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Perimenopause is the time in a woman's life when her body is making the transition from being fertile and able to have babies to menopause, meaning the end of her reproductive years. During perimenopause, the levels of hormones made by your ovaries -- estrogen and progesterone -- can fluctuate unpredictably, rising or falling, causing symptoms such as hot flashes, menstrual irregularities, and mood swings.

Natural menopause typically describes the period when a menstruating woman reaches her late 40s or 50s and goes for 12 months without a period. Menopause also can be brought about as the result of medical treatments rather than as a normal consequence of aging. Some cancer treatments, such as chemotherapy and radiation, can induce menopause earlier than it would have come naturally. Having your ovaries surgically removed will do the same.

Although perimenopause and menopause are natural, normal events, there are many variations from woman to woman, including the age of onset, the symptoms that occur, how long those symptoms last, and whether the end of the childbearing years is regarded as something to be mourned or celebrated.

Perimenopause generally lasts from two to eight years before your final period to a year thereafter.

The average age of menopause in American women is 51. Some women start perimenopause as early as their 30s, but most go through menopause between ages 45 and 55. Women often experience menopause around the same age as their mothers and sisters.

However, some conditions can affect the age at which menopause starts. Menopause may occur a year or two earlier in women who smoke, and there is some evidence to suggest that a number of other factors -- such as never having given birth and having a history of heart disease -- may lead to early menopause.

You may or may not notice perimenopausal changes in your body, and it is not always possible to tell whether a given symptom is related to menopause, aging, or another medical condition.

The following are among the most common symptoms and conditions associated with perimenopause:

•Changes in your menstrual cycle. Your periods may be longer or shorter, heavier or lighter than they used to be. They may come early or late, or in some months not at all. About 90 percent of women have menstrual irregularities for four to eight years before they finally stop having periods altogether.

•Hot flashes (or hot flushes) and night sweats. A hot flash is a sudden rush of heat from your chest to your head that can last from a few seconds to several minutes. You may break out in a sweat. Hot flashes that occur while you sleep are called night sweats. Although the intensity, frequency, and duration of hot flashes may vary, about 75 to 85 percent of perimenopausal women experience them.

•Sleep problems. Sleep problems are often the result of hot flashes or night sweats, but you may also experience other kinds of sleep problems during perimenopause, such as having a hard time getting to sleep or staying asleep.

•Mood changes. You might feel sadder, crabbier, or moodier than usual. This may be attributable more to sleep disruption or stress than to hormonal changes.

•Vaginal and bladder problems. Declining estrogen levels can leave you more susceptible to vaginal and urinary infections. With less estrogen, the lining of your vagina gets thinner, drier, and less flexible, which can make sex painful. The decrease may also thin the lining of the urinary tract and diminish tissue tone, causing you to leak urine when you cough, sneeze, or laugh. This is called stress incontinence.

•Reduced fertility. As ovulation becomes less regular, you are less likely to conceive, but as long as you're still having periods, pregnancy is possible. If you don't want to get pregnant, use birth control until you've gone for a full year without getting your period.

•Changes in sexual function. Your sexual desire and response may change in the perimenopausal years. Arousal might take longer. However, most women who were satisfied with their sex lives before perimenopause will remain satisfied with it afterward.

•Bone loss. Your body continually breaks down old bone and replaces it. Estrogen helps control bone loss. With declining levels of estrogen during perimenopause, your body starts to lose bone faster than it can be replaced. This increases your risk of osteoporosis, a condition resulting in weak bones that break more easily.

•Increased risk of heart disease. Declining estrogen levels and other age-related changes may lead to an increase in body weight, blood pressure, and cholesterol levels, which can all put you at greater risk of developing heart disease.

Other symptoms reported at perimenopause include an increase of body fat around the waist, problems with concentration and memory, thinning hair on the head, and increased hair growth on the face.

As unfortunate as all this may sound, for most women the symptoms associated with perimenopause are manageable.

Eat a healthful diet to lower your risk of osteoporosis and heart disease. This includes getting plenty of whole-grain foods, vegetables, and fruits. Snack on calcium-rich foods (such as yogurt, milk, and cheese) or take a calcium supplement. Before age 50, you need 1,000 milligrams of calcium daily. After menopause, you need 1,200 mg per day.

Vitamin D helps your body absorb calcium. Your body can make enough vitamin D if you get 15 minutes of sunshine daily. Women under 50 should also take a supplement that provides at least the recommended daily amount of 400 and preferably 800 international units. Women over 50 should take even more vitamin D -- between 800 and 1,000 IU. Vitamin D may have other subtle benefits aside from increased calcium absorption, such as improving muscle strength and boosting the immune system.

If you have hot flashes, try to avoid the things that can trigger them, including hot drinks, spicy foods, alcohol, caffeine, and stress. Dress in layers, so you can remove some when a hot flash hits.

Some women take low-dose birth control pills containing the hormones estrogen and progestin to regulate their periods and ease perimenopausal symptoms. If you smoke or have a history of blood clots and you are over age 35, however, you should not take oral contraceptives.

•Regular exercise -- including tennis, aerobics, and dancing -- will help the heart, bones, and muscles. Exercise also helps control weight, boosts your mood, and helps you sleep better. Try to exercise for at least 30 minutes a day most days of the week. Some form of weight-bearing exercise -- such as walking -- is especially good, if you can incorporate it into your routine.

•If vaginal dryness makes sex painful, you can use a water-based, over-the-counter vaginal lubricant (like KY® Jelly), an over-the-counter vaginal moisturizer, or vaginal estrogen products (cream, tablet, or ring).

•Yoga and meditation may help you relax and cope with stress. Be sure you don't drink too much and don't smoke.

•Before you use alternative treatments, such as plant-based substances (phytoestrogens) or herbs like black cohosh, talk to your doctor. They can be harmful when combined with some medications, and there is no conclusive proof that they help with symptoms. In some cases, they may not be safe to take.

Menstrual irregularities are the signature symptom of perimenopause and are usually nothing to worry about. However, you should see your doctor if you also have any of the following, because they could be signs of an underlying medical problem requiring treatment:

•Extremely heavy menstrual bleeding, especially if your periods haven't been heavy before

•Bleeding that goes on for more than a week, or periods that are two or more days longer than usual

•Spotting or bleeding between periods

•Periods that are regularly fewer than 21 days from the start of one to the start of the next

•Vaginal bleeding after sex.

Some of these symptoms are signs of other, more serious conditions, such as endometrial hyperplasia, which could lead to uterine cancer if ignored. Simple tests (usually an endometrial biopsy) can help you find out whether or not there is anything to worry about. If the tests turn out to be normal, the doctor can usually prescribe medication that can help with the symptoms.

Even if you're feeling well, you should still see your doctor for regular screenings. Talk with your doctor about maintaining a healthy lifestyle, and have routine screenings for breast, cervix, and colon cancer according to national guidelines. You should also get Pap tests, mammograms, and cholesterol checks. The best way to stay healthy is to pay attention to your health before you have a problem.

-- Susan Murphy is an award-winning journalist and former staff writer for The Phoenix Gazette and The Press-Enterprise in Riverside, California. She has worked as a medical/clinical content editor for companies providing patient education and has won two National Health Information awards.

References

First published August 20, 2008
Copyright © 2008 Consumer Health Interactive

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