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The Perimenopause Transition
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What You Need To Know

Around age 40, women’s bodies begin perimenopause, the transition leading to menopause (the point in time when you stop menstruating permanently). The hallmark of this transition is a change in the levels of the hormones estrogen, progesterone, and the androgens. Yet this is not solely a physical event—it is also the biggest opportunity for personal growth and empowerment since adolescence. Approximately 40 million American women are going through the menopause process today, so if you are one of them, you are in very good company. Here’s a summary of what you need to know about this transition to help make it as smooth as possible.

There are three types of menopause. About 25 percent of women experience artificial menopause (menopause resulting from surgical removal of the ovaries, surgical disruption of the blood supply to the ovaries, radiation, chemotherapy, or taking certain drugs). For these women, menopausal symptoms can be severe and debilitating because there is no opportunity for gradual adjustment to the hormonal drop-off. Hormone treatments are often prescribed to help lessen these severe symptoms. The second type of menopause is premature menopause, which is diagnosed when a woman goes through menopause in her 30s or early 40s. It’s usually secondary to autoimmune disease, nutritional deficiency, or some form of chronic stress (including excessive athletic conditioning) that has adversely affected hormone-related reproductive functions. Premature menopause occurs not only earlier but also faster than normal menopause, often necessitating supplemental hormones to maintain physical comfort during the transition.

Most women go through the third type of menopause—natural menopause, which occurs gradually, usually between ages 45 and 55, in a woman who has at least one of her ovaries. Many women begin noticing changes in their menstrual cycle and/or mood years before they actually have their final period. This transitional perimenopause period usually lasts five to ten years, though the entire process can sometimes take up to 13 years. There’s normally a gradual crescendo in the beginning, a peak as one approaches mid-transition, and a gradual decrescendo towards the end, as the body learns to live in harmony with its new hormonal and emotional milieu. During perimenopause, periods may stop for several months and then return, and they may also increase or decrease in duration, intensity, and flow. Whether you need hormone replacement or alternatives for symptom relief during this time depends on what else is going on in your body and your life.

It is virtually impossible to tell when you’re finished with the menopausal transition until it has been a year since your last menstrual period. In other words, menopause itself can only be diagnosed a full 12 months after the transition is finished. Nevertheless, because hormone levels both in the brain and the body undergo progressive changes during perimenopause, salivary hormone levels, urine levels, or blood levels can be measured to give you an idea of where you stand. Hormone levels can also help you monitor your need for hormone replacement or your dose.

In order to have the best transition possible, it is important to be optimally healthy going in. That means understanding what is happening in your body, and supporting it so that you continue to produce adequate amounts of hormones for the rest of your life.

Typical Perimenopausal Symptoms:

Many women sail through “the change” without any symptoms at all. Others experience a wide range of symptoms, all of which have physical, emotional, and psychological aspects. During the years before menopause levels of progesterone typically decline, while estrogen levels remain stable or even increase. This is the most significant issue for the majority of women; many of the early symptoms that women feel are due to progesterone levels that are too low, in relation to their levels of estrogen. This state of a low progesterone-to-estrogen ratio is also referred to as “estrogen dominance.” Some of the symptoms that women suffer when progesterone declines include:

  • Breast swelling and tenderness
  • Mood swings
  • “Fuzzy thinking”
  • Irritability
  • Trouble sleeping
  • Water retention
  • PMS
  • Weight gain

Testosterone levels may also start to decline well before the last menstrual cycle. While the symptoms of low testosterone are often more subtle that those of low progesterone, for some women they can be significant. Symptoms of low testosterone include:

  • Loss of sex drive
  • Decreased sexual response
  • Decreased sensitivity in your erogenous zones
  • Decreased sense of well-being, energy, and ambition
  • Depression
  • Loss of or thinning pubic hair

Estrogen is often the last hormone to decline, but is the hormone that is traditionally associated with menopausal symptoms. As you approach menopause your ovaries slow their production of estrogen. While your ovaries continue to make some estrogen for the rest of your life and your body is still producing it from other sources, the overall effect is a dramatic drop in the level of estrogen circulating in your body—about 30–60 percent for most women. Symptoms of estrogen decline include:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Decreased energy and ambition
  • Depression or mood swings
  • Dizziness
  • Headaches
  • Mental confusion
  • Urinary incontinence
  • Recurrent urinary tract infections
  • Increased susceptibility to vaginal infections

The Wisdom of Menopause

Although women have been taught to dread menopause, this life stage ushers in the springtime of the second half of life and is often accompanied by surges in creativity, vitality, newfound ambition, and the need to be of meaningful service to the community in a larger way. During perimenopause and beyond, our goals and behavior become more motivated by the demands of our souls, not just those of society. We quite naturally seek answers from deep within instead of looking for approval from the outside.

The menopausal transition is actually a profound developmental stage in which unfinished business from the past comes up once again for resolution and healing, so that we can free ourselves from the outmoded beliefs and behaviors of our past. All the issues that weren’t resolved during puberty and early adulthood—such as body image, relationships, vocation, fear of aging, and self-esteem issues—now arise once more to be healed and completed.

While menopause itself is a normal life stage that does not cause health problems, the menopausal transition is marked by a statistically increased risk for breast cancer, osteoporosis, heart disease, arthritis, depression, and memory loss—all of which can be prevented if a woman heeds the wisdom of menopause and opens to her increased intuitive capacities. There are also a wide variety of options available for addressing and relieving the most common symptoms that arise during the menopausal transition.

Learn More | Recommended Reading or Resources
For a full discussion of the three different types of menopause and effective approaches for possible symptoms, see Chapters 4, 5, and 6 in The Wisdom of Menopause by Christiane Northrup, M.D.
Last updated: August 21, 2009