Perimenopause, or more colloquially premenopause, is the period preceding the actual menopause, i.e. the cessation of ovarian activity and the conclusion of childbearing age, which can occur in a period of approximately between 45 and 55 years.
The duration of this previous period of time is not fixed and can vary significantly from one woman to another, but settles on average around 5 years.
This period is accompanied by a series of physiological changes which, despite their different nuances, are common to all and easy to identify. Let’s see what they are.
Irregular cycles
Often the first signs of approaching menopause are provided by the menstrual cycle, which begins to become irregular.
The time intervals between one menstrual period and the next can decrease (technically polymenorrhea), just as they can instead dilate (oligomenorrhea), sometimes even skipping a period.
Also in the flow there are variations: this can become more abundant (hypermenorrhea), as well as very light (hypomenorrhea).
Obviously, hormones are responsible, in particular estrogen and progesterone, which, in different ways and with different times, see their presence decrease sharply.
Skin, hair and waistline
The hormonal changes and the months or years of body adjustment typical of perimenopause also bring with them various physical changes, starting from an initial tendency to accumulate weight, especially in the abdominal area.
The physiological slowdown of the metabolism and the lower hormonal production lead in fact to become more inclined to gain weight and to accumulate fat, such as the classic “pancetta”, even where there were none previously.
Even the skin and hair can communicate a change in progress, becoming drier and, in the case of hair, possibly thinning out a bit.
These are far from dramatic or inevitable changes, which can be contained with a little self-care and by adopting a healthy lifestyle, and which in any case are perfectly natural and not to be demonized or feared.
Heat, sleepless nights and headaches
A classic symptom of menopause are the so-called hot flashes, but even in perimenopause it is sometimes possible to feel a sudden and annoying increase in body temperature, forcing the woman to stay in a tank top even in the middle of winter.
Equally typical are night sweats, which can cause them to wake up clammy in the middle of the night, which, in addition to a potential increase in insomnia and irritability, can disrupt sleep.
Among the other “can” (here we are talking about non-universal symptoms) there is headache, which in this period can appear even in those who were not used to headaches .
Vaginal dryness and pain during intercourse
Although these are more typical symptoms of menopause than of perimenopause, it may happen that even in the period preceding the cessation of ovarian activity, intimate discomforts may occur, ranging from a greater predisposition to burning and itching to less lubrication of the walls, with possibility of pain during intercourse.
Speaking of sexual intercourse, it is important to point out that although perimenopause is the antechamber of menopause and sees fertility decrease significantly, it is by no means excluded, although unlikely, that in this period one can still get pregnant.
Energy and mood
Of all the factors, emotional well-being and energy level are perhaps the most difficult to tie neatly to a single, precise cause, as they are notoriously influenced by many factors that can combine, from stress to diet, life stages of each to other health disorders.
Having said this, and given that excessive tiredness or a sense of depression should always be promptly discussed with a doctor before making a self-diagnosis, it is a fact that the symptoms of perimenopause can also include energy drops (in this period may experience exhaustion and muscle fatigue) and those in mood.
Increased risk of depression and premenstrual syndrome
The discourse that links mood as menopause approaches has various facets: on the one hand it can be a consequence of the fact that one is not accepting or processing the physical change taking place, on the other it is connected on a “chemical” level to the drop in progesterone, which in turn also interacts with the release of serotonin .
Moreover, by determining the mood disorders of premenstrual syndrome with its cyclical decrease, progesterone can make this more critical during the premenopausal years, precisely because it is further decreased.
In any case, those who have a tendency to depression, feel its signs for the first time or suffer from premenstrual syndrome, do well to seek advice from a specialist and keep in mind the increased risk of depression in this period.
How long does it last, and how much “impact”
There are no precise rules or exact timing: for some women the change is rapid, for others gradual and intermittent. In some cases the physiological changes, which cover an area ranging from the body to the emotions, are distinctly felt, in others they are disturbances on a smaller scale, sometimes imperceptible.
Of course, being informed about what your body may encounter helps both not to become excessively alarmed, and to prepare and, if necessary, adapt your lifestyle to healthier choices, which can definitely help contain the most common and annoying symptoms.
In short, it’s time to eat in a balanced and healthy way, not to neglect a light but regular movement, to stop smoking if you still have this bad habit.
Speaking of smoking, moreover, this not only can further lower estrogen levels, but it is an important cardiovascular risk factor which, from now on, women must keep in mind as they are no longer “covered” by female hormones , in the full fertile phase, made them much less exposed than men to strokes and heart attacks.
Lifestyle and supplements
Your trusted doctor and gynecologist can prescribe hormonal therapies in menopause, and also in perimenopause, the details and dosages of which must be strictly discussed with an expert.
To mitigate the most annoying ailments, however, you can also help yourself with ad hoc supplements and foods. For example, an adaptogen such as Rhodiola Rosea can contain both energy drops and emotional ones (only if in a mild form). Green tea, in addition to being a good antioxidant, is an adjuvant in keeping weight under control.
This provided, of course, that the diet is also well balanced: no to drastic diets, yes to balanced food plans, perhaps agreed with a nutritionist who, in addition to the needs of a perimenopausal body, knows the person’s medical history.
Furthermore, it is important to keep stress levels low, completely eliminate smoking, reduce alcohol and not neglect movement.
Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.
She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.