From the Guidelines
Perimenopause, also known as premenopause, is the transitional phase before menopause that typically begins in a woman's 40s, characterized by a decline in estradiol levels, irregular menstrual cycles, and various symptoms that can last 4-8 years before menopause officially begins. This phase is marked by a gradual decrease in estrogen production by the ovaries, leading to symptoms such as irregular periods, hot flashes, night sweats, sleep disturbances, mood changes, vaginal dryness, and decreased fertility 1. During this time, women may experience a rise in LDL levels and a decline in high-density lipoprotein levels, as well as an increase in blood pressure, which can increase the risk of stroke and cardiovascular disease 1.
Key Characteristics of Perimenopause
- Irregular menstrual cycles
- Decline in estradiol levels
- Increased risk of stroke and cardiovascular disease
- Rise in LDL levels and decline in high-density lipoprotein levels
- Increase in blood pressure
Symptom Management
For symptom management, lifestyle modifications such as regular exercise, stress reduction techniques, and avoiding triggers like caffeine, alcohol, and spicy foods can help. Medical treatments may include hormonal options like low-dose birth control pills or hormone replacement therapy, although the use of estrogen-containing hormone therapy is associated with an increased risk of stroke, particularly in women over 60 years of age 1. Non-hormonal medications such as SSRIs, gabapentin, or clonidine may also be used to manage symptoms. Vaginal moisturizers and lubricants can address dryness, and it's essential to maintain bone health through calcium and vitamin D supplementation.
Importance of Regular Health Screenings
Regular health screenings are crucial during this phase to monitor for changes in lipids, blood pressure, and other risk factors for cardiovascular disease. Women with a history of premature or early menopause are at a substantially increased risk of stroke and should be closely monitored and managed to reduce this risk 1. It's essential to discuss specific symptoms with a healthcare provider to develop a personalized management plan.
From the Research
Definition of Premenopause (Perimenopause)
- Premenopause, also known as perimenopause, is a transitional period in a woman's life, characterized by the cessation of ovarian reproductive function, resulting in the end of menstrual bleeding 2.
- This transition is usually a gradual process, occurring over several years, and is marked by fluctuations in ovarian function and hormone production, including oestrogen, progesterone, and testosterone 2, 3.
- The perimenopausal period is associated with a wide range of symptoms, affecting multiple organ systems, including hot flashes, vaginal dryness, mood changes, and sleep disturbances 4, 5.
Symptoms and Effects of Perimenopause
- The symptoms of perimenopause can be highly prevalent and bothersome, driving many women to seek medical advice 4.
- Common symptoms include hot flashes, poor sleep, depressed mood, and increased anxiety, which can interact with each other and impact quality of life 4.
- Vaginal dryness and dyspareunia are also common symptoms that can persist without treatment 4.
- The management of perimenopausal symptoms can be challenging, but options include lifestyle adjustments, talking therapies, dietary supplements, and prescribed medications, such as hormone replacement therapy 2, 5.
Hormonal Changes and Menopause
- The menopausal transition is characterized by the depletion of ovarian follicles, leading to decreased inhibin, increased follicle-stimulating hormone, and loss of the menstrual cycle 3.
- The decrease in estradiol production can lead to typical menopausal symptoms, and hormone therapy can be an effective intervention for symptom management 3, 6.
- However, hormone therapy is not without risks, and the benefits and potential risks must be carefully considered 3, 6.