Your Guide to Perimenopause & Menopause

We all know that menopause — the end of your menstrual cycle and natural reproductive years — is an inevitable stage of life. But oftentimes, it can sneak up and catch us off guard. Maybe you think you’re still years off from that stage, or that you’ll know once you start having hot flashes. The reality is that menopause and the transition period immediately before, known as perimenopause, look different for everyone. Some people enter these phases at younger ages than others, while symptoms can vary from person to person. As there is no definitive starting or ending point to perimenopause or menopause, knowing some of the most common signs and symptoms can help you better navigate these phases and be proactive about your health. Here’s everything you need to know:

Perimenopause, meaning “around menopause”, refers to the period of time during which the body begins naturally transitioning to menopause. For this reason, it’s often referred to as menopause transition. During perimenopause, your body’s estrogen levels rise and fall unevenly and begin to decline, leading to irregular or skipped periods and changes in menstrual flow, such as shorter, longer, heavier, or lighter periods. While the average duration of perimenopause is about 3 or 4 years, it can last as short as a few months or as long as a decade. Most individuals will start this transition in their 40’s, though some may notice signs even earlier in their 30’s. Unlike menopause, it is possible to still get pregnant during perimenopause, even if your periods are irregular, so it’s important to continue the use of contraception.

Perimenopause ends and menopause occurs when 12 consecutive months have passed since your last period. At this point, the ovaries produce so little estrogen that they no longer release eggs and you can no longer get pregnant naturally, as your period stops altogether. While perimenopause is considered a period of time, menopause is only considered a point in time. Once you hit this mark, you’re considered post-menopausal, though you may continue to experience symptoms for about four or five years. Most individuals reach menopause between 40 and 55, with the average age in the U.S. being 51. Some people may undergo menopause earlier though due to certain factors, such as family history, smoking, chemotherapy, radiation, or hysterectomy.

The symptoms typically associated with menopause actually occur during perimenopause and can last beyond menopause. While the experience is different for everyone, common symptoms can include:

• Hot flashes
• Night sweats
• Irregular or skipped periods
• Breast tenderness
• Vaginal dryness
• Chills
• Mood swings or changes
• Trouble sleeping
• Discomfort during sex
• Lowered sex drive
• Fatigue
• Weight gain
• Trouble concentrating
• Headaches
• Depression, anxiety, or irritability
• Dry skin
• Joint or muscle aches
• Thinning hair
• Frequent urination
• Urinary incontinence
• Urinary or vaginal infections

Some individuals may have worse symptoms than others, and some may have little to no symptoms at all. Likewise, some symptoms may be consistent, while others may fluctuate. Typically, however, symptoms tend to be stronger and more frequent one to two years before menopause hits.

Many of these symptoms can also have other causes aside from menopause, so it’s important to talk to your primary care provider about any changes in your physical and mental health or if you are concerned about any symptoms. Reach out to your primary care provider, if you experience any of the following:

• Spotting after your period
• Blood clots during your period
• Bleeding after sex
• Periods that last way longer or shorter than usual

In most cases, your primary care provider will be able to determine whether are perimenopausal or postmenopausal based on your symptoms. In some cases, however, your primary care provider may order blood tests to measure follicle-stimulating hormone (FSH) or estradiol levels, in order to rule out any other causes. Other tests that measure thyroid, liver, or kidney function may also help your provider determine your course of care.

Though perimenopause and menopause may be unavoidable, there are numerous ways to relieve uncomfortable, painful, or bothersome symptoms. If your symptoms are interfering with your daily life, talk your provider about the following:

• Hormonal birth control pills: In the years before menopause, many individuals benefit from taking birth control pills. These pills can help regulate irregular, painful, or heavy periods, as well as reduce hot flashes, vaginal dryness, and mood swings.
• Hormone Therapy: Many perimenopause and menopause symptoms are the result of lower estrogen and progesterone levels. Hormone therapy helps alleviate some of these symptoms by providing additional estrogen and progesterone. The two different types of hormone therapy include estrogen and combine hormone therapy, both of which come in a variety of forms, such as pills, patches, rings, and vaginal creams.
• Other medications: In addition to hormonal treatments, there are over-the-counter supplements and prescription medications to treat various symptoms. For instance, certain antidepressants may help with mood changes associated with menopause. Likewise, numerous topical creams can help with hair thinning, while vagingal lubricants can alleviate pain during intercourse and vaginal dryness.
• Lifestyle changes: There are also several ways to reduce symptoms naturally, without the use of medications or hormones. Eating a nutritious, balanced diet, exercising regularly, limiting alcohol, getting a good night’s sleep, and practicing mindfulness techniques, for instance, can all help you feel better. Learn more here.

Your primary care provider is there to help you through all phases of life. If you have questions about perimenopause or menopause or are concerned about your symptoms, book an appointment today.