Is it perimenopause? Find out some of the obvious (and not-so-obvious) symptoms leading up to menopause.
Some call it a transition. To others, it's a stage. But no matter what view you take, perimenopause is the period in a woman's reproductive life that begins some years — anywhere from 2 to 10 — before menopause. Diana E. Hoppe, MD and gynecologist, says, "For most women, perimenopausal symptoms show up in their 40s, although for some, the signs may start as early as their 30s."
The average length of perimenopause is four years, and it ends when you're officially in menopause, meaning that you have gone without a period for 12 consecutive months. As a woman nears the end of perimenopause — generally in the last year or two — she may begin to have menopausal symptoms, such as experiencing consecutive months during which she doesn't have a menstrual period.
Many of the symptoms of perimenopause are like those of premenstrual syndrome (PMS). "The difference is that PMS is usually predictable and is based on your menstrual cycle," Dr. Hoppe says. "Perimenopausal symptoms are based on hormones that aren't necessarily still following a typical 28-day cycle." Additionally, while many perimenopausal symptoms, including hot flashes and night sweats, are similar to those experienced in menopause, Hoppe says you can tell the difference because you'll still have a period during perimenopause. "It may be erratic," she says, "but until you've gone one full year without having a period, you're not in menopause."
Key Symptoms of Perimenopause
Experiencing any, or all, of these typical and common symptoms, says Hoppe, is a tip-off that you may well be in perimenopause:
- Irregular cycles, shorter intervals between cycles (every 24 to 26 days instead of every 28 days)
- Skipped menstrual cycles (cycles every two to three months, then bleeding for two full weeks, rather than a normal flow each month)
- Hot flashes
- Night sweats
- Trouble falling or staying asleep
- Mood swings and/or irritability
- Breast tenderness
- Worsening of premenstrual syndrome
- Decreased libido (sex drive)
- Increased fatigue, which may cause difficulty concentrating or memory problems
- Vaginal dryness; discomfort during sex
- Urine leakage when coughing or sneezing
- Urinary urgency (a pressing need to urinate more frequently)
Perimenopause: When to See Your Doctor
Abnormalities in menstrual bleeding during perimenopause may be the result of other conditions, such as hormonal imbalances or fibroids (noncancerous growths on the uterus). If any of the following situations occur, see your doctor to rule out causes other than perimenopause:
- Much heavier than normal periods, or periods accompanied by blood clots
- Periods lasting several days longer than usual
- Spotting between periods
- Spotting after sex
- Periods occurring much closer together (by several days or weeks)
If you suspect you're in perimenopause, it's important to talk with your gynecologist. "Usually doctors can make a diagnosis based on symptoms," Hoppe says. "They can also discuss possible treatments to alleviate those symptoms." Although many physicians say they're not necessary, there are diagnostic blood tests that may help determine whether you're in perimenopause. Hoppe, though, warns that these tests are not always accurate: "A perimenopausal woman's hormone levels are very erratic."
Perimenopause and Fertility
Missed periods and recurring hot flashes are hard to overlook, but one indicator of perimenopause that is not so easy to spot is a decline in fertility. Although a woman in perimenopause may still get pregnant, the odds are greatly reduced. Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology at Yale University School of Medicine, emphasizes that if you don't want to get pregnant, you must continue to use birth control until you officially hit menopause. "But if you do want to get pregnant," she says, "you should see a doctor as soon as possible to preserve fertility in this stage."