What happens leading up to menopause is a big issue for women. There are many facets to aging, so let’s start out by tackling perimenopause, and subsequent posts will cover menopause entirely.
The word itself is pretty clear when you look at it: meno-pause. Essentially, our menstruation is paused. It typically doesn’t happen abruptly unless you have a hysterectomy or other medical conditions. So, the time leading up to menopause is called perimenopause. You can think of the word “peri” as around or about (perimeter).
What is Perimenopause
Perimenopause, also known as pre-menopause, is the phase when the body begins transitioning to menopause. It typically begins in a woman’s 40s and lasts 4 to 8 years. The menopausal transition happens in response to changing hormone levels and the gradual decline of ovarian follicles. If you’re interested in the science behind this: the levels of the follicle stimulating hormones (FSH) increase, progesterone hormones decrease, and estradiol hormones stay the same. Upon menopause, estrogen production by the ovaries stops and estradiol levels dramatically decrease.
One of the early changes women might notice is a lengthening intermenstrual interval (more time between menses). Normally, this interval is 25 to 35 days; however, during perimenopause, this can increase to between 40 and 50 days. As the transition deepens, the menstrual cycle becomes irregular and episodes of amenorrhea (missed menses) increase. Episodes of missed menses typically begin 1-3 years before the final menstrual period. Most women experience a gradual decrease in menstrual bleeding. However, some women experience heavy bleeding at times due to obesity or uterine fibroids.
Hot Flashes and Night Sweats
These irregular cycles are accompanied by major fluctuations in FSH and estradiol levels. The primary symptom of perimenopause is hot flashes. Approximately 80% of women experience hot flashes during menopause. During a hot flash, a sudden sensation of heat is felt on the upper chest and face. This heat often lasts for 2 to 4 minutes and is occasionally accompanied by sweat and palpitations. When hot flashes happen at night, they are referred to as “night sweats”. When hot flashes disrupt sleep, they can contribute to anxiety and depression.
If you didn’t think it could get worse, hang on to your hat. Early on in menopause, changes in estradiol levels can cause breast tenderness and migraine headaches. In the long term, estrogen deficiency can contribute to the development of cardiovascular disease and weight gain (metabolism and fat distribution changes). The estrogen loss also results in decreased bone density which may lead to osteopenia and osteoporosis. In situations like this you will want to increase your Vitamin D levels which are explained in a previous post.
Supplements for Menopause
Similar to bone loss, collagen levels substantially decrease during the early stages of menopause. Collagen production drops by about 30% which results in thinner skin each year. When combined with dryness and other factors, you will definitely have to enhance your skin care routine and possibly adjust your vitamin supplements during this critical period.
Women who do not take estrogen supplements also tend to gain fat and lose lean muscle mass. The fat gained tends to accumulate in the central abdominal region. It’s important to look for a Primary Care Provider (PCP) whom you trust and one who can work with you for a long time. In the following post we’ll discuss what to expect during menopause and get into the reasons for night sweats, mood swings, and the best times to drink alcohol to avoid disrupted sleep.