What Is Perimenopause?

Years before the end of your periods, you go through a transitional time that is called perimenopause. This transition - puberty in reverse - occurs as your hormones are gearing down from the high levels needed to reproduce. This transition can take between a year and 10 years, but averages about three years. After a full year without a period, a woman is proclaimed menopausal.

Hormonal changes are responsible for the onset of perimenopause. As a woman reaches the end of her childbearing years, production of her ovarian hormones begins to fluctuate. During perimenopause, many cycles are annovulatory (do not include ovulation) and estrogen levels can sharply rise and then quickly drop. This causes menstrual periods to become shorter and then more and more irregular until they stop.

In the United States, the average age of menopause is 51.

What are some of the symptoms of perimenopause?

The variations in hormones that occur during perimenopause are responsible for many of the symptoms. Symptoms may last for months or years. About one-third of women have no symptoms, while a third have mild ones and a third have severe ones. Overall, many women feel unstable during this time with temperature control (hot flashes), heart rates (palpitations), energy (fatigue), moods (irritability) and even thinking (fuzzy thinking).

Here are some of the commonly mentioned symptoms:

• Fatigue
• Insomnia
• Irregular menstrual periods
• Heavy bleeding
• Irritability
• Hot flashes and night sweats
• Memory difficulties (fuzzy thinking)
• Mood swings

How to know if it is perimenopause?

It's best to talk with your physician when you start to notice changes in your menstrual cycle or when you begin to have any of the previously listed symptoms. Your doctor will want to confirm the diagnosis of perimenopause by going over your medical history and reviewing your symptoms. He or she will also check to make sure there aren't any other causes for the changes.

Although perimenopause is perfectly normal, some symptoms should probably be checked to make sure that they are not a sign of something else. This is particularly true for persistent heavy bleeding, persistent palpitations (especially when accompanied by chest pain or shortness of breath), severe depression or fatigue.

It would be great if there was a blood test that women could get to tell them whether they are in perimenopause, how long it will last and when the symptoms will be over. However, it just doesn't exist. Extreme variations in hormones make testing hard. The FSH test, which checks the blood level of the follicle stimulating hormone (FSH), is only valuable after you have been without a period for a year, by which time you will have probably figured out that you are in menopause.

Related Articles Menstrual Changes Fertility Changes Hot Flashes Mood Swings Urinary Problems Insomnia and Perimenopausal Women Lower Sex Drive Heart Palpitations in Menopause Menopause Treatments

External Sources The North American Menopause Society Menopause Guidebook The Hormone Foundation American Society for Reproductive Medicine A Practice Committee Report, The Menopausal Transition, (American Society for Reproductive Medicine, 2001).

This article was reviewed and updated June 2007.

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