal symptoms starting a number of years before menopause. You will likely experience menopause around the same time your mother did, providing she had a natural menopause and not a hysterectomy. The world-wide age range for menopause is from the 30’s to the 60’s. Most Western women enter perimenopause around age 45, but it often occurs much earlier in Third World women.

If you are Westernized and do not smoke, expect perimenopausal symptoms from age 45 until the average menopause at age 51. If you smoke, expect menopause to occur two years earlier, around age 49. Some women with late menopause experience perimenopausal symptoms at age 55 and menopause at 60.

If you had a simple hysterectomy, with only the uterus removed and the ovaries left intact, then you may experience menopause slightly earlier (around age 47), particularly if the surgeon has cut the nerves or blood vessels feeding your ovaries.

Premature menopause, primary ovarian insufficiency (POI) or early menopause is considered the end of childbearing ability before age 40. You may experience premature ovarian failure due to one of these conditions:
Diabetes mellitus
End-stage renal (kidney) failure (ESRD)
Autoimmune disease (e.g., lupus)
Thyroid disease
Genetic abnormalities
Cancer chemotherapy
Radiation therapy
Anorexia nervosa

Your doctor can measure your anti-Mullerian hormone (AMH) levels to predict the time when you will likely reach menopause, but the actual date will be influenced by other factors. If you smoke, have no children, take antidepressants, work with toxic chemicals, or received cancer treatment, then you are more likely to have an early menopause. If you have children or have been pregnant more than once, are overweight, or had high IQ test results as a child, then you are more likely to have a late menopause.

Generally speaking, measuring estrogen and progesterone hormone levels in a perimenopausal woman does not provide a clear picture of what is happening. During this time hormone levels swing wildly from day to day and month to month. A one-off blood or saliva hormone test is a waste of time and money, especially if taken outside the window of day 21-23 of the menstrual cycle when progesterone levels are peaking. Initially, evaluating symptoms is the best starting point for assessment followed by specific blood hormone and genetic testing depending upon the range and severity of symptoms.

Understand more on perimenopause:

What is perimenopause?

Perimenopauuse menopause treatments & side effects

The information in this article has been taken with permission from the official Lawley booklet on Understanding Perimenopause.