Perimenopause refers to the years before and after the actual last menstrual period. Only following the last menstrual period can menopause be confirmed.
What is perimenopause?
Perimenopause refers to the years before and after the actual last menstrual period. Perimenopause is difficult to diagnose with certainty because it begins before the actual last menstrual period. It is characterized by symptoms that accompany menopause and give the woman clues about what is happening to her. However, menopause itself is not considered to have passed until a full year has passed since the last menstrual period and there has been no bleeding since then. If a subsequent bleeding occurs, menopause is not yet complete – even though this case is rare, it can occur. Perimenopause therefore covers a period of several years before and after menopause. It is followed by postmenopause, during which a woman’s estrogen levels continue to decline, preparing her for senility from around the age of 65. This in turn can be determined. Perimenopause is not to be understood as a disease; it is a natural process in the body of the aging woman. However, its manifestations can take on disease value if they are associated with suffering for the woman or seriously affect her. Such effects of perimenopause can, however, be treated and alleviated by a doctor. Furthermore, a suspected or very probable perimenopause is not considered a safe contraceptive. While it would be unlikely, the woman could still become pregnant during unprotected sex.
Function and purpose
A woman’s menstrual period is – in very simplified terms – the result of estrogen and progestin. These two hormones build up during puberty and settle to a constant level in adulthood, allowing the woman to become pregnant over many years. On the other hand, it takes several years for these hormone levels to decrease again: the perimenopause phase then begins. During this time, the woman’s last remaining eggs begin to pop, but often no longer on a regular basis. Menstrual periods become less frequent and no longer run according to the previous cycle, but with longer intervals in between. Theoretically, the woman can still get pregnant now, but this is unlikely to happen naturally and the pregnancy carries risks for both woman and child. Once the last egg has matured, this is followed by the last menstrual period. Relatively common during perimenopause are intermenstrual bleeding and spotting, although these do not constitute a menstrual period. Perimenopause continues to extend to the years after menopause, i.e. the actual last menstrual period, because hormone levels cannot simply drop rapidly. Rather, this happens slowly and is therefore more gentle. Finally, the drop in estrogen levels also poses risks such as osteoporosis, which the body thus keeps low. However, the processes of perimenopause also ensure that the woman is very unlikely to become pregnant again, as pregnancy at this age is usually too dangerous and can be associated with health risks for the woman as well as hereditary diseases in the child.
Diseases and medical conditions
Perimenopause is not a disease, but menopausal disorders are known in connection with it. The symptoms of perimenopause turn out differently in every woman; while some women notice almost nothing, others suffer greatly from the accompanying symptoms of perimenopause. Common symptoms include hot flashes, bloating, headaches, palpitations, circulatory problems, dizziness and occasional nausea. While these symptoms can be nonspecific, because they often occur together, most women come up with perimenopause as a possible explanation on their own. Furthermore, menstrual periods change, become heavier or lighter than usual, may become painful again, and occur irregularly. The early age of onset of perimenopause in women may be related to an unhealthy lifestyle: Smokers and women addicted to alcohol and drugs occasionally enter perimenopause earlier than women who live healthier lives. However, premature menopause can also be triggered by malfunctioning ovaries or serious diseases such as tumors. Perimenopause before the age of 45 should therefore be examined more closely, as it can also be a sign of another disease.Concomitant symptoms such as hair loss, the onset of osteoporosis or other typical symptoms of perimenopause can be treated with the aid of hormone replacement therapy in order to reduce the women’s potential suffering. However, the preparations used for this purpose increase the risk of developing breast cancer later on or suffering a stroke in old age, which is why the attending physician must weigh up the benefits and risks. Furthermore, very heavy bleeding can occur during perimenopause, especially if it becomes irregular. In some rare cases, surgical scraping of the uterus may then be necessary to remove a very thick uterine lining. Such cases usually occur in perimenopause in association with other hormonal disorders and also improve with hormone replacement therapy.