What You Need to Know About Perimenopause, and Menopause
Your guide to understanding the changes in your health and fertility
Premature Ovarian Insufficiency
What is premature ovarian insufficiency?
As nature takes it course, many women begin experiencing reduced fertility at around the age of 40. This is noticed by them as irregular periods, meaning that the ovary doesn’t release an egg every month as it should. The average age for complete cessation of ovarian activity and, therefore, a woman’s periods, is 51. However, when this happens before the age of 40, the woman is said to have premature ovarian insufficiency (POI), previously known as premature ovarian failure.
So, what’s actually going on?
The ovaries are a pair of small, oval-shaped glands in the lower part of a woman’s stomach (abdomen). Roughly once a month, one of the ovaries releases an egg. The ovaries also make the hormones estrogen and progesterone, which play vital roles in pregnancy, the menstrual cycle, and breast growth.
When a woman has POI, she typically has fewer eggs, or her ovaries may not mature or release eggs correctly. This means her ovaries don’t make the usual amount of hormones, leading to the symptoms of POI.
What are the symptoms of POI?
Most women with POI experience normal puberty and have regular menstrual periods before symptoms begin to show.
Symptoms to look out for include:
- Irregular periods
- Periods that stop completely
- Decreased sex drive
- Hot flashes and night sweats
- Difficulty getting pregnant
- Irritability
- Painful sex due to vaginal dryness
However, it’s worth noting that some women may have regular periods without any symptoms of POI, while others might have symptoms that come and go.
If these symptoms sound familiar, it’s because these are many of the same symptoms of normal menopause.
Although the same hormones are at play, POI is not the same as menopause. Menopause typically happens at around age 51. In the transition period before menopause, the ovaries make smaller and smaller amounts of hormones. This is called perimenopause – but more on that in a bit.
By the time a woman reaches her menopause, there are no more eggs left in the ovary to be released every month (we’ll also get more into that in a bit). But women with POI may have irregular or even normal menstrual cycles and may also still have eggs in their ovaries.
POI isn’t uncommon – it can happen to 1 out of 100 women younger than age 40. It’s more common for women in their 30s than for those in their teens and 20s. And, it can affect women who have had children as well as those who haven’t.
When should you see a doctor?
See your gynecologist if:
- Your menstrual cycle has been irregular for a few months
- If you are concerned about you future fertility
- If you have other symptoms of POI
- If you’re looking for preventive guidance and care
Did you know…
There are now tests to predict if you are heading towards POI, giving us time to help you to plan your pregnancy or preserve your fertility.
If you have any questions or concerns, set up a meeting with an experienced Obstetrician and Gynecologist (OBGYN) who’d be happy to address them and assist.
Perimenopause
What is perimenopause?
You’ve probably heard of menopause, but the journey of your periods coming to an end is much too intricate and complex to be concluded by just one marker. Menstrual cycles aren’t a light switch that one day gets turned off – the whole process is more of a gradual transition.
Perimenopause, which literally translates to “around menopause”, is also known as menopausal transition, and refers to the time during which your body makes the natural transition to menopause, marking the end of a woman’s reproductive years.
At what age does perimenopause occur?
While perimenopause may start when a woman is in her 30s, it usually begins between the ages of 40 and 44. It is marked by changes in menstrual flow and in the length of the cycle, along with other physical and emotional symptoms, typically lasting between 2 to 10 years.
During this time, a woman’s body:
- Releases eggs less regularly
- Produces less estrogen and other hormones
- Becomes less fertile
- Has shorter and more irregular menstrual cycles
What are the symptoms of perimenopause?
The symptoms of perimenopause are brought on by changing hormone levels in your body. When estrogen is higher, you might feel symptoms similar to PMS (premenstrual syndrome). And when estrogen is low, you typically experience hot flashes or night sweats. These hormone shifts might happen alongside your regular menstrual cycles.
