If you are in your late 30s or early 40s and experience night sweats that wake you up, irregular periods with heavy bleeding (or no bleeding at all), you may be experiencing perimenopause.
The symptoms may be sporadic and seem beyond your control, but it is important not to panic or feel overwhelmed during this often-confusing new phase. The best way to deal with perimenopause is to understand the changes happening in your body and why. Once you understand the basics, you will be able to face this transition head-on. 

What is perimenopause? 

Perimenopause is the transitional phase before menopause, marking the natural end of menstruation and fertility. During this time, perimenopausal symptoms such as insomnia, night sweats, and vaginal dryness may begin to appear. Perimenopause lasts about 8 to 10 years, and most women enter perimenopause around age 39 to 49.

Are “perimenopause” and “menopause” the same? 

These terms may sound like they mean the same thing, but they actually have completely different meanings. The North American Menopause Society (NAMS) defines perimenopause as “the transitional period leading to menopause, which usually lasts about 6 years.” Perimenopause, on the other hand, is “the period from a woman’s first period until the start of menopause,” and is generally a time when she can become pregnant[2]. 

What causes perimenopause?

But what is happening inside your body to cause these changes? During perimenopause, your body’s estrogen levels may increase or decrease. As a result, many women begin to notice that their menstrual cycles become irregular in length and flow, with heavier bleeding or no bleeding at all[1]. 

Perimenopause and estrogen

Many of the changes that occur during perimenopause are due to estrogen, or a lack of it(3).
During the menstrual cycle, when reproductive activity is at its peak, estrogen levels in the body rise and fall to a certain level. Estrogen levels are controlled by two hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the follicles in the ovaries (fluid-filled sacs containing eggs), causing them to secrete estrogen. When estrogen levels reach a certain threshold, the brain sends a signal that causes the pituitary gland to stop producing FSH and surge LH. This flood of LH prompts the ovaries to release an egg from a follicle (ovulation). After ovulation, the remaining follicle secretes progesterone and estrogen in preparation for pregnancy, which in turn lowers FSH and LH levels. If ovulation does not result in pregnancy, progesterone levels drop, menstruation occurs, and the cycle begins again.
However, as the ovaries age, they produce fewer hormones, and the amounts of FSH and LH that regulate estrogen production decrease. As a result, women’s estrogen levels fluctuate during perimenopause and drop completely once they enter menopause. 

Perimenopause symptoms

Now that you understand what is happening hormonally in your body, here are some symptoms that may be caused by fluctuating estrogen levels. Key symptoms include:  

• Irregular, heavier, or longer periods
• Hot flashes 
• Insomnia 
• Night sweats 
• Heart palpitations
• Headaches 
• Vaginal dryness 
• Breast tenderness 
• Acne breakouts

What is the difference between premenopause and perimenopause?

Both stages affect a woman’s reproductive system and often involve similar symptoms, but there are some differences between the two. For example, during the early part of perimenopause, many people still have periods, so pregnancy is still possible. Once perimenopause progresses, the ovaries stop releasing eggs, and the production of estrogen needed for reproduction also largely ceases. In other words, you can think of premenopause as the preparation period leading up to the main event of menopause. 

How do I know if I am in perimenopause?

If you have any of the symptoms listed above, we recommend consulting a healthcare professional. 

For advice on staying at your best through perimenopause and menopause, see the “Menopause Guide”

References

1. Mayo Clinic (2020). Perimenopause - Symptoms and Causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666 [Accessed 13 Jan. 2020].
2. Menopause.org. (2020). Menopause Glossary, Menopause Resources: The North American Menopause Society, NAMS. [online] Available at: http://www.menopause.org/for-women/menopause-glossary#P [Accessed 13 Jan. 2020].
3. Publication, H. (2020). Perimenopause. The Rocky Road to Menopause - Harvard Health. [online] Harvard Health. Available at: https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause [Accessed 13 Jan. 2020].
4. Menopause.org. (2020). How Do You Know When Menopause Is Approaching? Menopause Stages, Symptoms, & Signs. The North American Menopause Society, NAMS. [online] Available at: https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/are-we-there-yet-navigate-now-with-our-guided-menopause-tour [Accessed 13 Jan. 2020].
5. Cleveland Clinic (2020). Perimenopause, Perimenopause, and Postmenopause. Cleveland Clinic. [online] Available at: https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-and-postmenopause [Accessed 13 Jan. 2020].