Your Guide to Perimenopause

Perimenopause, or menopause transition, is the stage of a woman's reproductive 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.

How Long Does Perimenopause Last?

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. Perimenopause ends the first year after menopause (when a woman has gone 12 months without having her period).

What Are the Signs of Perimenopause?

You will know you are transitioning into menopause when you begin experiencing some or all of the following symptoms:

• Hot flashes
• Breast tenderness
• Worsening of premenstrual syndrome
• Decreased libido (sex drive)
• Fatigue
• Irregular periods
• Vaginal dryness; discomfort during sex
• Urine leakage when coughing or sneezing
• Urinary urgency (a pressing need to urinate more frequently)
• Mood swings
• Difficulty sleeping

How Do I know If Changes in My Periods Are Normal Perimenopausal Symptoms or Something to Be Concerned About?

Irregular periods are common and normal during perimenopause. But, other conditions can cause abnormalities in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:

• Your periods are very heavy, or accompanied by blood clots.
• Your periods last several days longer than usual.
• You spot between periods.
• You experience spotting after sex.
• Your periods occur closer together.

Potential causes of abnormal bleeding include hormonal imbalances, birth control pills, pregnancy, fibroids, blood clotting problems or, rarely, cancer.

How Is Perimenopause Diagnosed?

Often your doctor can make the diagnosis based on your symptoms. Blood tests to check hormone levels may also be beneficial but may be difficult to evaluate due to erratic fluctuations of hormones during this period. It may be more helpful to have several tests done at different times for comparison.

Can I Get Pregnant If I Am Perimenopausal?

Yes. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should continue to use some form of birth control until you reach menopause (you have gone 12 months without having your period).

For some women, getting pregnant can be difficult once they are in their late 30s to early 40s due to a decline in fertility. But, if becoming pregnant is the goal, there are fertility-enhancing treatments and techniques that can help you get pregnant.

Are There Treatments That Can Reduce the Symptoms Associated With Perimenopause?

Many women experience relief from hot flashes after taking low-dose birth control pills for a short period of time. Other options that may control hot flashes include the birth control skin patch, vaginal ring and progesterone injections. But, certain women should not use birth control hormones, so talk to your doctor to see if they are right for you.