The transition to menopause, known as perimenopause, can be a confusing time for many women. During perimenopause, your body begins the shift towards the end of menstruation and fertility. The hormonal changes associated with this transition can begin years before your final period. Knowing what signs to look for can help you determine if you’re in the premenopausal stage.
What is premenopause?
Premenopause refers to the time leading up to menopause when you may start experiencing changes related to decreasing estrogen levels. It typically begins for most women in their 40s, but can start as early as the mid-30s. Perimenopause is the official medical term for this transitional stage.
During premenopause, you may notice your menstrual cycles becoming irregular as ovulation begins to become more inconsistent. You may also start having common menopausal symptoms like hot flashes, night sweats, vaginal dryness, and mood changes. However, you are still having menstrual periods during this stage.
Premenopause can last anywhere from 2-8 years on average. When you have gone 12 full months without a period, you’ve officially reached menopause.
Signs of premenopause
Here are some of the key signs that you may be in premenopause:
Changes in your period
One of the earliest signs of premenopause is changes in your menstrual cycle. Some things to watch for include:
- Shorter or longer cycles
- Lighter or heavier bleeding
- More or less time between periods
- Spotting between periods
These irregularities are normal as you transition towards menopause. Estrogen levels fluctuate more, disrupting ovulation and causing period changes.
Hot flashes are sudden feelings of intense warmth in the upper body that may cause flushing and sweating. They are a classic sign of perimenopause. Some women only have occasional, mild hot flashes. For others, they can occur multiple times a day and be severe.
Night sweats are episodes of excessive sweating at night. Perimenopausal women may wake up feeling overheated with damp sleep clothes and sheets.
Vaginal and bladder changes
Lower estrogen levels can thin the lining of your vagina and urethra, leading to:
- Vaginal dryness
- Pain with intercourse
- More frequent UTIs
- Light bladder leakage
Many women in perimenopause have trouble falling asleep and staying asleep. Night sweats and hot flashes can disrupt sleep. Changing hormones may also affect sleep patterns.
Hormone fluctuations may cause mood swings, anxiety, irritability, and depression in some women. Sudden drops in estrogen levels have been associated with low mood.
Changing cholesterol levels
Estrogen helps keep cholesterol levels in balance. Declining estrogen can lead to higher LDL cholesterol and lower HDL cholesterol.
Loss of breast fullness
Your breasts may start losing glandular tissue and fat, causing them to become less dense. You may need a smaller bra size.
Hormonal fluctuations can trigger more frequent headaches or migraines in some women.
Many women gain weight during the transition to menopause. Declining estrogen may cause your body to store more fat around your abdomen.
You may notice more shedding and thinner hair as estrogen levels fall. This can be mild for some women and more extreme for others.
Lower progesterone levels can cause more bloating during perimenopause. Gas, constipation, stomach pain and indigestion are common.
Changes in odor, taste, and appearance
You may notice changes related to decreasing estrogen levels like:
- More body odor
- A different scent to your urine or sweat
- A metallic taste in your mouth
- Thinner skin
- More wrinkles
When to see your doctor
Consult your doctor if:
- Your periods suddenly stop before age 45
- You have heavy bleeding or severe pelvic pain
- You have extreme mood changes or depression
- You have persistent vaginal bleeding after sex
- You need treatment for severe hot flashes or night sweats
- You have headaches, heart palpitations, or bone loss
Blood tests can help confirm you’re in perimenopause. Your doctor may check your FSH and estrogen levels. They may also want to rule out other conditions.
How long does premenopause last?
There is no set timeline for premenopause. It can last anywhere from a few months to several years. The average is around 4 years. However, perimenopause usually lasts longer for women who start having symptoms in their early 40s compared to women who begin transitioning in their late 40s.
The process is gradual for most women. You may go months without symptoms, then have a return of irregular periods or hot flashes. Towards the end of perimenopause, symptoms tend to become more consistent as estrogen levels remain low.
Can you still get pregnant in premenopause?
