Perimenopause (menopause transition) is the stage in woman’s reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogen. It means around the menopause. It usually starts in woman age of 40. It is the time where the body produces erratic and unpredictable secretion of hormones. During this period the fertility decreases.

The average length of Perimenopause is four years. In some it may lasts from few months to 10 years. It ends the first year after menopause.

Signs and symptoms:

• Hot flashes.
• Breast tenderness.
• Worsening of premenstrual syndrome.
• Decreased libido or sex drive.
• Fatigue.
• Irregular periods.
• Vaginal dryness, discomfort during sex, pain during sex, decreased libido.
• Urine leakage when coughing or sneezing.
• Mood swings, irritability, fatigue, memory loss, depression.
• Difficulty in sleeping.
• Weight gain.
• Palpitations.
• Joint pain, back pain, muscle pain.
• Night sweats.
• Breast atrophy.
• Skin thinning.
• Sensation of pins and needles, or ants crawling under the skin.

Perimenopause occurring in earlier age

• Smoking.
• Family history of early menopause.
• Never having delivered a baby.
• Childhood cancer treatment.
• Hysterectomy

Clinical evaluation

• Detailed history
• Blood tests to measure FSH, estrogen levels
• Physical examination
• Risk factor assessment
• Serum lipid profiles
• Pap smear
• Dual energy X-ray absorptiometry
• Mammograms at regular intervals

Complications

• Irregular periods are hallmark of Perimenopause. See a doctor if you have:
• Heavy bleeding, changing pads or tampons every hour.
• Bleeding lasts longer than eight days.
• Bleeding occurs between periods.
• Periods regularly occur less than 21 days apart.
• Spotting between periods.
• Bleeding after sex.

Treatment

• Oral contraceptives: Low dose pills reduce hot flashes and vaginal dryness. Local estrogen creams can be prescribed for vaginal dryness.
• Progestin therapy: Cyclic progestin can be prescribed for irregular periods. Endometrial ablation: Can be performed for heavy bleeding.
• Anti depressants medications can be taken for mood swings.
• Transdermal estrogen.

Lifestyle modifications and home remedies to prevent the symptoms

• Regular exercises.
• Stop smoking.
• Get enough of sleep.
• Decrease the amount of alcohol.
• Maintain a healthy weight.
• Take a multivitamin supplement and take adequate calcium in diet.
• Take calcium supplements daily.
• Reduce stress