Perimenopause

Menopause is when you stop having periods for good. For many women, this happens around age 50. The time of change before this is called perimenopause. It may start in your late 30s or 40s. It can last for months or years. During this time, your body makes lower levels of female hormones. This causes certain changes in your body. You may already have begun to feel the effects of these changes. By taking steps to relieve symptoms, you can still feel good.

Front view cross section of uterus, vagina, fallopian tubes, and ovaries. Lining of uterus is endometrium. Arrow from ovary to uterine lining shows progesterone causing lining to be shed. Arrow from ovary to uterine lining shows estrogen causing lining to thicken.

The menstrual cycle

Hormones are chemicals that have specific jobs in the body. A menstrual cycle is caused by changes in the levels of 2 female hormones. These hormones are estrogen and progesterone. They are made by the ovaries. In a normal cycle, estrogen creates a lining in the uterus to allow for pregnancy. The ovary then releases an egg. This is called ovulation. Progesterone levels start to go up. If the egg is not fertilized, progesterone levels go down. This causes the lining in the uterus to be shed. This is the bleeding that is your period.

Changes in hormones

As a woman ages, her ovaries begin to make hormones less regularly. In some months, there may not be ovulation. Without ovulation, progesterone isn’t secreted so a normal period doesn’t occur. The menstrual cycle will be harder to predict. Over time, the ovaries stop working. This can cause symptoms. Some women who have had their uterus taken out (hysterectomy) but still have ovaries may still have symptoms. When estrogen levels reach their lowest point, periods will stop completely. This is menopause.

Symptoms of perimenopause

The change in hormones can cause physical symptoms. It can also cause emotional symptoms. These may include:

  • Periods that come more or less often

  • Periods that are lighter or heavier than you’re used to

  • Hot flashes, night sweats, or trouble sleeping

  • Vaginal dryness, which may make sex painful

  • Mood swings or fatigue

  • Palpitations

  • Sleep disturbances

  • Urinary symptoms including frequency and incontinence.

Medications that may help

Some medications can help ease the effects of perimenopause. These include:

  • Low-dose birth control pills. These often contain both estrogen and progesterone. They can help regulate your periods.

  • Hormone therapy (HT). This replaces some of the hormones your body has stopped making.

  • Antidepressants. These help balance brain chemicals that may decrease during this time. Signs of depression can include often feeling sad or hopeless. If you feel this way, be sure to talk to your health care provider.

  • Gabapentin. This is a medication also used to treat seizures. This controls hot flashes and night sweats in some women.

  • Clonidine. This medication may control hot flashes and night sweats.



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