Although no two women experience perimenopause in the same way, here are the most common symptoms:
- Mood changes
- Changes in sexual desire
- Difficulty concentrating
- Headaches
- Night sweats
- Hot flashes
- Vaginal dryness
- Trouble with sleep
- Joint and muscle pain
- Heavy sweating
- Frequent urination
- PMS-like symptoms
It’s worth noting that the symptoms of perimenopause may look like those of other conditions. So, it’s important to consult with your doctor to get the right diagnosis and care.
Does perimenopause require treatment?
Typically, no. Since it’s a natural and transitional period, perimenopause does not need to be treated unless the symptoms are affecting your quality of life.
If they are, and depending on your unique situation, your doctor may suggest hormonal or non-hormonal therapy to help you cope with your symptoms.
Tips to help prevent and manage perimenopausal symptoms
Although you can’t stop perimenopause from occurring, there are things you can do to help yourself manage the symptoms. Some of which include:
- Eat a healthy diet with fruits, vegetables, and whole grains
- Get at least 1,000-1,200 mg of calcium each day through your diet (or supplements – if necessary)
- Exercise regularly
- Find out and avoid the things that trigger your hot flashes (for example, alcohol, coffee or tea) by keeping a record
These are general recommendations. For the most effective personalized advice, consult with a specialist doctor who can provide you with tailored guidance and preventive treatment measures best suited for you.
Menopause
What is menopause?
Characterized largely by the absence of menstrual periods for at least 12 months, menopause is a natural and inevitable part of aging that marks the end of a woman’s reproductive years.
On average, menopause occurs at age 51.
As with perimenopause, the menopause process is all about hormones. The body begins to produce less estrogen, and the ovaries gradually deplete their egg supply. But this doesn’t happen all at once.
The 3 stages of menopause:
- Perimenopause: As explored earlier, this is the transitional period leading to menopause, and it can last for years — sometimes even a decade.
- Menopause: A woman can say she’s entered menopause when she hasn’t had a menstrual period for one full year. At this stage, your ovaries have stopped producing most of their estrogen and no longer release eggs.
- Postmenopause: Here, menopausal symptoms start to slow down and might even disappear altogether (though random hot flashes may still occur). Although symptoms – we’ll discuss that next – will eventually go away, at this stage, you’re now at an increased risk for conditions like osteoporosis and heart disease.
What are the signs and symptoms of menopause?
Every woman experiences menopause differently, but there are some common symptoms to look out for, such as:
- Hot flashes
- Night sweats
- Vaginal dryness that causes discomfort during sex
- Frequent urination
- Difficulty sleeping
- Emotional changes such as irritability, mood swings or mild depression
- Dry skin, dry eyes, or dry mouth
- Breast tenderness
Some women might also experience:
- Racing heart
- Headaches
- Joint and muscle pain
- Changes in sex drive
- Difficulty concentrating or memory lapses (often temporary)
- Weight gain
- Hair loss or thinning
How long do the symptoms of menopause last?
It depends, but you can have symptoms of menopause for up to 10 years. However, most women experience menopausal symptoms for less than five years.
Can menopause be treated?
As we know, menopause is a natural process that every woman will endure. In most cases, you do not need treatment. However, if you do have bothersome symptoms, you can explore treatment options for menopause with your doctor, which will focus on treating the symptoms that are affecting your quality of life.
There are many different types of treatments for the symptoms of menopause. The main types of treatment for menopause are:
- Hormone therapy, such as estrogen therapy and estrogen progesterone/progestin hormone therapy
- Nonhormonal treatments, such as supplements, herbs, or anti depressants
It’s important to speak with your doctor while you’re going through menopause to design a treatment plan that works for you since every woman is different and has unique needs.
In a nutshell
Understanding the changes in your health and fertility during premature ovarian insufficiency, perimenopause, and menopause is crucial. Each phase presents unique challenges, but with awareness and proactive preventive management, you can navigate these transitions comfortably. By staying informed and seeking guidance, support, and appropriate care from a women’s health expert, you can embrace this journey confidently.