From birth till death, everything in life has a start and an end. The same rule applies when it comes to women’s reproductive age as well. Puberty is the start, and menopause or climacteric is the end here. They are well known amongst the population. The term perimenopause means ‘around menopause’ – this is related to the events taking place related to menopause. In simple terms, the female reproductive system prepares to cease its reproductive functions. This article explains perimenopause and help you track this transition with a perimenopause tracker.
Menstruation or periods is a basic physiological change that happens for women. Vaginal bleeding occurs as an indication that the reproductive system is mature and ready for pregnancy. You can simply think of it as when she fails to get pregnant, and the reproductive system sheds the lining of the uterine wall called endometrium. Usually, women get periods in regular, predictable intervals. The average time between periods is every 28 days, mostly 25-30 days. However, some women experience cycles that last less than 21 days or more than 35 days. On average, menstrual bleeding usually takes place for 3–8 days. These durations vary between women.
Premenopause means ‘before the menopause’. It starts with puberty – when a woman enters her reproductive years. And it ends with the signs of menopause. The first menstrual cycle defines the beginning of premenopause. The reason behind this cycle is to prepare your body for pregnancy. The hormones are the controller of the menstrual cycle.
The human endocrine system is comprised of various glands. Hormones are a kind of chemical messengers in the human body. The respective gland of each hormone secretes the hormone directly into the blood. The blood carries them to the respective organs or tissues, and in turn, they respond to the signal. Hypothalamus produces hormones that are regulatory to other endocrine glands in the system. The amount of these regulating hormones stays unchanged, but the endocrine organs and tissues’ response may change with age.
Reproductive organs are dependent on hormones. Reproductive hormones of the female are estrogen and progesterone.
Estrogen is the primary sex hormone. The ovary secretes estrogen. It influences the reproductive menstrual cycle. Even though we call estrogen, there are three types. Their predominance varies during the menstrual cycle, pregnancy and menopause. Estradiol is the standard type in women of childbearing age. Estriol is common during pregnancy. Estrone is the estrogen type that occurs after menopause.
Estrogen is responsible for females’ secondary sexual characteristics, such as breasts, wider hips, pubic hair, and armpit hair. In the uterus, estrogen controls the growth of the uterine lining called the endometrium. If the egg is not fertilized, estrogen levels drop abruptly, leading to the endometrium’s shedding. Subsequently, menstruation occurs. If the egg is fertilized, estrogen joins hands with another sex hormone, progesterone. The duo maintains the pregnancy and stops ovulation during pregnancy.
On the other hand, estrogen influences bone formations. Along with other hormones, vitamin D and calcium, estrogen plays a role in rebuilding bones according to the body’s requirements.
Moreover, estrogen influences skin, hair, mucus membranes, blood clotting etc. Also, it maintains the vaginal wall and urethral lining and plays a role in vaginal lubrication.
Progesterone is the other primary sex hormone, regulating menstruation and supporting the pregnancy. A part of the ovary, adrenal glands and placenta produce progesterone.
When the egg is fertilized, progesterone prepares the uterus to hold the pregnancy. It stimulated the development of glandular tissue and new blood vessels in the uterus. If the egg is not fertilized, the endometrium sheds down, and menstruation begins.
Natural menopause is the cessation of the menstrual cycle as a part of a woman’s ageing process. It symbols the end of her reproductive days. The age of menopause differs for every woman. The typical age to start experiencing signs is above 45 years. Studies reveal the median age for natural menopause is 51-52 years (R). While natural menopause occurs between 45 and 55 in the ageing process, menopause can also result from surgical intervention, radiotherapy or chemotherapy. For example, surgical removal of both ovaries, or treatment for cancer can cause iatrogenic menopause. Natural menopause can be explained in three stages – perimenopause, menopause and post-menopause.
Regardless of the cause, if menopause occurs before the age of 45, it is called early menopause. If menopause occurs at 40 years of age or younger, it is considered ‘premature menopause’
Stage 1. Perimenopause
This is the period when a woman experiences symptoms of fluctuating hormone levels. It lasts until menopause begins. When women approach menopause, they go through this transitional phase from regular menstruation to irregular menstruation to no menstruation. Hence perimenopause has another name, menopausal transition. Climacteric is another word used synonymously for perimenopause. The symptoms experienced are similar to menopause.
Stage 2. Menopause
This is the point when a woman no longer has menstrual periods. At this stage, the ovaries have entirely stopped ovulating and producing most of their estrogen. Menopause is diagnosed by the absence of a menstrual period for 12 straight months. This marks that a woman has reached menopause, and the perimenopause period is over (R).
Stage 3. Postmenopause
Postmenopause is the stage after a woman has not menstruated for an entire year. During post menopause, the menopausal symptoms may start to fade for many women. However, for some women, menopausal symptoms persist for a decade or so even after the menopause transition.
