Introduction to Perimenopause

This period typically begins in a woman's 40s, although it can start earlier, and lasts until menopause, defined as the cessation of menstrual periods for 12 consecutive months (Santoro, 2016). Perimenopause is a unique stage of life characterized by physiological, psychological, and social changes, requiring a multidimensional understanding to support women's health effectively.

The hallmark of perimenopause is a significant fluctuation in oestrogen and progesterone levels, driven by declining ovarian follicular activity (Prior, 2018). These hormonal changes often result in irregular menstrual cycles, which may be shorter or longer than usual, and varying menstrual flow. Estrogen dominance during this phase can cause symptoms such as breast tenderness and heavy bleeding, while lower levels of estrogen later in the transition are associated with hot flashes, night sweats, and vaginal dryness (Burger et al., 2002).

Symptoms of perimenopause vary widely among women in intensity and presentation. Vasomotor symptoms, such as hot flashes and night sweats, affect up to 80% of women and are among the most commonly reported concerns (Freeman et al., 2014). Sleep disturbances, mood swings, and cognitive changes, including memory lapses and difficulty concentrating, are also prevalent. These symptoms can have a significant impact on quality of life, contributing to increased stress, anxiety, and depression for some women (Greer et al., 2020).

In addition to physical and emotional symptoms, perimenopause is associated with long-term health considerations. Declining estrogen levels contribute to bone density loss, increasing the risk of osteoporosis. Cardiovascular health may also be affected, as the protective effects of estrogen on heart health diminish (Sullivan et al., 2021). Addressing these risks through preventive care, including regular exercise, a balanced diet, and screenings for bone and cardiovascular health, is vital during this transition.

Management of perimenopausal symptoms varies based on the individual’s symptoms and medical history. Menopause hormone therapy (MHT, previously known as hormone replacement therapy) is often recommended for women with moderate to severe vasomotor symptoms (Manson et al., 2015). Non-hormonal options, such as selective serotonin reuptake inhibitors (SSRIs) or gabapentin, may be effective for managing vasomotor symptoms in women who cannot or prefer not to use MHT. Lifestyle modifications, including regular exercise, stress management techniques, and maintaining a healthy weight, also play a crucial role in symptom management and overall health (Santoro et al., 2016).

Raising awareness about perimenopause and fostering open conversations about its effects are essential for empowering women to seek appropriate care. Education and support can help mitigate the stigma associated with this natural life stage and encourage proactive health management.

References

• Burger, H. G., Hale, G. E., Robertson, D. M., & Dennerstein, L. (2002). A review of hormonal changes during the menopausal transition: Focus on findings from the Melbourne Women's Midlife Health Project. Human Reproduction Update, 8(5), 483–490.
• Freeman, E. W., Sherif, K., & Rickels, K. (2014). Symptoms in the menopausal transition: Hormone and nonhormone management. Obstetrics and Gynecology Clinics of North America, 41(4), 623–635.
• Greer, W., Sandoval, R., & Murji, A. (2020). Perimenopause: Symptoms, diagnosis, and treatment. Canadian Family Physician, 66(6), 385–390.
• Manson, J. E., & Kaunitz, A. M. (2015). Menopause management—getting clinical care back on track. New England Journal of Medicine, 374(9), 803–806.
• Prior, J. C. (2018). Perimenopause: The complex endocrinology of the menopausal transition. Endocrine Reviews, 39(6), 681–705.
• Santoro, N. (2016). Perimenopause: From research to practice. Journal of Women's Health, 25(4), 332–339.
• Sullivan, S. D., Sarrel, P. M., & Nelson, L. M. (2021). Hormone replacement therapy in perimenopausal and postmenopausal women. Endocrinology and Metabolism Clinics of North America, 50(2), 197–216.