Perimenopause: What Changes on the Road to Menopause?

For a while now, your periods have not been the same, you wake up sweating at night or your mood goes up and down for no reason. These may be signs of perimenopause, the transition to menopause. The World Health Organization (WHO) describes menopause as a natural part of biological aging. Knowing what is going on can help you get through this time more easily.

What do perimenopause and menopause mean? According to WHO, menopause is defined as 12 months in a row without a period, with no other obvious cause. Perimenopause is the time from when the first signs of the transition appear until 1 year after the last period, and it can last several years. Most women reach menopause between ages 45 and 55. WHO notes that in some women, menopause can come very early, before age 40.

The first sign is often a change in your periods. According to the NHS, periods may come more or less often, and bleeding may become heavier or lighter. Keeping up with period tracking makes it easier to notice these changes and give your doctor clear information.

Hot flashes and night sweats: WHO describes a hot flash as a sudden feeling of heat in the face, neck and chest, often with flushed skin and sweating, that can last a few minutes. The NHS recommends:

• Wear thin, light clothing and keep your bedroom cool.
• Take cool showers and try to reduce stress.
• Notice and cut back on triggers such as spicy food and caffeine.
• Exercise regularly and try to maintain a healthy weight.

Sleep, mood and mind: According to the NHS, trouble falling or staying asleep, mood swings, low mood or depression, forgetfulness and "brain fog" are among the common symptoms. WHO also lists anxiety among these symptoms. A regular sleep routine, exercise, relaxing activities such as yoga or meditation and talking with women going through the same thing can help.

Other changes: The NHS also lists weight gain, vaginal dryness, urinary tract infections, heart palpitations, headaches, muscle aches and reduced sex drive among possible symptoms. According to the NHS, symptoms usually last 7-9 years, sometimes longer, and can change over time. WHO stresses that the loss of bone density that comes with menopause is an important factor in osteoporosis and fractures. That is why the NHS recommends calcium-rich foods, sunlight and weight-bearing, strength-building exercise. Smoking can make symptoms worse.

Pregnancy is still possible in perimenopause. According to the NHS, it is possible to get pregnant during perimenopause, and you need to keep using birth control for:

• 1 year after your last period if you are 50 or older
• 2 years after your last period if you are between 40 and 49

You can talk with your doctor about which method is right for you.

Hormone replacement therapy (HRT) and other options: According to the NHS, the main ingredient in HRT is estrogen, and it can be used as a tablet, patch, spray or gel. Women who have a uterus also need to take a progestogen along with estrogen to protect the uterus. Cognitive behavioral therapy (CBT) may be recommended for hot flashes and night sweats, and if it does not work, the doctor may consider non-hormonal medicines. The NHS notes that there is very little evidence about how well herbal products sold for menopause work and how safe they are. WHO recommends deciding on the right option for you together with your doctor, based on your health history, values and preferences.

Bleeding after menopause should always be checked. According to the NHS, any vaginal bleeding that happens after more than 12 months without a period should be checked. This applies even if it happens only once, is a very small amount or is spotting or pink or brown discharge.

When to see a doctor? Contact your doctor if:

• Your symptoms are affecting your life and you want to talk about your options
• You still have periods and your bleeding is getting heavier instead of lighter
• You have symptoms such as heart palpitations
• You have any bleeding 12 months after your last period
• Your periods stopped or menopause symptoms started before age 40

If you have very heavy bleeding along with dizziness, feeling faint or shortness of breath, call your local emergency number.

Dear woman, perimenopause is not an ending; it is your body moving into a new stage. If the changes are hard on you, you do not have to carry them in silence. Listen to yourself and ask for the support you need.