The lower level of estrogen increases the risk for postmenopausal women of some health conditions. For example, osteoporosis and heart disease are common conditions. There is no treatment that fits for all women when it comes to menopause. Medication, such as hormone replacement therapy and adopting healthy lifestyle changes may reduce the risk of some of these conditions. Since every woman shows a different risk level, your physician would advise the best appropriate steps you can take to optimize your risk.
What happens in perimenopause?
Perimenopause happens in stages. There are two stages, namely early perimenopause and late perimenopause. The primary condition that marks entry into the early perimenopause includes the onset of irregular or ‘variable length’ menstrual cycles with at least 7-day variance in cycle span between next cycles or a cycle length less than 25 days or more than 35 days. Once the cycle length is more than 60 days, it indicates the late perimenopause stage’s commencement.
Perimenopause can begin a few years ahead of menopause. It usually starts in the 40s but can start earlier as well. During this period, the ovaries tend to reduce the production of estrogen gradually. The drop in estrogen is rapid during the last one to two years of perimenopause. During this stage, menopause symptoms persist. Women will still have menstrual cycles during perimenopause and can get pregnant. Perimenopause continues up until menopause, the time when the ovaries stop releasing eggs.
How long is the transition?
The menopause transition lasts between two to eight years, giving an average length of about four years. The stretch of each stage of the climacterics varies for each individual.
Some women stay in this stage for a few months, while others go through this transition phase for years. If you have no period for more than 12 months, you are not perimenopausal anymore. However, medications or medical conditions that affect periods can be more challenging to know the specific stage of the menopause transition. Although only menstruation was highlighted more, perimenopause includes various other physical signs.
Hormonal changes in perimenopause
You are aware of the hormones – estrogen and progesterone and their influences on normal menstruation. During the menopause transition, the level of the primary female hormone, estrogen, starts to fluctuate. The uneven changes alter your menstrual cycles. Consequently, your menstrual cycles may be lengthened or shortened. At times you may even have menstrual cycles during which your ovaries skip releasing an egg. In medical terms, this is called an anovulatory cycle.
You may encounter symptoms similar to menopause, for example, hot flashes, sleep disturbances, vaginal dryness etc.
Physical symptoms in perimenopause
The transition is a natural process and symptoms will be similar to those of menopause. Using the perimenopause tracker will be helpful in identifying your symptoms and follow them.
Most women, roughly 85%, will experience hot flashes at any stage while going through menopause. Hot flashes are described as an unexpected sensation of hotness coming from nowhere and spread throughout the body. Sweating, palpitations and facial flushing may also be associated with hot flashes. Hot flashes can affect some women very occasionally, so they do not really worry. On the other hand, some might find them uncomfortable, embarrassing and disruptive. Subsequently, they affect their moods. In that case, talk to your physician.
- reduce, if possible, stop coffee and tea
- reduce alcohol
- sip cold or iced drinks
- stop smoking
- keep your room cool
- use cool water spray or use a cold face pack your face
- wear appropriate layers of light clothes made of cotton or silk
- avoid the hot shower
- if you are on medications to cause hot flushes, discuss with your physician
The moodiness varies from just low mood to depression. Women with low moods may feel sad, anxious, angry, frustrated, tired than usual, and lack self-confidence. This low mood is usually associated with headaches and poor sleep, as well. This low mood can improve with time, maybe after a few days or a couple of weeks. However, if the low mood lasts more than two weeks, it may be a sign of depression. Women with depression would feel hopeless, not enjoying anything out of life, fail to concentrate on daily activities. Moreover, they may have the tendency to have thoughts to cause self-harm or to commit suicide.
- talk about your moods to a family member, friend, health professional or counsellor
- try to adopt simple lifestyle changes to help you feel more in control and able to cope
- explore ways to nurture your self-esteem
- seek peer support, to use their experiences to help each other
- try mindfulness and focus on the present moment
- download and use the CareClinic app and use it to track your mood
- find out more on features on depression and mood tracking in the CareClinic blog article
- overwhelm yourself by attempting to do everything at once
- complicate your targets so that you can easily achieve them
- focus on the unchangeable things
- tell yourself that you’re alone
- try to use alcohol, cigarettes, gambling or drugs to relieve a low mood
As mentioned above, sex hormones are essential to maintain the lubrication of the vagina. Due to low hormonal levels during perimenopause, vaginal lubrication is lost. This vaginal dryness gives you a feel of soreness or itchiness around your vagina, painful sexual intercourse, frequent urge to urinate and repeated urinary tract infections. This altogether would affect your mood negatively, lower your sex drive and disturbances in sleep.
