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What is Perimenopause? Guide to Age, Signs, Causes & Treatment

The myths and misinformation surrounding menopause are vast, starting with perimenopause and continuing through menopause to post-menopause. Not to worry. That’s why we created the PRiME Women Guide to Menopause, a three-part series that will cover perimenopause, menopause, and post-menopause. The guide is meant to be a primer on the nuts and bolts about this important life cycle. First up? Everything you wanted to know about perimenopause, including when does perimenopause start, perimenopause insomnia and more.

Have a pressing concern? Skip ahead to the part that matters most to you:

What is perimenopause?

First, the easy part of perimenopause — the definition. Perimenopause, also sometimes known as menopause transition, begins when a woman’s ovaries start making less estrogen and progesterone. Women typically start skipping periods as production of these hormones decreases. Perimenopause lasts until menopause, defined as the point when the ovaries no longer release eggs. A woman reaches menopause after she has not had a period for 12 months in a row. At that point, a woman’s fertility is officially over.

What is the difference between perimenopause and premenopause?

The difference between perimenopause and premenopause comes down to the hormones. Doctors on Sharecare offered these subtle differences: Premenopause describes women who are still getting their periods, which may or may not be irregular (a sign of perimenopause) while perimenopause describes a woman who is having irregular periods that are being caused by changing hormonal balances. Under this analysis, all perimenopausal women are premenopausal but not all premenopausal women are perimenopausal. Another way to look at it is that premenopause is before menopause while perimenopausal is around menopause.

When does perimenopause start?

Perimenopause is when the nuances associated with each woman’s perimenopause experience begin. While perimenopause symptoms typically begin in a woman’s 40s, they also can start as early as a woman’s 30s, according to WebMD. How long you experience perimenopause symptoms and even the symptoms themselves can also vary from woman to woman — so much so, in fact, that women often aren’t sure they’re going through perimenopause until they are, perhaps, well into the process.

What are the signs of perimenopause?

Not every woman’s perimenopause symptoms are the same. There are as many experiences of perimenopause as there are hair colors. And, of course, if you have any concerns about signs you should consult your personal medical professional. That said, here are some of the most common perimenopause symptoms:

Hot flashes in perimenopause:
For many women, hot flashes are among the most annoying — and often most visible — perimenopause symptoms. As with many other perimenopause symptoms, they can range from a simple sudden feeling of warmth in the upper body to a flushed (hard-to-miss) face with blotchy skin. Full-on night sweats that have you tossing off the covers until it’s over are another variation. Some women have both. The Mayo Clinic also reports that a rapid heartbeat can sometimes be part of a hot flash, as can a chilled feeling afterward, in part due to the sweat cooling. The Mayo Clinic notes that hot flashes usually stop on their own within four to five years. Not all women experience hot flashes.

Sleep disturbances and insomnia in perimenopause:
Sleep problems are fairly common for those going through perimenopause because the production of progesterone, a sleep-inducing hormone, wanes along with the production of estrogen, according to the Sleep Foundation. The perimenopause symptoms in this category range from wakefulness (waking up in the middle of the night and not being able to get back to sleep) to not being able to fall asleep. Add in some nighttime hot flashes and you’ve got an evening where there just aren’t enough sheep to count. The Sleep Foundation advises creating the right “sleep environment” as one solution. The nonprofit’s tips include making sure your bedroom is dark, keeping the room as cool as possible, avoiding alcohol and tobacco, and maintaining a consistent bedtime routine, including a regular bedtime and avoiding stimulus from devices such as tablets and phones right before bed.

Hypo-desire and decreased sex drive in perimenopause:
In addition to changing levels of estrogen and progesterone, women also experience decreasing levels of testosterone during perimenopause as the ovaries gradually stop secreting this hormone. Testosterone is the hormone that affects women’s ability to get aroused and achieve orgasm.

Irregular periods in perimenopause:
Skipping periods is one of the first perimenopause symptoms women notice. After decades of having (mostly) regular periods, that first month of missing a period can be an unsettling one, especially if you’re young enough to still think you might be pregnant. Periods can also come more frequently and change in flow (everything from lighter to heavier), according to the Mayo Clinic. The clinic notes that a persistent change of seven days or more in the length of your typical menstrual cycle might indicate that you are in early perimenopause. A space of 60 days or more in the cycle might indicate you’re in late perimenopause.

