The Change Before the Change: 9 Questions About Perimenopause

Friends laughing together

There are two words that are packed with meaning and unite women around the world: The Change.

The Change, otherwise known as the time around menopause, can be a confusing time in a woman’s life. But as confusing as it is, women talk about menopause. They rally around it and with friends, embrace it.

And then there is perimenopause - when was the last time you heard that phrase? Exactly. That’s because it is the unspoken, often left out part of womanhood. The black sheep, if you will.

Perimenopause is the transition phase right before menopause and, quite honestly, many of those symptoms you associate with menopause itself - hot flashes, irregular periods, night sweats- actually occur more often during this transition period.

Now that we’ve quite possibly introduced another new-to-you phase of womanhood, let us answer some common questions.

Q: Is perimenopause the same thing as premenopause?

A: Although people often use the two terms interchangeably, they actually mean two separate things. The North American Menopause Society (NAMS) defines them as:

  • Premenopause is the time between a woman’s first period and the onset of perimenopause.
  • Perimenopause is the transition phase into menopause that typically lasts about six years. It typically occurs in women in their 40s to early 50s, according to the National Institute on Aging.

Q: Does everyone go through perimenopause?

A: Women who have sudden induced menopause—both ovaries removed or damaged by cancer treatments—might not experience perimenopause.

Q: What are the symptoms of perimenopause?

A: During perimenopause, estrogen levels fluctuate and eventually drop, causing many different symptoms. NAMS identifies some of these as:

  • Irregular, heavier or longer periods
  • Hot flashes
  • Insomnia
  • Night sweats
  • Palpitations
  • Headaches
  • Vaginal dryness
  • Breast tenderness
  • Acne flare-ups

Q: Are there other health risks?

A: Although perimenopause and menopause don’t cause heart disease, the changes in a woman’s body during this time can result in an increased risk. Several things change in a woman's physiology - decreasing estrogen levels, cholesterol and blood pressure to name a few - and some of those changes can lead to heart disease. But, there are actions you can take to decrease your risk during this time.

Q: Can I get pregnant during perimenopause?

A: Yes, although, the chances of getting pregnant decline as you get older. This is because the number of eggs in your ovaries drops over time. Also, as women age they are more likely to develop problems that interfere with getting pregnant, such as uterine fibroids, the natural aging of eggs and the number of eggs available to fertilize.

However, because of the irregular periods of perimenopause, it’s harder to know when your ovary is releasing an egg. This makes natural family planning more difficult. If you skip a period, check with your doctor to be sure you’re not pregnant.

Q: Should I use birth control during perimenopause?

A: If you do not desire to become pregnant, the North American Menopause Society (NAMS) highly recommends using safe and effective methods of birth control, such as oral or hormonal contraceptives, long acting reversible contraception (LARC), or less reliable barrier methods, like condoms.

Oral contraceptives have benefits beyond birth control. Perimenopause symptoms like hot flashes, irregular periods, low bone strength and acne can be alleviated or reduced in severity.

Q: Will perimenopause affect my sex life?

A: It can. You might experience symptoms like vaginal dryness, lower libido or pain during sex. NAMS has many suggestions for overcoming sexual problems during menopause, ,such as vaginal lubricants or moisturizers, low-dose vaginal estrogen, or therapy, including sex therapy.

Q: Is it true that women can be more emotional during perimenopause?

A: Many women experience mood swings during perimenopause, and NAMS says this might be due to hormone fluctuations, or lack of sleep from insomnia and night sweats. However, the mood swings might be due to other factors that often occur around the time of perimenopause, such as stress, infertility or aging. Existing mood disorders may temporarily worsen during perimenopause.

Q: If I am in the perimenopause phase, how do I prepare for menopause?

A: When you start experiencing symptoms of perimenopause, it might be a good idea to talk about these symptoms with your gynecologist or health provider. Oftentimes, they can let you know what to expect as well as tips to alleviate the symptoms and decrease risk for potential coexisting health problems. Don’t be afraid to ask questions! There is plenty of information on the internet, but a health provider can answer your more personal questions.

Date Archives


Author Archives

Share This Page: