Perimenopause: Symptoms, Diagnosis and Treatment

Perimenopause refers to the normal period surrounding menopause. It is the transition to menopause in a woman. Most women commonly experience perimenopause in their 40s, although some can begin menopausal changes from their 30s as well.

This period is marked by menstrual irregularity and decreasing fertility. It occurs from a decrease in the level of estrogen in the female body. Estrogen is a hormone produced by the ovaries and is the key hormone in regulating the menstrual cycle.

It is to be noted that while there is a decrease in fertility during perimenopause, the individual can still become pregnant. So women should continue to use contraception if they wish to avoid pregnancy. Women who want to conceive may have difficulty but may be assisted through fertility treatments.

Perimenopause lasts for an average duration of 4 years. However, for some it may extend for even 10 years. A woman is said to have entered menopause when she has not had any menstruation for 12 consecutive months.

Symptoms of Perimenopause

Irregular periods
Hot flashes and night sweats
Disturbance in sleep and fatigue
Mood swings
Worsening of existing premenstrual syndrome
Breast tenderness
Vaginal dryness leading to discomfort during sexual intercourse
Decreased sex drive
Urinary incontinence
Increased risk of urinary tract infections

Menstrual irregularity is by far the most common symptom experienced by women to suggest perimenopause. There is no need to panic as this is a normal age related change in most women. Severe, prolonged and frequent bleeding may occur in a few and requires more detailed evaluation.

Diagnosis of Perimenopause

The symptoms described above in a woman over 40 years old is suggestive of Perimenopause. A clinical examination to look for vaginal dryness and urinary incontinence is performed.

In case of an abnormally early onset of perimenopause, laboratory investigations may be done to assess the values of several hormones in the blood including estrogen, progesterone, luteinizing hormone and follicle stimulating hormone. Thyroid hormones are also measured as abnormalities can manifest with irregular periods.

Treatment of Perimenopause

As this is a normal transition into menopause, no treatment is required. There are also no ways to delay menopause. However, if the symptoms are severe and debilitating, several remedies may be helpful

Hormone therapy: this involves taking a pill of estrogen. This corrects the decrease in estrogen in the body and can reduce symptoms like hot flashes and fatigue. Estrogen alone in high doses can increase the risk of breast and uterine cancer, hence it is recommended in the lowest dose suitable. In women with a uterus, progesterone is added to decrease the risk of cancer.
Vaginal creams: local application of estrogen creams in the vagina helps to reduce dryness
Vaginal lubricants: this can also help to decrease he dryness and pain during sexual intercourse
Antidepressants: for severe disturbance in mood, antidepressants like selective serotonin reuptake inhibitors (SSRIs) are helpful
Smoking cessation: this decreases the intensity of perimenopausal symptoms in addition to other benefits
Healthy diet and an active lifestyle: these help in overall improvement in health and wellbeing

References

Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/home. Accessed April 18, 2019.