Perimenopause is the final years of a woman’s reproductive life, characterized by menstrual irregularity and amenorrhea. It has two stages: early, where cycles are regular, and late, where amenorrhea lasts for at least 60 days. Research has linked these stages to specific hormonal events and symptoms. This article integrates findings with clinical presentations and treatment options.
Physiology of Perimenopause
Perimenopause is a phase of menopause characterized by a decline in ovarian follicles, resulting in decreased levels of inhibin B, anti-Mullerian hormone, and ovarian oestradiol. This decline has an emotional and psychological Impact, including vasomotor symptoms and irregular menstrual cycles. Menopause and associated amenorrhoea occur due to the loss of ovarian follicular activity, leading to increased follicle-stimulating and luteinizing hormone production.
Hormonal Changes During Peri-menopause
Your progesterone levels may drop somewhat in the early stages of perimenopause, particularly if you “miss” ovulation in some cycles. Your estrogen levels may also drop significantly later in perimenopause as you approach menopause and the end of your egg supply.
Physical Symptoms to Watch For
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Menopause and Vasomotor Symptoms
- Vasomotor symptoms (VMS) are sudden, intense feelings of warmth affecting the face, neck, or chest.
- VMS are not related to estrogen withdrawal but are linked to genetic makeup, physical changes, and other influences.
- Up to 80% of women experience VMS during perimenopause, increasing over the transition from early to late menopausal transition.
- VMS may represent a biomarker for cardiovascular disease (CVD), with frequent VMS increasing the risk of developing CVD over 14 years.
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Vaginal and Sexual Symptoms
- Vaginal dryness, atrophy, and associated symptoms are common in postmenopause.
- Symptoms may also arise in the perimenopause, termed the genitourinary syndrome of menopause.
- Factors influencing sexual function include prior premenopause transition level of sexual function and relationship satisfaction.
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Menopause Transition and Sleep and Mood Changes
- 37% of women aged 40-55 reported difficulty sleeping, with the highest rates in Caucasian and Hispanic women.
- The risk of adverse mood symptoms increased from 20% to 62% by the early perimenopause.
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Bleeding
- Bleeding patterns vary among women in the perimenopause.
- Evaluation should include a thorough menstrual, medication, family history, and endocrine dysfunction or bleeding disorders assessment.
When does the perimenopause start and end?
Perimenopause can last anywhere from a few months to ten years, but most women experience it for four years. Perimenopause is over when you haven’t had your period for a year.
Perimenopause Tests
Based on symptoms and hormone levels, perimenopause tests, such as blood tests and tests that can be done at home, are used to identify the condition. Health professionals, on the other hand, say that these tests shouldn’t be done because FSH levels change and other things come into play.
Treatment
- Perimenopausal symptoms can be treated with various medications. Systemic estrogen therapy, administered through pills, skin patches, sprays, gels, or creams, is the most effective treatment for hot flashes and night sweats.
- Vaginal estrogen, administered directly to the vagina, can relieve vaginal dryness and urinary symptoms. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may also reduce hot flashes.
- Gabapentin, approved for seizures and migraines, has been shown to reduce hot flashes. A hormone-free option called fezolinetant (Veozah) can also help.
Summary
Menopause, a physiological condition, can cause significant morbidity and poor quality of life. A collaborative, multidisciplinary approach is needed to improve patient-centred care, outcomes, and team performance.
Related: Symptoms of Menopause at 50
References:
- Santoro N. (2016). Perimenopause: From Research to Practice. Journal of women’s health (2002), 25(4), 332–339.
- Delamater, L., & Santoro, N. (2018). Management of the Perimenopause. Clinical obstetrics and gynecology, 61(3), 419–432.
- Peacock, K., Carlson, K., & Ketvertis, K. M. (2023, December 21). Menopause. In StatPearls [Internet]. StatPearls Publishing.
