What is Perimenopause?
When does it occur and what are the symptoms and treatment methods?
1. What is perimenopause?
It is the period in a woman's life, which is about 3-5 years before menopause.
It is the period when the ovaries start to make less oestrogen .In the last one or two years of perimenopause, the oestrogen level starts declining rapidly.
2. At which Age group does perimenopause occur?
It usually starts in the mid 40's and lasts up to menopause, but in some women, it may start in their late 30's itself. The average length of perimenopause is 4 years. Perimenopause ends when a woman has gone 12 months without having her period. The mean age for menopause is 51.2 years. The age at which menopause is attained is usually genetic and it follows the mother's pattern.
3. How is it diagnosed?
By typical clinical history as mentioned above, blood work involving hormonal analysis like Follicle Stimulating Hormone, Anti- Mullerian hormone, Inhibin B, and Estradiol represent the four primary hormones of investigation in which there is an increase in FSH decrease in AMH, Inhibin B and Estradiol. Transvaginal ultrasound is also done.
4. Is pregnancy possible during perimenopause?
Yes, it is possible hence a suitable form of birth control should be used.
5. What are the signs of perimenopause?
- Mood swings
- Hot flashes
- Breast tenderness
- Worsening of pre menstrual symptoms
- Irregular periods
- Vaginal dryness
- Loss of libido
- Weight gain
The most common being irregular periods each cycle will last for 5 to 7 days with normal or excessive flow with months of no bleeding in between the Menstrual cycles.
6. How can perimenopause be managed?
Treatments include lifestyle modifications and medications, exercise, to stop smoking, getting more sleep, taking calcium and vitamin supplements.
Mood swings and hot flashes can be managed by select antidepressant medications. And SSRI. They help with irritability, depression, and moodiness. They can be used before and after menopause as a symptom treatment alternative to hormonal replacement therapy. SSRI (Selective serotonin re-uptake inhibitors) like venlafaxine, escitalopram are used.
Treatment for excessive bleeding - Dilatation and curettage along with a hysteroscopy and preferably biopsy to rule out other causes of the irregular cycles are done.
Hormonal tablets and intrauterine devices are used to regulate the menstrual cycle. Intrauterine devices are progesterone only devices which when used can provide relief from symptoms up to five years with minimum side effects like MIRENA. There are newer generations of IUD s available and it can be used be inserted in the outpatient department and does not require anaesthesia.
The last resort would be Hysterectomy without removing the ovaries.
Interview by Dr. Rohini Rohit, MS. OBG