Perimenopause Q & A

Perimenopause– Questions & Answers

What is perimenopause?

Perimenopause is the time “around” menopause.  It begins in the late reproductive years when women begin having irregular menses and lasts until 1 year after the final menstrual period.  Since the average age of menopause is 51, it can start as early as the late 30’s.

How long does it last? 

All women are different.  Some women hardly notice it, while other women may have symptoms off and on for 8-10 years.

What sort of symptoms does it cause? 

All women are different.  The menstrual changes are the hallmark symptom (90% of women have irregular menses for 4-8 yrs.).  In general, menses tend to get a little closer together before women start skipping them.  Menses can be heavier or longer & can vary from month to month.  Also, any of the menopausal symptoms can occur (such as hot flashes, mood swings, migraines, etc.).  In general, in the early stages of perimenopause, the signs of not enough estrogen (hot flashes, migraines, vaginal dryness, and sleep problems) tend to occur from the day prior to the menses to the end of bleeding and the signs of progesterone “imbalance” (mood swings, depression) tend to be worst during the 10-14 days prior to the menses.

Can I still get pregnant?

Yes, although the chances decline, it is still possible.  Women who want to conceive may need to see a fertility specialist.  Women who do not desire a pregnancy should continue to use some form of birth control until 1 year after the final menses.

woman checking Calender on phone

Source: Thinkstock

How do I know if I am in perimenopause?

The most reliable thing is a menstrual chart, with start & stop dates.  Blood tests can be done on menstrual Cycle Day 2 or 3, but since every month is different, this is rarely helpful.  They can be helpful for women who have had a hysterectomy or a uterine ablation or for women who are considering pregnancy.

Should I get my hormones balanced?

It is impossible to “balance” female hormones prior to menopause.  Since the female menstrual cycle is due to the egg growing and releasing and the uterus preparing to receive a baby, the levels of hormones change daily throughout the month.  Some months, the egg may be hard to stimulate or there may not be any ovulation at all.  There is also no “ideal” hormone range to achieve.

What treatment options do I have?

Since this is a natural process, it is not necessary to treat it, unless the symptoms are interfering with your life.  Heavy bleeding can be treated with progesterone, birth control pills, ring, or progesterone only IUD.  If those options don’t work, a uterine ablation (burning or freezing the lining of the uterus) or hysterectomy (removal of the uterus) can be performed.  Birth control pills, ring, or IUD can provide birth control and regulate periods.  The symptoms of low estrogen can be treated with a very low dose of estrogen, either daily or during the menses.  The mood swings and depression can be treated with an antidepressant, either daily or during the premenstrual time.  When the menses become very irregular, this is harder to predict, so we frequently use daily medications.  For mild symptoms, some women are helped by over the counter medications like black cohosh or phytoestrogens (plant based estrogens like soy products).

How do I know if my bleeding is normal or not?

Contact a doctor if you have very heavy menses (soaking a super pad every hour), heavy bleeding lasting more than 7 days or entire menses (including spotting) lasting 14 days, frequent bleeding (closer than 21 days from the start date to the next start date), spotting between menses, or bleeding after sexual intercourse.

What about weight gain and lack of interest in sex?

Weight gain is not directly related to female hormones and this is not changed by taking hormones.  It is related to changes in metabolism that are age related and to the disrupted sleep.  Lack of interest in sex is rarely related to female hormones (unless pain is involved).  It is related more to fatigue and lifestyle issues that can occur at this time of life.

About the author: Patricia Gunter, MD is a menopause specialist at The Austin Diagnostic Clinic certified by the North American Menopause Society.   She practices at ADC North and is accepting new patients.  To make an appointment call 512-901-1111.