Perimenopausal Disorder

Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, which marks the end of the reproductive years. Perimenopause is also called the menopausal transition.

Women enter the perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. The average age of menopause is 51 years.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to ease these symptoms.

Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause.

Symptoms

Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:

• Irregular periods: As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you're likely in late perimenopause.
• Hot flashes and sleep problems: Hot flashes are common. The intensity, length and frequency vary between women. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.
• Mood changes: Mood swings, irritability and an increased risk for depression are associated with the perimenopause, particularly in women who have had depression earlier in their lives.
• Vaginal and bladder problems: When estrogen levels diminish, your vaginal tissues lose lubrication and elasticity, which makes intercourse uncomfortable. Low estrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.
• Changes in sexual function: During perimenopause, sexual arousal and desire may change. But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.
• Decreased fertility: As ovulation becomes irregular, your ability to conceive diminishes. However, as long as you're having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months. 
• Loss of bone: With declining estrogen levels, you start to lose bone more quickly than you replace it, which increase your risk for osteopenia and osteoporosis — conditions that are associated with fragile bones.
• Changing cholesterol levels: Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

The symptoms of the perimenopause are manageable with interventions, including medications. Attention to physical and mental wellness, exercise, diet and stress reduction are critical factors in managing this period of life, the gateway to the last third of women’s lives.