Column: Dr Nour On Perimenopause & More
[Column written by Dr Nawal Nour]
As many women move through their 30s, 40s and 50s, perimenopause is a common – and often confusing – phase of life that can bring changes in periods, mood, sleep and more, yet it’s a topic we don’t always talk about openly. As an OBGYN, here are some of the questions we get asked most often.
What is perimenopause?
Perimenopause is the natural period of transition leading up to menopause, when the ovaries gradually produce less oestrogen and progesterone. This phase can take several years – even up to eight to ten – before menstrual periods stop completely.
During the perimenopause phase, hormone levels can fluctuate significantly from month to month, which can lead to physical and emotional changes. For some people the transition is subtle, but for others, symptoms are more noticeable and even disruptive.
What are the symptoms of perimenopause?
These can vary wildly from patient to patient, which can be frustrating and can result in patients not understanding that they are in fact perimenopausal. Some symptoms include:
- Changes in periods [they can get shorter, longer, heavier, lighter or even just be skipped over altogether]
- Hot flashes and night sweats
- Trouble sleeping well
- Irritability, anxiety or feeling low
- Brain fog
- Breast tenderness
- Changes in weight
- Decreased libido
- Vaginal dryness or discomfort
There are many, many more symptoms that have been reported – so these should not be considered prescriptive.
How are symptoms of perimenopause different from symptoms of menopause?
Many symptoms overlap, but it’s the pattern that is different: In perimenopause, symptoms tend to be variable and unpredictable, reflecting hormone swings and periods are still occurring, even if not regularly.
In menopause, symptoms are due to consistently low oestrogen levels which means that periods have stopped completely and many symptoms, such as hot flashes or vaginal dryness may become more consistent – sometimes improving over time, sometimes persisting without treatment.
Who is affected?
Anyone who menstruates and has ovaries will eventually experience perimenopause if they live long enough. Most people begin perimenopause in their 40s, though it can start earlier or later. Genetics, smoking, medical conditions and certain treatments [such as chemotherapy or ovarian surgery] can influence timing and severity.
What about younger people who experience perimenopause symptoms?
It’s not uncommon for people in their 30s or even late 20s to notice symptoms that resemble perimenopause. In these cases, several possibilities may be considered:
- Early perimenopause
- Thyroid disease or other hormonal conditions
- High stress, sleep deprivation, or significant life changes
- Side effects of medications or contraception
If you’re concerned about your symptoms, you should consult your GP or OBGYN.
How can perimenopause be managed?
Perimenopause is a normal life stage, not an illness. But some of its symptoms may be better managed to improve quality of life or overall health, such as:
- Lifestyle changes: regularly exercising activity, improving sleep habits or diet, limiting alcohol and managing stress
- Non-hormonal treatments: certain medications can help with hot flashes, mood symptoms, or sleep
- Hormone therapy: low-dose oestrogen [with progesterone when needed] can be very effective in managing hot flashes, night sweats and vaginal symptoms in certain patients
- Local vaginal therapies such as creams or tablets can help to treat dryness and discomfort
Some people may choose no treatment at all while others benefit greatly from medical support – there is no ‘one size fits all’ approach.
When should you consult an OB-GYN?
You should consider seeing an OB-GYN if you have:
- Unexpected changes to menstrual periods or bleeding after sex
- Hot flashes, sleep problems or mood changes affecting daily life
- Vaginal dryness, pain with intercourse or urinary symptoms
- Symptoms at a younger age that raise concern
- Questions about hormone therapy, contraception, fertility or long-term health risks such as bone or heart health
Even when symptoms are mild, perimenopause can be an important time to review preventive care and plan for healthy ageing.
- Dr Nawal Nour, Chair of Obstetrics and Gynecology, Mass General Brigham
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