- use water-based lubricants for sex
- put vaginal moisturizers for vaginal dryness
- use unscented soaps and washes on your vagina
- try to have more foreplay
- use scented soaps and washes on your vagina
- put creams or lotions like petroleum jelly inside your vagina
- use moisturizers not suitable for your vagina
Lower Sex Drive
There is no benchmark for normal sex drive. But low libido means that you might feel the lack of your desire for sex is distressing or harm your relationship. There are several causes for low libido, but in perimenopausal women, the reasons are mostly related to hormonal changes.
A hormonal drop itself would result in lower libido. Low mood and depression would influence the sex drive. Vaginal dryness resulting from hormonal insufficiency results in painful sex, making you lose the desire for sex.
Also, changes in physical appearance, reduced breast tissue, for instance, may lower your self-confidence and subsequently affects your sex life. Pubic musculature loses tone. In turn it affects the vagina, uterus and urinary bladder prolapse. This also has been a reason for trouble in sex.
On average, an adult needs 7 to 9 hours of sleep a day to pursue a healthy lifestyle. This will keep you energetic, refreshed and concentrate on daily activities. Your mood changes influence your sleep.
- go to sleep and wake up at a fixed time every day
- relax at least an hour before bed – for example, read a book
- make sure your bedroom is favorable for sleep – adequately dark and quiet – i.e. use thick curtains or blinds, an eye mask or earplugs, comfortable mattress, pillows and covers
- regularly exercise
- drink alcohol, coffee or tea minimum 6 hours before bed
- have a big meal late at night
- exercise a minimum of 4 hours before bed
- use mobile devices or watch television right before going to bed
- sleep during the day
Increased Risk of Bone Loss (Osteoporosis)
Estrogen is an important hormone that plays a role in actively maintain bone density in women. With menopause, the lower estrogen level raises the risk of developing osteoporosis. Osteoporosis is a disease of bones where the bones become porous and fragile.
Hormone Replacement Therapy (HRT)
In addition to specific treatments for specific conditions mentioned above, the mainstay treatment related to menopause or climacterics is Hormone Replacement Therapy.
Hormone replacement therapy with estrogen or progesterone, or a combination, would relieve perimenopause symptoms. Hormone replacement therapy has its risks, and it is not indicated for every woman. Your physician would discuss the risks and benefits of hormone replacement therapy with you. For example, if you have had a specific type of cancer sensitive to hormones, your physician will not recommend HRT and offer alternatives. You can follow the effects of the therapy by using the perimenopause tracker.
Cognitive Behavioral Therapy (CBT)
Cognitive-behavioral therapy is a combination of behavioral and cognitive therapy. CBT can help with low mood and anxiety. The treatment goal is to recognize the link between someone’s thoughts and beliefs and their influences in the actions and moods, focus on their problems, and work around a solution. Consequently, the long-term goal of CBT is to make your thinking and behavioral patterns healthier. You can follow the effects of the therapy by using the perimenopause tracker.
Most importantly, behavioral changes to do regular exercise, eat healthy foods and involve in activities with friends and family to overcome these symptoms.
CareClinic App as a Perimenopause Tracker
CareClinic is a one-stop health app, provides several useful features to help you maintain a health record. Create a Self-Care Action Plan and add medications, supplements, diet, physical activities, and therapies you receive. Set your healthcare team who manages your health and add your physician, RN and family members.
The diary entry feature lets you make entries about your daily life. Use the diary entry feature of the app as a part of the perimenopause tracker to track your day-to-day symptoms you experience. It is useful to have an overall idea of how pain intervenes in your activities of daily life.
The symptom tracker functions as a part of the perimenopause tracker and lets you add symptoms you are experiencing. You can track the symptoms to understand the worsening of your symptoms or the progress of your treatment. If you start tracking your symptoms before seeking medical attention, you can compare how well the therapy relieves you from symptoms after visiting the doctor’s office with the perimenopause tracker.
Medication & Supplements
Never miss a pill anymore with the medication reminder. Add your medications to the medication and supplements tracker and set a reminder. The pill reminder helps you track your medications and doctor’s appointments.
CareClinic offers the nutrition tracker, which helps you maintain your diet log. In specific cases with a specific diet to improve your food habit, you can follow your diet accordingly to lead a healthy life.
Use this feature to track any physical activity. Your activity tracker helps you identify any activities that worsen or relieves your symptoms.
Keep a record of any therapies you follow to get rid of the symptoms you experience. The therapy feature of CareClinic app is another part of the perimenopause tracker.
Reports are a great feature offered by CareClinic, can provide a lot of perception into your lifestyle change. It considers your logs in diary, nutrition, activities, symptoms etc. and subsequently generates reports that show the association between those entries. As a perimenopause tracker, this association would be helpful for treatment.
In conclusion, you can record the symptoms in the perimenopause tracker and follow up your transition with the CareClinic app itself.