About perimenopause and menopause
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PERIMENOPAUSE is the stage of a woman’s life that begins several years before menopause when the ovaries gradually begin to produce less estrogen. It usually starts in a woman’s 40s, but can start in the 30s as well.
Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, this decline in estrogen accelerates. At this stage, many women experience menopausal symptoms.
The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for 10 years.
When a woman has gone without her period for 12 months, then she has reached menopause. It is a natural part of ageing that signals the end of a woman’s reproductive years.
Symptoms
- Menstrual irregularities: The intervals may be longer or shorter, your flow may be scanty to profuse, and you may skip some periods. As ovulation becomes more erratic, the lower levels of progesterone may lead to longer and heavier periods.
- Hot flashes (or hot flushes) and sleep problems: About 75% to 85% of women experience these. Their intensity, duration and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes erratic even without them.
- Mood changes: Some women experience mood swings, irritability or depression, but the cause of these symptoms may be sleep disruption or other menopausal symptoms rather than hormonal changes.
- Vaginal and bladder problems: When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen levels may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
- Decreasing fertility: As ovulation becomes irregular, your ability to conceive decreases. However, as long as you’re having periods, pregnancy remains a possibility.
- Changes in sexual function: During perimenopause, sexual arousal and desire may change.
- Breast tenderness, worsening of premenstrual syndrome and fatigue.
- Loss of bone: With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis.
- Changing cholesterol levels: Declining estrogen levels may lead to unfavourable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol – the “bad” cholesterol – which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol – the “good” cholesterol – decreases in many women as they age, which also increases the risk for heart disease.
Risk factors
Menopause is a normal phase in a woman’s life. But in some women, it may occur earlier than in others. For example, the onset of menopause occurs one to two years earlier in women who smoke, compared with women who don’t.
Also, a few specific genetic variations have been associated with early onset of menopause. Although not conclusive, some evidence suggests that other factors may predispose a woman when entering perimenopause at an earlier stage in life, including:
- Family history: Women tend to experience menopause around the same age as their mothers and sisters, although the link between family history and age at menopause is still inconclusive.
- Never having delivered a baby: Some studies show that never having had a baby may contribute to early menopause.
- Heart disease: A history of heart disease may be associated with early menopause. Results from a recent study suggest a link between an increased risk of heart disease, such as elevated blood cholesterol levels and high blood pressure, and early menopause, but further research is needed.
- Childhood cancer treatment: Treatment for childhood cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.
- Hysterectomy: A hysterectomy that removes your uterus, but not your ovaries, usually doesn’t cause menopause. Although you no longer have periods, your ovaries still release eggs. But such an operation may cause menopause to occur earlier than average.
In addition, menopause may be induced at any time after your first period because of medical interventions, including:
- Total hysterectomy and bilateral oophorectomy (surgical removal of ovaries): An operation that removes both your uterus and ovaries does cause menopause. There’s no perimenopausal phase. Instead, your periods stop immediately, and you’re likely to have hot flashes and other menopausal signs and symptoms.
- Chemotherapy and radiation therapy. These cancer therapies can cause signs and symptoms of menopause, such as hot flashes and cessation of periods, during the course of treatment. In some women, ovarian activity may resume after treatment is over. But if these therapies cause irreparable damage to the ovaries, they can end fertility and menstruation permanently, either immediately or over several months.
Seeking medical advice
Some women seek medical attention for their perimenopause symptoms. But others either tolerate the changes or simply don’t experience symptoms annoying enough to warrant attention.
Because subtle symptoms may come on gradually, you may not realise at first that they’re all connected to the same thing – declining and fluctuating levels of estrogen and progesterone.
If you do experience symptoms that interfere with your life or well-being, such as severe hot flashes, mood swings or changes in sexual function that concern you, see your doctor.