Yes, it is still possible to get pregnant during perimenopause. As long as you are still having periods and releasing eggs, pregnancy can occur. However, your chances of conception decrease as ovulation becomes more unpredictable.
Birth control is important if you wish to prevent pregnancy during the transition to menopause. Also be aware that pregnancy risks like miscarriage, preterm birth, and high blood pressure increase for women over 35.
Managing symptoms of premenopause
Here are some tips for relieving symptoms of perimenopause:
- Exercise regularly – This helps manage symptoms like hot flashes, mood changes, and trouble sleeping.
- Practice stress reduction – Try yoga, meditation, or deep breathing exercises.
- Avoid triggers – Spicy foods, caffeine, alcohol, and heat can worsen hot flashes for some women.
- Dress in layers – This allows you to adjust clothing during hot flashes.
- Keep your bedroom cool – Use fans, open windows, and keep the thermostat low.
- Use vaginal moisturizers – These can relieve vaginal dryness and discomfort.
- Eat soy foods – Soy contains isoflavones that mimic estrogen. Try tofu, tempeh, and edamame.
- Consider supplements – Black cohosh, vitamin E, and omega-3s may help with some symptoms.
- See your gynecologist – They can prescribe very low-dose birth control, estrogen creams, or hormone therapy if symptoms persist.
Lifestyle changes during premenopause
Making healthy lifestyle changes can ease this transition:
- Quit smoking – Smoking worsens menopausal symptoms.
- Limit alcohol – High alcohol consumption is linked to more severe hot flashes.
- Manage stress – Find healthy ways to relax when you feel anxious or overwhelmed.
- Improve your diet – Eat a balanced diet with fruits, vegetables, whole grains, lean protein, nuts, seeds, beans and healthy fats like olive oil.
- Stay active – Exercise helps balance hormones and lifts mood. Aim for 30 minutes per day of moderate activity like brisk walking.
- Get enough sleep – Try going to bed at the same time each night and limiting electronics before bed to improve sleep quality.
- Practice self-care – Take breaks when you need them and make time for activities you enjoy.
When does premenopause end?
Premenopause ends once you have been without your period for 12 consecutive months. This marks the beginning of menopause. At this point, your estrogen levels remain consistently low and you are no longer having menstrual cycles.
The average age for menopause in the United States is 51. But it’s normal for it to occur anytime between ages 45 and 55.
The phase after your final period is known as postmenopause. Most postmenopausal symptoms are similar to perimenopause, but may vary in severity. Talk to your doctor about any persistent symptoms after menopause begins.
Should I have any tests during premenopause?
Your doctor may recommend certain medical tests during perimenopause, including:
- Bone density test – Low estrogen increases your risk of osteoporosis and bone fractures. A baseline bone density test can help assess your bone health.
- Mammogram – Yearly mammograms are recommended starting at age 45 to screen for breast cancer.
- Cholesterol test – Your cholesterol levels may rise and fall during the transition to menopause. Your doctor can monitor this.
- Pap smear – Continue getting regular Pap tests to screen for cervical cancer.
- Blood glucose test – Fluctuating hormones can affect your blood sugar. Testing can screen for diabetes risk.
- Thyroid test – Changing hormones can influence thyroid function. Your doctor may want to check your thyroid.
Stay up to date will all recommended health screenings and tests during perimenopause. Report any unusual symptoms to your physician promptly.
Here’s a quick overview of premenopause:
- It’s the transition period leading up to menopause, typically lasting 2-8 years.
- You may have common symptoms like irregular periods, hot flashes, trouble sleeping, and mood changes.
- Hormone levels fluctuate more, but you still ovulate and menstruate.
- Pregnancy is still possible, but fertility declines as you near menopause.
- Symptoms vary between women. Some have no issues while others struggle.
- Making healthy lifestyle changes can help you manage this transition.
- Premenopause ends after 12 months without a period, when menopause begins.
Navigating the changes of premenopause can often feel confusing and unpredictable. Remember that this transitional time before menopause is different for each woman. Pay attention to your body, talk to your doctor, and take care of your overall health. With time, you’ll discover the self-care strategies that help you best cope with your symptoms.