All you need to know about perimenopause

Perimenopause - The term means "around menopause", is a time when your hormones undergo changes in preparation of menopause, points out Dr Asha Baxi, Consultant Obstetrician & Gynaecologist, Motherhood Hospital.

Here, the level of estrogen (the female hormone) falls and women may also begin to have cycles where they do not ovulate (release an egg). Most women begin their perimenopause period at some point after their mid-40s. Many could also skip this stage entirely and directly experience menopause. But there are also cases when perimenopause could hit you as early as in your mid-30s, she adds.

The symptoms of perimenopause can be subtle, they come on gradually and many women fail either to notice it or just tolerate the changes. This phenomenon is generally ignored by most people. But it is very important that whenever you experience changes in your menstrual cycle that interfere with your day to day life and well-being that you go see a doctor as these symptoms may indicate perimenopause, Dr Baxi says. If experienced at an early age like in your 30s, perimenopause will cause problems in conceiving and can cause infertility.

The expert shares some features of perimenopause:

Periods are irregular: The length of time between periods will start to vary as a woman starts experiencing perimenopause. Ovulation becomes irregular and you may have a space of 60 days or more between periods.

Hot flushes & night sweating: You may suddenly feel feverish during perimenopause. Hot flashes may also be accompanied by redness of skin and excessive sweating. Your sleep patterns are also likely to be affected.

Fertility decreased: Due to irregular ovulation, you may experience problems in conceiving. The levels of estrogen, progesterone and other essential hormones decrease during perimenopause. The quality of the egg decreases leading to infertility.

Mood swings: Due to change in sleeping patterns and hot flashes, women tend to get irritable and depressed during perimenopause.

Problems related to the Vagina and the bladder: Low levels of estrogen will lead to loss of lubrication and elasticity in the vagina. Due to this intercourse may be painful. Libido also decreases. Diminishing estrogen levels will make women more susceptible to urinary and vaginal infections.

Decrease in Bone Mass: Estrogen is the hormone that protects the bones in women. During perimenopause, as estrogen levels fall leading to bone loss. This also makes women more vulnerable to osteoporosis. This is a disease where your bones become so brittle that a simple fall or even mild bending/stretching may lead to fractures.

She replies: "Irregular periods are quite common due to multiple reasons and most often than not women tend to generally ignore them. However, it is important to pay attention if this becomes a regular occurrence and schedule an appointment when one experiences the below symptoms:

Extremely heavy bleeding or if the bleeding has clots

Spotting between periods

Bleeding last for more than 7 days

Spotting after intercourse

Painful bleeding or painful intercourse

Doctors take many things into consideration before determining whether a woman has entered perimenopause or not. There are a number of factors like age, menstrual history, the symptoms shown etc. There is no one test or process to determine this, Dr Baxi says.

She adds perimenopausal complications can be treated with drug therapies like:

Hormone Therapy: This is the most effective form of treatment used to relieve the complications. Estrogen doses are given in the form of pills, skin patch, gels or creams to reduce your perimenopausal symptoms.

Estrogen administered into vagina: This form of treatment will help reduce the vaginal dryness caused due to decrease in the estrogen levels due to perimenopause. It will provide relief from vaginal and urinary infections.

Art procedures like IVF/ ICSI may be needed for women wanting to become pregnant.

It is very important to consult a gynaecologist to plan the course of medication. It is very easy to ignore mild symptoms like irregular periods or mood swings but remember these may all indicate underlying perimenopause. Detecting perimenopause and offering treatment in time provide a window of opportunity for long term benefits in conditions like protection against cardiovascular disease or osteoporosis. Talk to your doctor about the options available, check for risks and benefits and then make an informed decision.