The time leading up to menopause, also known as perimenopause can often be a hormonal maelstrom. We help you understand what to expect during perimenopause and how to prepare for it so that the perimenopausal symptoms can be managed better.
The time leading up to menopause is known as the perimenopause. This is a natural process that every woman goes through as their ovaries age and slowly stop working. One important hormone for women, estrogen, starts to decline due to lack of ovulation and production by the ovaries.
Perimenopause is the bridge to menopause that starts in your 40’s. Menopause is when one has not got their period for an entire year. Perimenopause may last anywhere from 2 to 10 years.
The changes during the transitional phase are affected by sociocultural, psychological, and race (Some studies have reported that African American and Latina women have natural menopause about 2 years earlier than white women). Every woman experiences the menopausal transition differently, therefore treating symptoms universally is not effective.
What happens during perimenopause?
Physical and mental changes
- Changes in the menstrual cycle: The period cycles and flow may become irregular.
- Hot flashes and night sweats are common.
- Dryness in the vagina: the vaginal tissue becomes thinner and feels dry.
- Gaining weight: The decline in estrogen changes the metabolism and the way the body stores fat. One may have reduced lean body mass and an increase in belly fat.
- Changes in sexual function may occur, like decreased libido.
- Headaches, sleep disturbances, and brain fog.
- Heart palpitations.
Endocrine changes
- The menopause journey starts with irregular menstrual cycles, elevation in the follicle-stimulating hormone (FSH).
- The hypothalamus-pituitary axis, a region of the brain, appears to become less sensitive to estrogen's positive and negative feedback throughout the perimenopausal era, leading to anovulatory (no ovulation) menstrual cycle patterns.
- During the early phases of the transition, there can be significant fluctuations in the circulating blood levels of the female hormones luteinizing hormone (LH), Follicular stimulating hormone (FSH), and estradiol (estrogen). All are female hormones involved in ovulation and maintaining menstrual cycle which normally rise and fall with the cycle in a regular manner.
- Early menopausal transition does not cause a major shift in circulating testosterone levels, which alters the ratio of androgens to estrogens and causes symptoms of androgen excess in certain women.
- These hormone fluctuations usually result in irregular menstrual cycles, which are characterized by early cycle shortening and eventually longer intervals between periods.
Psychological changes
- Mood swings
- Depression- There is a two- to three-fold risk of depression during perimenopause
Factors that influence the age at which one enters perimenopause include:
- Diet
- Level of physical activity and exercise
- Smoking status- Smoking may cause an earlier transition to menopause
- Socio-economic status - Socially, a women’s experience of menopause may be influenced by gender norms, familial and sociocultural factors, including how female ageing and the menopausal transition are viewed in her culture and economically the level of education, lifestyle may cause bodily changes leading to earlier perimenopause.
- Body mass index- a higher BMI is likely to be related a prolonged perimenopausal period and delayed menopause
- Any coexisting medical or gynecological issues (women with autoimmune diseases, thyroid diseases or chronic diseases like tuberculosis and gynecological issues leading to surgical removal of uterus or ovary)
- Family history: age at which mother got menopause
What are the symptoms and signs of perimenopause?
Over 80% of women have menopausal transition symptoms, with over one-third of these women experiencing severe symptoms.
- Vasomotor symptoms (hot flashes and nocturnal sweats). Mostly, the vasomotor symptoms last for 1–6 years; Sometimes they may extend to 15 years or more years in 10–15% of women. Variations in physiology, genetic susceptibility, soy-rich foods, and sociocultural context can affect hot flush frequency and intensity.
- Sleep issues
- Exhaustion
- Mental health changes: mood swings, elevated anxiety, palpitations
- Dryness in vagina
- Dyspareunia (painful sexual contact)
- Urinary bladder symptoms (urgency, frequency, and incontinence)
- Joint pain
- Neurological- brain fog
- Skin, hair and nail changes- thinning of nails, dryness of skin/eyes, and skin/hair. Thinning of the skin and reduced melanin may cause increased sun sensitivity during perimenopause.
What can we do for a smoother perimenopause?
Regular exercise, including strength training to maintain the muscle mass and bone strength: As estrogen declines, it has a negative impact on the density of the connective tissue, joints, bone matrix, and skin. Ageing combined with the hormonal have a deeper impact on the muscle and bone health.
Diet: Consume a diet with diverse colors, including whole grains, high fiber, high protein, vegetables and fresh fruits. Do not forget the healthy fats.
Sleep: One of the most studied and underestimated factors is sleep. The quantity and quality of sleep both matters significantly in one’s physical, mental and emotional health. Practice good sleep hygiene (regular sleep timings, declutter your sleep environment, avoid blue light exposure before sleep, avoid caffeine 1-3 hours before sleep and practice some relaxing activities before sleep).
Limit alcohol and caffeine intake – Both can exacerbate certain symptoms such as nocturnal perspiration. Alcohol consumption can lead to sudden increases in body temperature, thereby intensifying night sweats. This occurs due to the dilation of blood vessels and accelerated heart rate, resulting in flushed skin and the stimulation of sweat production.
