Most of us have a general idea… but what is menopause exactly? Let’s clear up some of the gray areas surrounding the process, like the fact that menopause actually comes in several different stages, one of which is perimenopause.
Menopause occurs when a woman is done with the reproductive stage of her life and stops menstruating. In addition to periods stopping, other symptoms may pop up.
Let’s review some basics about the stages of menopause…
What is Premenopause?
Premenopause occurs before perimenopause, when you are still menstruating and you don’t yet have any signs or symptoms of menopause. If you are still having normal periods, then you are premenopausal.
During this stage, many women notice a few changes in:
- Cycle length
- Period symptoms such as pain, cramping, and bloating
- Premenstrual (PMS) symptoms1
What is Perimenopause?
Perimenopause, on the other hand, is when a woman has not fully entered menopause, but she is experiencing the first symptoms. This stage of the female reproduction cycle can also be referred to as “the menopausal transition.”
Perimenopause symptoms can include:
- Hot flashes
- Changes in the menstrual cycle (including timing, frequency, and severity)
- Sleep disturbances and insomnia
- PMS changes (particularly worsened PMS symptoms)
- Weight gain
- Hair changes
- Loss of sex drive
- Forgetfulness or difficulty concentrating
- Muscle aches
- Urinary tract infections (UTI)
- Fertility issues
- Psychosocial factors (changes in mood and/or frequent mood swings)
- Vaginal dryness
- Breast tenderness2
Perimenopause typically occurs after age 40 (be sure to check out the reproductive timeline below).
Furthermore, premenopause and perimenopause are often used interchangeably. But they are technically two different stages in a woman’s reproductive cycle.
Now, the word menopause specifically refers to the last period a woman has – but this isn’t necessarily used directly when it comes to the diagnosis. Why?
Well, it’s almost impossible to determine if a period is your last, or if there will be one (or several) more. For this reason, the term “postmenopausal” is more often used. A woman who is diagnosed as postmenopausal is about one year out from her last period.3
There are also many symptoms that come along with menopause/postmenopause. You’ll notice that some of these symptoms overlap from the perimenopause list.
Menopause symptoms can include:
- Hot flashes and night sweats
- Changes in mood, and more frequent mood swings (depression, anxiety, and irritability)
- Vaginal dryness
- Dry skin
- More frequent urination
Timeline for Premenopause, Perimenopause, and Menopause (Postmenopause)
As mentioned above, any woman having normal periods is in the premenopausal stage. Most females begin menstruation around age 12.4 If you are menstruating, then you are technically premenopausal.
Perimenopause can start when a woman is in her 30s or 40s. At this point, you’ll likely start to notice some changes, or you’ll begin experiencing some perimenopausal symptoms. Now would be a great time to start talking with your doctor about menopause and what to expect (as well as what to look out for).5
Changes in Hormones
While perimenopause was traditionally viewed as a rapid drop in estrogen production, the production of this hormone can actually increase during this time.
Women in the perimenopause stage often have major fluctuations in estrogen production, including higher-than-normal levels. Ovarian function is also erratic during perimenopause. This period of time can be looked at as more of a “hormonal transition,” as opposed to previous views of “declining ovarian function.”6
There will be a more severe drop in estrogen at the end of perimenopause.
This does not mean that you can’t get pregnant. It is totally possible for you to get pregnant during this time, so long as menstruation is occurring.
This time of rapid estrogen depletion can last anywhere from a few months to several years. It is not complete until you have had your last period. Again, doctors will traditionally consider women “postmenopausal” at one year out from their last period.
Menopause usually occurs around age 50, but this can obviously vary from person to person (just like every step in the reproductive cycle).7
Some women will experience perimenopause and menopause much earlier than others. There are some risk factors that can lead to this, including:
- Genetics (family history)
- Hysterectomy (uterus removal) or oophorectomy (ovary removal)
- Certain medical treatments (like chemotherapy or radiation)
- Use of oral contraceptives8
If you think you are experiencing perimenopause, it’s never a bad time to talk with your doctor and ask questions.
Health Risks During This Time
During perimenopause, and especially menopause, you are at a higher risk for certain medical conditions. These include conditions that affect your:
- bones and entire skeletal system
- cardiovascular system
- neurological system
- endocrine system
It’s important to discuss these risks with your doctor during perimenopause and postmenopause – especially if you have a family history of certain conditions.9
Furthermore, many women experience extra side effects of perimenopause/menopause. Some of these can lead to other health issues, particularly in regards to your sleep cycle.
Lack of sleep can affect almost all other areas of your life and health, including your decision-making abilities and your ability to manage stress. Some studies even suggest that menopause can create changes to your airway, leading to sleep apnea in women who have never experienced it before.10
It can’t be stressed enough: talk with your doctor about any and all changes you experience during this time, even if only minor sleep disturbances are occurring. He or she will know what’s best for you and your body.
Now you know all the basics about the premenopause, perimenopause, and menopause stages of your reproductive cycle. It’s strongly recommended that you track your periods, take note of any changes, and always communicate these changes with your doctor. Know your body, and watch for any abnormal signs or symptoms to keep up with your reproductive health during and after perimenopause.
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