What is Perimenopause?

Perimenopause is a phase that many women encounter as they age, yet it remains a condition shrouded in misunderstanding and disbelief. Countless individuals dismiss the symptoms as unrelated to any distinct hormonal change, often attributing them to stress, lifestyle, or other causes. This disbelief can lead to a lack of awareness, even among those going through the transition. That's why it’s crucial to understand what perimenopause is, why it happens, and how to manage it. In this and the following articles, we will answer these key questions. Today, we begin by addressing the foundational question: What is Perimenopause?

My Story: The Journey into Perimenopause

For many women, the journey into perimenopause can feel isolating, filled with confusion and self-doubt. I, too, was no exception. It started with irregular periods, mood swings, night sweats and unexplained weight gain. At first, I dismissed it as just part of my regular cycle, but over time, I realised these changes were signalling something more significant. When I sought medical advice, I was shocked by how often these symptoms were brushed aside or deemed "normal." This disbelief fuelled my desire to understand better and share the reality of perimenopause.

What is Perimenopause?

Perimenopause, often referred to as the "menopausal transition", is the period of a woman’s life when her body begins to make the natural transition toward menopause, marking the end of the reproductive years. It typically occurs in a woman’s 40s but can start as early as the mid-30s in some cases. This transition usually lasts several years, and the symptoms associated with perimenopause can vary significantly in duration and intensity.

The hallmark of perimenopause is the fluctuation of oestrogen and progesterone levels, hormones that regulate the menstrual cycle. As a woman's ovaries gradually produce less oestrogen, the menstrual cycle becomes irregular, and other symptoms like hot flashes, night sweats, sleep disturbances, and mood swings may occur. While the onset of menopause (defined as 12 consecutive months without a menstrual period) signifies the end of perimenopause, the symptoms can overlap between these two phases.

Why Does Perimenopause Happen?

Perimenopause is a natural biological process, often misunderstood. A woman is born with a finite number of eggs stored in her ovaries; as she ages, the number of eggs diminishes. Oestrogen and progesterone levels, which are crucial for regulating menstruation and fertility, begin to decline. This hormone fluctuation causes a wide range of symptoms that many experience during perimenopause. Understanding this transition is vital because perimenopause isn’t just about the end of periods—it’s a complex interplay of hormonal shifts that can affect mental, emotional, and physical health.

Symptoms of Perimenopause

The most common symptoms of perimenopause include:

• Irregular periods manifest as longer or shorter cycles, missed periods, or heavier or lighter menstrual flows.
• Hot flashes and night sweats: Sudden feelings of heat, which may cause sweating and discomfort, especially at night.
• Sleep problems: Insomnia or difficulty staying asleep is commonly reported.
• Mood changes: Increased irritability, anxiety, or depressive feelings can arise due to hormonal fluctuations.
• Vaginal dryness and changes in libido: A decrease in oestrogen can affect vaginal lubrication and sexual desire.

Each woman's experience of perimenopause is unique. Some may go through this transition with mild symptoms, while others find the symptoms disruptive to daily life.

Why People Struggle to Believe Perimenopause is Real

Despite its prevalence, perimenopause is often met with disbelief or minimized in its significance. Part of this stems from a lack of education and understanding about this life stage. Perimenopausal symptoms can mimic or overlap with other conditions like thyroid disorders or chronic stress, leading to misdiagnoses or the assumption that the symptoms are unrelated to hormonal changes.

In addition, the societal stigma around ageing and menopause further fuels this disbelief. Many women feel reluctant to discuss their symptoms openly, fearing they’ll be dismissed or labelled as overly emotional. This cultural tendency to downplay the physical and emotional toll of hormonal shifts has created a gap in both understanding and support for those going through perimenopause.

Conclusion

Perimenopause is a natural and significant transition in a woman’s life, yet its symptoms are often met with scepticism. Understanding what perimenopause is and why it happens is the first step in demystifying the experience and empowering women to take control of their health. In the upcoming articles, we’ll explore why perimenopause happens and how to manage its symptoms.

References:

1. North American Menopause Society. (2015). "Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging." Menopause, 22(7), 683-695. https://doi.org/10.1097/GME.0000000000000368
2. Shifren, J. L., & Gass, M. L. S. (2014). "The North American Menopause Society Recommendations for Clinical Care of Midlife Women." Menopause, 21(10), 1038-1062. https://doi.org/10.1097/GME.0000000000000319
3. Harlow, S. D., Gass, M., Hall, J. E., et al. (2012). "Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging." Fertility and Sterility, 97(4), 843-851. https://doi.org/10.1016/j.fertnstert.2012.01.128