What is Perimenopause

What you need to know about perimenopause

It’s time we start talking about perimenopause. More than 50% of South Africans are women, or people assigned female at birth.¹ And if they’re lucky enough to live a long life, they’ll experience hormonal changes that older generations called “the change”, if they spoke about it at all.

The truth is, perimenopause, or menopausal transition, is natural² and nothing to be shy or ashamed of. The sooner we start talking about one of life’s natural times, the sooner women will feel empowered and confident to embrace their bodies at all stages. If you don’t experience this beautiful change directly, chances are you’ll experience it indirectly as a loving and supportive husband, partner, or friend.

So, without holding back, let’s talk openly, so you have the facts and support to embrace this transition.

What is perimenopause?

Night sweats, hot flashes, and sleep problems are all symptoms of perimenopause, the beginning of a new and beautiful life journey as the female body prepares for menopause.²

Perimenopause signals the end of the reproductive years,² and in addition to the above experiences, your menstrual cycle may also become longer or shorter, heavier, or lighter than usual.^{2, 3} Some women even notice a change in their premenstrual syndrome (PMS) symptoms.³

Perimenopause is natural and can start anytime from eight to 10 years before menopause, and for most women, the symptoms are so subtle that no medical attention is necessary.^{2, 4}During this time, the main female hormone, estrogen, rises and falls unevenly^.2 The ovaries gradually produce less estrogen, and in the last two years of perimenopause, estrogen decline accelerates. Even though you may experience menopause symptoms, you’re still getting your menstrual cycle and can fall pregnant.^{2, 4}

When does perimenopause start

Perimenopause lasts until menopause, which is defined as 12 consecutive months after your last menstrual period, and when the ovaries stop releasing eggs.⁴ Perimenopause can start at different times. Some women may notice a change in their mid-30s, others notice menstrual irregularity during their 40s, and for others, perimenopause can start as late as their mid-50s.^{2, 3, 4}

How long does perimenopause last

Perimenopause can last between four and eight years.^{3, 5} However, some women can experience this phase for a few months.²

Why does the body go through perimenopause

Perimenopause is the first stage of menopause, when the body prepares to stop releasing eggs and is no longer able to fall pregnant.³

How is perimenopause diagnosed?

Because the symptoms can be subtle, it may be hard to tell if you’re going through perimenopause.⁶ Your age, symptoms, medical history, and a physical examination will assist your doctor to provide a diagnosis. Sometimes blood tests are used to measure hormone levels.⁶

Can you fall pregnant while perimenopausal?

Yes. When you’re perimenopausal, your period may be irregular, but you can still fall pregnant. The most effective way to prevent pregnancy is to use contraception.^{2, 3, 4}

Risk factors of perimenopause

While perimenopause is natural, certain factors may cause it, and menopause to start earlier. These include,²

Smoking – people who smoke start menopause one to two years earlier than non-smokers.

Family history – if there’s a family history of early menopause, you may experience the same.

Cancer treatment – chemotherapy or pelvic radiation therapy has been linked to early menopause.

Hysterectomy – if the uterus, but not the ovaries, has been removed, menopause can start earlier than the average age.

Period complications due to perimenopause

Irregular periods are the first sign of perimenopause, and there’s nothing to worry about. Unless the bleeding is heavy and lasts for more than a week, or if you’re bleeding in between cycles or less than 21 days apart,² it’s advisable to see your doctor, as there may be a problem that requires diagnosis and treatment.²

Why prepare for this beautiful transition?

Perimenopause can have an impact on your body and mind. Some symptoms, such as hot flashes, disrupted sleep, and bladder problems, can affect daily life. Vaginal dryness can cause pain or discomfort during sex, and there can be an increased risk of depression and mood swings.^{2, 3}

When should you see a doctor?

For many women, perimenopausal symptoms are so subtle that they don’t realise what their body is going through at the time.² For others, symptoms can be severe and require medical attention.² If your symptoms interfere with your well-being, or if you’re concerned about anything, speak to your doctor. Treatment is available. Doctors may recommend hormone therapy, medication, or suggest lifestyle changes so that you can enjoy this beautiful transition and thrive.

Perimenopause