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What to Know About Perimenopause—the Menopause Transition

By Monica Agar, MD, Obstetrician and Gynecologist—Virtua OB/GYN

For many women, the transition to menopause often begins in their early 40s. Called "perimenopause," or the "menopause transition," this life stage is defined by physical, emotional, and psychological changes. You'll know you've reached menopause when you haven't had a menstrual period for 12 consecutive months.

In the years leading up to it, you may start to experience many of the symptoms women associate with menopause. As your body's hormone levels decrease, you may notice these changes:

  • Menstrual periods that are heavier or lighter, or shorter or longer than you're used to
  • One or more missed menstrual periods followed by a regular period
  • Hot flashes, irritability, decreased sex drive, difficulty concentrating, and problems sleeping

Think about when you hit puberty and got your first period—it didn't happen all at once. Signs that you were changing and growing up happened gradually over time.

It's the same with perimenopause. You may start to see some of these changes in your early 40s or a little later. Each woman is unique in how she feels and the symptoms or timing of the changes she experiences. For some women, these changes are no big deal. For others, they may need some help through this transition. 

Here are some of the changes you may experience—and what you can do about them.

Menstrual cycle changes

It's important to know what constitutes a normal menstrual cycle and when the changes you're experiencing require medical attention. Perimenopause is a normal life stage. However, bleeding that occurs more frequently than what's normal for you, bleeding between periods, or prolonged bleeding should be evaluated by your OB/GYN. Your doctor will talk with you about options for managing menstrual irregularities.

Classic menopause symptoms

Many women experience hot flashes, night sweats, mood changes as they go through the menopause transition. These symptoms can come and go in waves or pop up when your stress level is high or when you gain weight. Making changes to your diet or reducing stress can help you deal with these nuisance symptoms.

Additionally, there are both prescription and over-the-counter medications you can use to help control these symptoms. Talk to your gynecologist to see what options are best for you.

Mood changes

You're inching closer to middle age and are wiser for it, but sometimes you may wonder where the years have gone. While this turning point can be a cause for celebration, it also can lead to anxiety and depression for some women.

Talk to your GYN or primary care provider if negative feelings about this life stage become overwhelming. You might find that simply establishing a healthy diet and exercise program—and sticking to it—will lift your spirits. If not, there are effective treatments for depression and anxiety, including medication, behavioral therapy, and stress-reducing activities like yoga and meditation.

Metabolism and weight changes

Your metabolism continues to slow during the transition to menopause, and your weight gradually shifts from your hips and thighs to your abdomen, shoulders, and chest. If you don't have a regular aerobic exercise and strength-training program, it's never too late to start.

Talk with your provider about putting together a plan that considers your age, health status, daily schedule, and goals. You'll improve your health, have more energy, and feel your best if you maintain a healthy weight and keep your muscles well toned.

It's also important to pay attention to what you're putting into your body. Be sure to eat lots of fresh fruits and vegetables and cut down on processed foods like chips, crackers, and sweets to help keep you healthy and fit. If you drink alcohol, limit consumption to no more than one drink per day, and if you smoke, get help quitting.

Loss of bone strength

Exercise and strength training will help your bones, too. Your body produces less estrogen as you near menopause, leaving you at increased risk for bone loss and the bone-thinning disease osteoporosis. In addition to exercising, make sure you're getting enough calcium in your daily diet. Your provider can advise you if you need supplements or medications to help you meet your calcium needs.

Increased risk for other medical conditions

As you go through your 40s, your risk for specific diseases increases. These diseases include osteoporosis, heart disease, high blood pressure, and diabetes. Some health conditions occur more often in families, and you may be nearing the age at which a parent developed an illness or disorder. That doesn't mean that you'll develop the same problem. Still, it's more important than ever to have regular medical checkups, vaccinations, bloodwork, and screening tests, including an annual pelvic exam and mammogram.

Don't forget to keep your family medical history up to date. Your provider should have a copy, and you should keep one in a safe place or an electronic medical record. This important document should include your personal medical history, illnesses of relatives, and the age at which family members were diagnosed with medical problems.

If you don't have one, check out the "My Family Health Portrait," created by the U.S. Surgeon General's office in the U.S. Department of Health and Human Services. It will help you organize your family tree

It's always a good idea to ask your health care provider about any physical or emotional changes you may be experiencing. Some are typical of this life stage, while others may need evaluation with your doctor.

Find a Virtua OB/GYN near you and schedule an appointment online today or call a Virtua women's health navigator at 844-896-6367

Updated January 14, 2022

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