The roller coaster of Perimenopause

If you’re in your 30s or 40s and have recently experienced night sweats, irregular periods and other strange symptoms cropping up, you might be a little confused. Could it be menopause? Isn't it too early for menopause. Could these symptoms be caused by something else? If you’ve had these thoughts, you’re not crazy. You might just be experiencing perimenopause.

Menopause, the cessation/stoppage of the menstrual cycle is a topic that has attained a fair degree of familiarity around the world. However, there is yet another important stage experienced by women that cannot be neglected from being discussed – the “perimenopause”. “Peri” which means “around” is a transitional stage that occurs before menopause. Menopause is a specific point in time, but perimenopause happens in extended transitional time duration. It is difficult to pinpoint when exactly perimenopause starts - it can begin in the 30s or early 40s and extend anywhere between 4 to 10 years.

What exactly is perimenopause?

Perimenopause is a natural process that commences when the ovaries show a gradual decrease in the secretion of the female hormone estrogen, which plays a vital role in menstrual cycle regulation. This will result in irregular menstrual cycles. There are two stages of perimenopause – the early transition stage with relatively fewer interruptions in the menstrual cycle and the late transition stage, where the cessation of the menstrual cycle could last even up to 60 days.

Generally, perimenopause lasts until menopause, to the point when the ovaries no longer produce eggs that are required for fertilization. The drop in estrogen escalates in the last one or two years before menopause, when many women start to experience typical menopausal symptoms. This said, during perimenopausal women can get pregnant since the ovaries continue to release eggs.

Why is it important to be aware of perimenopause?

Aging is naturally accompanied by various health complications. Hence, menopause which is a part of the natural ageing process in women also can cause some complications that one needs to be aware of.

  • Cholesterol - During perimenopause, the cholesterol levels tend to soar, and it needs to be tracked periodically. Because of the drop in estrogen levels, the low-density lipoprotein (LDL) cholesterol levels which are sometimes called “bad cholesterol” gradually get escalated.

  • Heart disease - Raised cholesterol level is a significant risk factor for heart disease. Also, estrogen helps to maintain the flexibility of blood vessels meaning, it can aid the blood vessels to relax and expand to accommodate a proper blood flow. Thus, reduced estrogen levels increase the risk for heart ailments.

  • Diabetes – Metabolism begins to slow down during perimenopause which results in lesser calorie burning efficiency. As a result, there is weight gain which makes the body more resistant to the effects of insulin and this leads to an increase in blood glucose level. There are also studies that state that diabetes predisposes to early menopause.

  • Alzheimer’s disease – Estrogen regulates glucose transport within the brain. Glucose is vital for the brain to produce energy. Estrogen dysregulation during perimenopause could alter this mechanism, leading to cognitive decline which in turn increases the risk of developing Alzheimer’s disease.

How to know if it is perimenopause?

Watch out for these symptoms if you feel you are going through perimenopause:

Hot flashes – They are experienced by 30 to 70% of perimenopausal women. This is a very common manifestation of perimenopause where women have sudden episodes of sweating and flushing lasting for 5 to 10 minutes and it happens mostly during the night. It varies from one person to another. Some women feel just the warmth, while others sweat profusely. Hot flashes may continue for up to a year or two after the commencement of menopause.

Sleep disturbances – It is mostly linked to night sweats caused by hot flashes and occurs in 40% of perimenopausal women

Dryness of the vagina – During late perimenopause, the estrogen level declines drastically which causes the vaginal tissue to become thin and dry out. This subsequently causes irritation and itching. It might cause pain during intercourse and it could lead to reduced sexual desire. This symptom appears relatively early in the transition.

Heavy period – The lining of the uterus becomes thicker before it is being shed, causing heavy bleeding during period.

Mood problems – The body goes through numerous changes during perimenopause. It is no wonder that extreme alterations in hormone levels could pave the way to mood-related issues. Anxiety followed by depression has been reported in perimenopausal women. Some studies have quoted estrogen to be associated with depression in the menopausal transition. Additionally, sleep disruptions also could cause emotional distress.

Osteoporosis – Fall in estrogen levels is linked with osteoporosis, a disease that causes fragile bones.

Discuss with your physician if you experience these changes. You might also be required to do a blood test to get your hormone levels checked.

How are the symptoms treated?

Perimenopause is a natural change that occurs in a woman’s reproductive cycle. Hence, treatment methods are aimed at managing the symptoms

  • Hormone therapy to normalize estrogen levels so that sudden shifts in the hormone levels do not cause discomfort. This also helps in the management of osteoporosis.

  • Antidepressants can help alleviate mood swings

  • Creams to reduce dryness in the vagina

  • Some anti-seizure drugs are prescribed to get some relief from hot flashes

How do I effectively take care of myself during this transition period?

  • Plan to get regular exercise to deal with mood swings. Avoid exercising before bed as this can cause insomnia

  • Smoking, caffeine intake, and spicy foods are some of the triggers that cause hot flashes. Hence, cut back on them to feel more comfortable

  • Join support groups to have more room for discussing about problems faced during menopause and to vent out your emotions

* Please consult a medical professional before taking any medication*

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About the author

Niranjana S. Rajalakshmi is a veterinary microbiologist turned science journalist, currently based in India. After her under graduation in Veterinary Medicine, she was curious to study diseases at a molecular level which led her to pursue a Master’s in Veterinary Microbiology. When the pandemic struck, she being a microbiologist felt the need to communicate about the hitherto unknown virus and its possible implications to a large audience. Subsequently, she produced several pieces on COVID-19 and other topics related to health, which are being published in leading news outlets in India.


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