Is It Perimenopause?
The transitional phase between normal fertility and menopause known as perimenopause. During this time, levels of estrogen progesterone drop, and periods become irregular—sometimes clustering and coming more frequently, then disappearing for months before starting again. Perimenopause can last anywhere from a few months to as long as a decade, and how long it lasts depends to some degree on family history, although on average it lasts about four years.
Essential
The average age for the onset of perimenopause is forty-eight, but estrogen levels start to change a decade earlier, when a woman is about thirty-eight. Perimenopause can start for women who are in their mid-thirties, although those cases are highly unusual. Also women who smoke tend to go through perimenopause one to two years earlier than other women.
Perimenopause also usually causes a number of cognitive and physical symptoms, such as forgetfulness, hot flashes (sometimes more intense than those of menopause), decreased sexual interest, decreased energy, mood swings, fuzzy thinking, heart palpitations, heartburn, vaginal dryness, urinary problems (incontinence, more frequent urinary tract infections, etc.), and sleep problems.
Question
What causes hot flashes?
The decline in estrogen levels affects the hypothalamus, a small structure at the base of the brain that serves as your body’s thermostat. If the brain believes your body temperature is too hot, it will send blood from the organs to the surface in an effort to cool off. Your heart beats faster, your blood vessels dilate, and you sweat. A woman’s skin temperature can rise as much as 6°C during a hot flash!
Doctors used to determine if women were in menopause, or the absence of periods for twelve months, by testing the levels of follicle-stimulating hormone in their blood. However, studies have shown that FSH levels fluctuate dramatically from month to month, until a woman’s periods have stopped. Now, menopause has defined by not having periods for a full year, but very high FSH, which are used as an indicator of ovarian reserve, have become indicative of menopause.
Hormones for Perimenopause
Just as is the case for PMS, your doctor might prescribe oral contraceptives to manage the symptoms of perimenopause (which would both restore regular menstrual cycles and reduce hot flashes). Other options include hormone skin patches and selective serotonin reuptake inhibitors (SSRIs), both of which reduce hot flashes. You should also modify your diet to avoid foods that intensify hot flashes, such as caffeine, alcohol, and spicy foods.
Alert
Low libido may be caused by medication not perimenopause. Decreased sexual interest, a fairly common complaint of older women undergoing perimenopause, can also be caused by certain medications, such as drugs for high blood pressure and depression. Check with your doctor if you experience this symptom to rule out other causes.
