What Is Perimenopause? A Doctor Explains.

A Keck Medicine of USC expert explains what symptoms to expect in perimenopause.

Menopause is defined as going 12 consecutive months without a menstrual period. For most women, menopause occurs between the age of 45 and 55. Before reaching menopause, however, women go through a transitional phase called perimenopause. During perimenopause, women can experience various symptoms ranging from menstrual irregularity and skipped periods to hot flashes and mood changes. Other common symptoms include sexual dysfunction and decreased libido.

Knowing what to expect can prepare you for the changes to come. Ahead, an obstetrician and gynecologist with Keck Medicine of USC explains the main symptoms women can experience during perimenopause.

Hot flashes and night sweats

The first signs of perimenopause are often vasomotor symptoms like hot flashes and night sweats. Declining estrogen levels during this time cause blood vessel changes that disrupt the body’s ability to regulate temperature changes.

A hot flash is described as a sudden flush of heat that starts from your lower body and rises to your head and face, lasting for a few seconds.

Women experience hot flashes to varying degree. Some women can have dozens of hot flashes a day, whereas other women experience hot flashes more intermittently. Some women, meanwhile, don’t experience hot flashes at all.

Insomnia, brain fog and mood changes

Falling estrogen levels can interfere with sleep regulation, causing insomnia during perimenopause. In addition, for some women, hot flashes at night further disrupt sleep.

Poor sleep can cause other problems like “brain fog,” characterized by an inability to concentrate or remember things. Poor sleep can also exacerbate any mood changes triggered by changing hormone levels.

If lack of sleep is negatively impacting you, consulting a doctor is beneficial. They can help identify the cause and also consider whether depression or anxiety are factors.

Genitourinary symptoms

Some women experience what is called genitourinary syndrome of menopause (GSM) as estrogen levels decline. GSM encompasses symptoms affecting the vagina and lower urinary tract during perimenopause. These can include everything from vaginal dryness to urinary incontinence.

For women experiencing these issues, doctors can advise treatments like pelvic floor physical therapy, which can address urinary incontinence. Pelvic floor physical therapy differs from the Kegel exercises one does on their own. It is overseen by physical therapists who are specialized in a wide range of gynecologic issues.

Gaining weight

Weight gain is a common challenge not only during perimenopause but due to aging in general as metabolism slows and muscle mass decreases. At this time in their life, women may experience weight gain especially around the middle abdomen because menopause causes more visceral vat to accumulate in the abdomen.

To combat weight gain, women may have to adjust their eating and exercise routines to include healthier habits and muscle-building exercises.

When to see a doctor for menopause symptoms

Doctors can support patients as they adjust to these changes. Unfortunately, many patients fail to ask for help when they need it.

Treatment recommendations will vary by patient and depend on multiple individual factors, including which symptoms you are experiencing and your personal health history. Remember that treatments that worked for your friend or sister may not necessarily work for you. For instance, if someone has a history of breast cancer, their treatment plan could look very different from someone else’s.

Some doctors may suggest menopausal hormone therapy, or what has been commonly referred to as “hormone replacement therapy” — a term some consider outdated because it implies that the goal of treatment is to restore hormone levels to premenopausal levels when in fact prescribed treatment dosages are much lower.

Other alternatives to menopausal hormone therapy may be recommended depending on a patient’s symptoms. Fortunately, more information about perimenopause and medications to treat symptoms are becoming available, expanding options for patients.

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