Quit smoking- Studies have shown that smoking more than 10 cigarettes a day after the age of 25 increases your risk of an earlier menopause.
Prioritize yourself: You may have been chasing the wellbeing of your family and loved ones at the cost of your wellbeing, well it’s time to set aside time for yourself as the journey ahead needs it.
Get regular health checks: Keep tabs on any nutritional deficiencies you may have or any comorbidities that may affect the hormonal transition during perimenopause so that they may be addressed in preparation. Perimenopause does not need any treatment but if you have severe or unbearable symptoms, speak to your gynecologists on how to alleviate these symptoms.
Heart health and blood pressure:
The increased weight gain and rising cholesterol levels and reduction of estrogen (a protective factor) may cause an in increased risk for high blood pressure and cardiovascular diseases and hence the lifestyle changes mentioned above play a significant role in regulating these changes. Regular health checks are immensely important to keep a check on these changes.
Questions you may want to ask/discuss with your gynecologist if you’re experiencing or are confused about some symptoms like hot flushes, irregular periods etc:
- Do these signs indicate I’m in perimenopause?
- How can you help me lessen my symptoms?
- How long do you expect these symptoms will last for me?
- Is hormonal therapy a possibility for me?
- Do I need to start taking any vitamins or medication?
- Do any tests need to be conducted?
- Is pregnancy still possible for me?
Lose weight if applicable: Weight loss helps reduce the intensity and frequency of hot flashes and night sweats and it also improves one’s energy levels and agility.
Start maintaining a menstrual log: It's helpful to track your period.
Take better care of your skin, hair, and nails: One may notice pigmentation (age spots) and skin may appear lighter as the melanin production decreases. To prevent UV damage to one’s skin, use SPF, exfoliate the skin frequently to rejuvenate it, and use an age-targeted moisturizer that hydrates the skin well. Speak to your dermatologist about any supplements or care you may need for your hair type and nails.
Work on your emotional hygiene: Journaling, meditation, making time to socialize, practicing self-love and being aware and accepting changes are some things one may work on.
Managing Hot flashes:
- Dress in multiple layers to allow for easy removal of clothing in case of overheating. Opt for clothing made from natural fibers rather than synthetic materials.
- Keep a portable fan in your purse for added convenience.
- When you sense a hot flash approaching, cool the back of your neck using a washcloth soaked in cold water or wet wipes.
- Take precautions to avoid triggers. Common triggers for most women include coffee and red wine.
- Discuss your medications with your healthcare provider, as certain high blood pressure and cholesterol medicines are known to induce hot flashes.
Few things you may do to help with the nocturnal (night) sweats:
- Wear clothing made from breathable fabrics like cotton and linen.
- For the bedding, try and avoid heavy covers and synthetic fabrics. Remove a layer if needed.
- Maintain the ambient temperature in your bedroom.
- Keep some water by your bedside so that you may sip on it when needed at night.
- Do regular exercise. Studies reveal that physical activity for 45 minutes per day, 4-5 times per week, significantly reduces the frequency of hot flashes.
References:
- Talaulikar, Vikram. “Menopause Transition: Physiology and Symptoms.” Best Practice & Research Clinical Obstetrics & Gynaecology, vol. 81, Mar. 2022, pp. 3–7, https://doi.org/10.1016/j.bpobgyn.2022.03.003.N. Santoro et al.
- The menopause transition: signs, symptoms, and management options; J Clin Endocrinol Metab; (2021 Jan 1)
- Cleveland Clinic. “Perimenopause: Age, Stages, Signs, Symptoms & Treatment.” Cleveland Clinic, 2021, my.clevelandclinic.org/health/diseases/21608-perimenopause.
- Johns Hopkins Medicine. “Perimenopause.” Www.hopkinsmedicine.org, www.hopkinsmedicine.org/health/conditions-and-
diseases/perimenopause" www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause. - Whitcomb B.W. et al (2018), ‘Cigarette smoking and risk of early natural menopause, American Journal of Epidemiology, 187(4):696-704. doi: 10.1093/aje/kwx292
- Mikkelsen, T.F., Graff-Iversen, S., Sundby, J. et al. (2007), ‘Early menopause, association with tobacco smoking, coffee consumption and
other lifestyle factors: a cross-sectional study’, BMC Public Health, 7, 149. doi.org/10.1186/1471-2458-7-149 - Did I just have a hot flash? Shen; https://www.hopkinsmedicine.org/health/wellness-and-prevention/did-i-ju…
- Bailey, T. G., Cable, N. T., Aziz, N., Dobson, R., Sprung, V. S., Low, D. A., & Jones, H. (2016, July 1). Exercise training reduces the frequency of menopausal hot flushes by improving thermoregulatory control. Menopause. https://doi.org/10.1097/gme.0000000000000625 In-Text Citation: (Bailey et al., 2016)
