Perimenopause: Understanding the Phase Before Menopause

Perimenopause: Understanding the Phase Before Menopause

Perimenopause, that often-overlooked phase before actual menopause, is a time when hormonal changes begin to affect the body and mind. While many may associate menopause solely with the end of menstruation, perimenopause brings with it a host of significant changes that are not always recognized or understood. 

What is perimenopause?

The term perimenopause has only been acknowledged in medicine for about ten years. When discussing perimenopause and its associated symptoms, individuals may consider the connection to menopause, but often healthcare providers do not recognize this link. Age seems to be one reason for this; menopause is generally considered to occur between the ages of 45 and 51, and menopause is often associated with the cessation of menstruation. In reality, hormonal fluctuations can often be felt in the body well before menstrual changes occur.

When does perimenopause start?

Perimenopausal symptoms are often associated with menstruation because the menstrual cycle is easy to track and serves as a clear indicator of hormonal balance. According to scientific sources, menstruation becomes irregular about 5 to 10 years before menopause begins, and this is regarded as a sign of perimenopause. The Health Library, an organization that provides medical treatment recommendations, states that perimenopausal age usually begins around the age of 40. Symptoms are often similar to menopausal symptoms but tend to be intermittent and milder.

In practice, perimenopause and hormonal fluctuations can begin as much as 10 to 15 years before the typical menopausal age. Menstruation may still be regular, but the body can experience a range of unusual sensations. At this stage, various diseases are often investigated, but an explanation for the symptoms is not always found.

During perimenopause, estrogen, progesterone, and testosterone levels begin to fluctuate and gradually decline. These hormones impact the overall functioning of the body and general health.

Symptoms of Perimenopause 

Menstrual Cycle:

Estrogen and progesterone are key reproductive hormones that regulate the menstrual cycle. During perimenopause, the levels of these hormones fluctuate and decrease, making the menstrual cycle irregular or changing the amount of menstrual flow, sometimes increasing it. PMS symptoms, or premenstrual symptoms, may become more pronounced.

Sexuality:

Changes in testosterone levels can affect mood, muscle strength, and sexual desire. Sensitivity to touch may also change. During puberty, testosterone promotes hair growth, and in perimenopause, excess testosterone can lead to unwanted hair or menstrual irregularities.

Muscles and Weight:

The decline of hormones significantly impacts the body's bones, muscles, fascia, and soft tissues. Estrogen affects fascia, reduces inflammation levels, and regulates bone growth. It nourishes the body’s tissues, keeping them youthful and flexible, and contributes to the regulation of the body’s fluid balance.

Progesterone affects pain threshold, and testosterone supports muscle and bone density and helps convert fat into muscle. Changes in hormonal balance can lead to muscle and joint pain, and the decline of estrogen increases the risk of osteoporosis and other musculoskeletal disorders.

Changes in hormonal balance also affect the function of involuntary or smooth muscle tissue. Weakening of smooth muscle can lead to disturbances in the function of the heart and internal organs, such as arrhythmias. Smooth muscle tissue is found in blood vessels, the respiratory tract, the digestive system, the urinary tract, and around the genitals, which can lead to increased respiratory issues, high blood pressure, or urinary incontinence.

Smooth muscle tissue is also present in the eyes and skin, such as in the small arrector pili muscles. During perimenopause, you may notice changes in vision, dryness of the eyes, or changes in the skin. For example, you might observe changes in hair or eyelashes. Although changes in the function of smooth muscle tissue have been studied relatively little, many perimenopausal symptoms may be related to imbalances in this muscle group.

Muscles play a crucial role in the overall metabolism of the body, so changes in hormonal balance also affect weight management and the risk of metabolic disorders.

Incontinence:

During perimenopause, pelvic floor muscle strength, as well as the smooth muscle around the bladder and genitals, may weaken. Additionally, mucous membranes often thin out, and their function may be disrupted, making individuals susceptible to incontinence, changes in sexual sensitivity, and increased susceptibility to infections.

Hot Flashes:

Hot flashes are perhaps the most recognized menopausal symptom, alongside night sweats. These symptoms result from the brain's vasomotor center reacting to changes in hormonal balance. This center is responsible not only for regulating the body's temperature but also for regulating smooth muscle function and controlling neurogenic regulation of blood circulation.

During perimenopause, changes in the functioning of the vasomotor center may first manifest as disturbances in nasal function, such as vasomotor rhinitis, nasal congestion, or increased sinus infections. Additionally, these disturbances may also affect the function of the eyes and hearing and cause respiratory symptoms.

Mood:

Hormones also affect brain function. During perimenopause, individuals may experience issues with mood and memory, such as brain fog, anxiety, fatigue, mood swings, and changes in concentration. The risk of depression, anxiety, panic disorders, and ADHD symptoms increases during perimenopause.

Sleep:

Sleep is a complex process that is not yet fully understood. However, in recent years, the relationship between sleep and hormones has been extensively researched. The effects of estrogen and progesterone on sleep are familiar to many, as sleep disturbances are common during PMS, pregnancy, the postpartum period, and especially during menopause and its aftermath.

Many areas of the brain that regulate sleep have estrogen-sensitive receptors, so it is natural that fluctuations in estrogen levels affect sleep architecture. Night sweats may occur during perimenopause because estrogen is responsible for regulating body temperature at night. Progesterone, on the other hand, influences the ability to fall asleep and maintain sleep.

How to Manage Perimenopause Symptoms

Managing perimenopause symptoms often involves lifestyle changes and medical treatments:

  1. Healthy Diet: Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can help manage weight and boost overall health.
  2. Regular Exercise: Physical activity can improve mood, maintain a healthy weight, and promote better sleep.
  3. Stress Reduction: Practices such as yoga, meditation, and deep breathing can help manage stress and improve emotional well-being.
  4. Sleep Hygiene: Establishing a regular sleep routine and creating a restful environment can improve sleep quality.
  5. Hydration and Moisturizers: Drinking plenty of water and using moisturizers can alleviate dry skin and vaginal dryness.
  6. Medical Treatments: Hormone replacement therapy (HRT), antidepressants, and other medications can be prescribed by a healthcare provider to manage severe symptoms.
  7. Supplements: Calcium, vitamin D, vitamin B, magnesium and omega-3 fatty acids can support bone health and overall wellness.

Although perimenopause has been relatively under-researched, it is crucial to recognize the associated symptoms to seek help promptly and avoid suffering from symptoms that can significantly disrupt daily life.

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