Discomfort during sex in perimenopause:
Vaginal dryness and its resulting discomfort during sex can be another offshoot of changing hormones during perimenopause. While the loss of estrogen can affect mood, it is what that loss does to the vagina that can create physical issues during sex. The vagina narrows, and the vaginal wall skin grows thinner, less moist and less elastic, according to the Women’s Health Network. The result can be painful sex. Vaginal creams can help (see hormone therapy below).

Urine leakage and urgency in perimenopause:
Low estrogen levels may also leave perimenopausal women more vulnerable to urinary or vaginal infections, WebMD notes. Additionally, a loss of tissue tone might contribute to urinary incontinence.

Mood swings in perimenopause:
The term “perimenopause rage” didn’t just happen on its own. In fact, mood swings, from happy to sad in the flip of an emotional switch, are a common sign of perimenopause, due to the hormonal changes that are creating an imbalance in your system.

Weight gain in perimenopause:
Yes, it’s unfair but the reality is that weight is easier to gain in the perimenopausal years and that much of it occurs around a woman’s middle rather than, say, her hips.

What causes hot flashes in women?

While it’s hard to miss a hot flash — both for the woman experiencing it and for a bystander wondering why that woman is fanning her face and taking off her sweater in the middle of a meeting — understanding the cause of perimenopause hot flashes is trickier. Changes in reproductive hormones and in a woman’s hypothalamus are likely  part of the explanation, according to the Mayo Clinic. WebMD suggests changes in a woman’s circulation may be part of the explanation for perimenopause hot flashes.

Given the variety of perimenopause symptoms and that the additional variations within a particular symptom — one woman’s hot flashes may only occur periodically while another woman’s occur multiple times daily — it can be hard to know what’s considered “normal.” As with any medical concern, the best place to start is with your doctor.

What eases perimenopause hot flashes?

While nothing definitively prevents perimenopause hot flashes, WebMD advises avoiding these potential trigger points: stress, caffeine, alcohol, spicy foods, tight clothing, heat, and cigarette smoke. Getting daily exercise and keeping your bedroom cooler are other suggestions. A plethora of natural so-called remedies are just a Google search away. Other women consider hormone replacement therapy. If you’re having particularly challenging perimenopause hot flashes, however, it’s probably wise to consult your medical professional before exploring any potential solutions.

What are perimenopause night sweats?

Perimenopause night sweats are the nighttime version of perimenopause hot flashes. Typically, a woman is sound asleep only to be awakened, often drenched in sweat, heaving her covers to the side. One minute you’re asleep; the next you’re sweating like you’re running a marathon. The duration and frequency of perimenopause night sweats depends on the woman. Some women never have them. Like perimenopause hot flashes, perimenopause night sweats can include an increased heart rate as well as flushing of face, neck and chest. Chills may follow after the burst of heat. The exact cause of perimenopause night sweats, which clearly add to perimenopause insomnia, is not known but is likely caused by a hormonal imbalance. Changing estrogen levels affect the hypothalamus, the brain’s body thermometer, which in turn sends the body some strange temperature messages during perimenopause.

How does perimenopause affect sleep?

Perimenopause affects sleep because about 40% of women suffer from perimenopause insomnia. That percentage doubles for women approaching menopause. The issue — waking up and not being able to get back to sleep, night sweats, trouble falling asleep — likely stems from the reduction in the production of progesterone, a sleep-promoting hormone, coupled with the adrenaline rush that often accompanies night sweats.

What causes perimenopause weight gain?

While it would be convenient to blame all middle-age weight gain on perimenopause, the reality is that aging and lifestyle choices are also factors. What is known, however, is that perimenopause weight gain tends to be more around a woman’s middle. Hormone changes are to blame for the muffin top, WebMD notes. As estrogen levels drop, the body fat that used to be stored as a fuel reserve for breastfeeding in the hips, thighs and butt is now transferred to the abdomen. Unfair, yes, but so it goes.

Knowing what is perimenopause can be the first step in managing its effects on your lifestyle. While you can’t make the symptoms disappear, knowing what they are can relieve some anxiety while they’re happening. If you believe that you’re experiencing symptoms that are unusual or extreme, consult your medical provider for more information.

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