What exactly is perimenopause?

During your 30s and 40s, the ovaries gradually stop producing eggs as frequently as they had in the past. At the same time, your estrogen levels begin to drop. As ovulation (egg production) becomes erratic, progesterone levels decline as well. These hormonal changes can cause symptoms that resemble premenstrual syndrome (PMS) but then become less familiar; that’s when you know you could be in perimenopause.

Can I get Pregnant?

Yes, conception is still possible during perimenopause; however, because ovulation is less consistent, the times at which you can become pregnant are highly unpredictable. If you don’t want to become pregnant, you need to practice birth control until you have stopped menstruating for at least 12 months.

What are the symptoms?

While reading the list below, you should keep in mind that it represents possible symptoms—you won’t necessarily have all of them. They may be somewhat related to your PMS symptoms; in fact, the variation and severity of perimenopause symptoms often mirror our experience with PMS. For example, if you don’t get irritable before your period, you may well avoid the mood changes sometimes associated with perimenopause.

Bleeding Irregularities. About 90% of perimenopausal women experience changes in their menstrual cycle or in the periods themselves. Irregularities can take the form of missed periods, more frequent periods, longer or shorter periods, and heavier or lighter flow. Some women may have two periods in one month and then skip a period or two. These changes may start in your late 30s or they may not occur until you’re 50 or so.

Hot Flashes and sleep problems. About 85% of US women have hot flashes, which occur when blood vessels dilate bringing large amounts of blood to the skin surface. You’ll experience a sudden sensation of intense heat in the upper part of your body, which causes your face and neck to become flushed and/or makes red blotches appear on your chest, back, and arms. A hot flash typically lasts 3 to 5 minutes, although it may take half an hour for you to recover from it. As your body temperature readjusts, you may then experience sweating followed by shivering. “Night sweats,” caused by hot flashes during sleep, can lead to sleep disturbance and insomnia.

Body and Skin changes. As progesterone and estrogen levels decrease, the collagen in your skin become thinner and less elastic, which leads to sagging and wrinkling. Other changes include a decrease in the body’s muscle mass, an increase in body fat and a thickening of the waist and abdomen.

Loss of Libido. Perimenopause may mark the beginning of a gradual decline in sexual desire for some women. Low hormone levels, fatigue, or genital discomfort (due to a loss of elasticity and lubrication of the vagina) may all play a part. The body’s reduced testosterone supply (yes, women’s bodies produce testosterone, but in much smaller amounts than men’s bodies do) may also be responsible for the loss of sex drive.

Changes in mood and memory. Some perimenopausal women experience mood swings, depression, irritability, and forgetfulness, which result from imbalances between female hormones and certain brain chemicals such as serotonin.

Urinary problems. Estrogen loss can weaken muscles around the urethra, causing urine to leak when you laugh, cough, or sneeze. In addition to urinary incontinence, some women also feel an increased urgency to urinate.

Other Symptoms. Smaller proportions of perimenopausal women complain of headaches and joint and muscle aches.

How can I ease these symptoms?

You have many options, all of which should be discussed with your doctor. Choices you make will depend on the nature and severity of tour perimenopausal symptoms, and on your overall health.

Oral contraceptives(OCs) can provide safe and convenient protection against unwanted pregnancy during this time of erratic ovulation. They can also help to regulate your periods, and have even been found to decrease hot flashes and improve sleep during perimenopausal. In order to take OCs during this time, you must be a nonsmoker and have no history of breast cancer or clotting disorders. Monophasic OCs, which provide the same levels of estrogen and progesterone throughout the month, may be ideal—particularly if you’re experiencing mood swings and/or have a history of migraines.

If you cannot or choose not to take OCs, you can still reduce hot flashes by eliminating spicy foods and alcohol. You may also want to consult your doctor about vitamin E supplements or primrose oil, both of which are known for reducing hot flashes.

If erratic bleeding is your most bothersome symptom, you might want to talk to your doctor about taking progestin, a synthetic form of progesterone, for 10 to 14 days each month. To ease vaginal dryness and other sex-related problems associated with perimenopause, you may be prescribed a topical estrogen cream to apply vulvovaginally (around the outer part of the vaginal area).

What about lifestyle changes?

This is indeed the time for lifestyle change—not only to make perimenopause easier but also to reduce the long-term effects that estrogen loss can have on the body.

• Start a mild strength-training program at the gym to prevent muscle degeneration later in life
• Do stretching exercises or join a yoga class to retain flexibility
• Take calcium supplements to retain bone mass
• Watch your diet. Your intake of calories from fat should be less than 30% of your daily total. Also, make sure to get five servings of fruits and vegetables every day. And, remember that at age 40, your body needs 120 fewer calories than it did when you were 30.
• Keep moving. Walking 30 minutes daily at least 4 times per week has enormous health benefits, and it will also help you to get a good night’s sleep
• Moisturize your skin and deep condition your hair. Skin and hair begin to lose their natural oils during perimenopause
• Always use sun block and exfoliate skin. As we lose collagen, wrinkles become more obvious

Anything Else I should know?

Yes—communicate! If perimenopausal symptoms start to interfere with your life, get help from your doctor. With all that’s understood these days about hormones and well-being, you have every reason to sail smoothly through these years.