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Understanding Perimenopause

Most women are familiar with menopause, a stage later in life when women no longer ovulate or have periods. What may not be as familiar is perimenopause, a transition period when women start to run out of eggs and experience a wide array of symptoms and changes to their bodies.

Many women have questions during this time of their life. Here, experts at University of Utah Health’s Midlife Women’s Health and Menopause Program provide some answers.

When does perimenopause begin?

For most women, perimenopause begins in their early 40s, but it can occur as early as their late 30s or not until after the age of 50. Menopause is defined as one year without a period. While the idea of 10 years of unpleasant symptoms can seem daunting, the symptoms often wax and wane over the years. Some women may go through a period of symptoms and then experience nothing for several years.

What are the symptoms of perimenopause?

While some women face little to no symptoms when they undergo perimenopause, most women will encounter at least some changes to their body. The most common change is irregular periods. This may manifest as skipped periods, erratic periods, or periods that are heavier or more frequent. 

Other symptoms may also include:

  • Hot flashes
  • Excessive sweating
  • Mood swings
  • Lower energy
  • Anxiety
  • Poor sleep
  • Changes in libido

Can family history play a role?

Doctors often ask women about their family history when discussing perimenopause since the experiences of a woman's mother or sisters can help determine both the severity of perimenopausal symptoms and when a woman will reach menopause. Of course, this is an estimate and not a guarantee.

Can women experiencing perimenopause still have children?

The onset of perimenopause does not mean that women can no longer have children. Even when periods are erratic and as infrequent as every three to six months, women can still get pregnant and should still use birth control if they wish to avoid pregnancy. 

"If you haven't gone a full year without a period, you can still get pregnant," says Sandra Van Leuven, MD, a family medicine physician at University of Utah Health.

The number of children that a woman has had are no indication of when or how severe perimenopause will be. Each woman is born with a set amount of eggs. When that supply of eggs begins to die off, perimenopause sets in.

What treatment options are available?

Many women seek treatment with perimenopause in order to help reduce the severity of their symptoms. Common treatments include birth control pills, anti-depressants, progesterone IUDs, and hormone therapy, along with over-the-counter options like herbal supplements and sleep aids. 

However, all of these treatment options come with possible complications. For example, antidepressants can affect libido and sexual function. Hormones can increase the risk of blood clots and breast cancer, along with elevating blood pressure and possibly causing liver or gallbladder disease.

This is not to say that women should avoid treatments if they need them. “Not everyone suffers during perimenopause, and there is no required treatment,” Van Leuven says. “The goal is to tailor treatment to help women feel their best with minimal side effects."

Keep in mind

Perimenopause affects the lives of all women one way or another and can cause discomfort and anxiety. Understanding what is happening with your body and knowing that it is a normal transition is key to managing and coping with this significant life change.