The Change Before “The Change”; Hot Flashes, Infertility, Happening Earlier Than You’d Expect?
Hot flashes and night sweats! I was kind of prepared for it. I knew that somewhere around my 50’s, I would start getting these symptoms or maybe a few years earlier. I also knew there would be mood swings; I would be more irritable or angry and so on.
But, I had reassured myself again and again that it was going to be just a natural phase of menopause that I couldn’t avoid. However, though most of the things I knew about menopause were correct, there was a small misconception I had and that was about the age!
I was under the impression all these symptoms wouldn’t start when I got closer to 45. So, when I was around 40, I was relaxed thinking I have a few more years to go before I need to face menopause.
But, during that age itself, I started getting those annoying symptoms. I used to feel a sudden surge of heat in my body. I used to get all sweaty even when the weather was pleasant. My moods had become unpredictable.
I started to wonder if it could be due to menopause. But I was still menstruating regularly. So, it didn’t make sense because menopause is actually a phase when the woman stops getting her periods.
So, why was I suffering from all these symptoms? It was very important for me to know that. I also wanted to find out how I could get relief because those hot flashes, mood swings, and sweating had started affecting my life in a huge way.
Since I wanted to get a clear idea of whether these symptoms had anything to do with menopause, I decided the best person to approach for advice was a gynecologist. When I met my gynecologist, she told me I was suffering from a phase called perimenopause. I came to know many facts about perimenopause from her which I want to share with you today.
What is Perimenopause?
“Most women think ‘this can’t happen to me as I am still menstruating,’” said my gynecologist.
However, the symptoms most women brush aside thinking they are not linked to menopause are actually due to a phase that occurs before menopause. And this phase is called perimenopause.
It is the time when the production of estrogen in the ovaries begins to reduce gradually.
Perimenopausal symptoms usually last up until menopause when the ovaries stop producing or releasing eggs. In the initial 1 or 2 years of perimenopause, the decline in estrogen levels speeds up.
“Perimenopause is a transitional time that can occur around the age of 35. Women may begin feeling symptoms like hot flashes, mood swings, and increase sweating”, said Corio, a gynecologist in New York.
However, not all women experience the same set of symptoms due to perimenopause. Some women are able to sail through this phase without much discomfort while others develop severe symptoms that interfere with their routine life significantly.
What are the common symptoms of Perimenopause?
The symptoms of perimenopause are quite similar to those of menopause. The only striking difference is perimenopause occurs before menopause. The symptoms may include:
- Hot flashes
- Reduced fertility
- Irregular periods
- Vaginal dryness
- Mood swings
- Decreased libido
- Heart palpitations
These are the common symptoms of perimenopause. In rare cases, women may develop tenderness in the breasts along with pain or discomfort in the vagina during sex that could be linked to vaginal dryness.
They may also experience involuntary leakage of urine, especially while coughing or sneezing along with urinary urgency or a frequent, urgent need to pass urine.
Difficult in getting sound sleep is also one of the symptoms of perimenopause that can affect the daytime productivity of women and worsen their mood swings and irritability. The loss of sleep can also lead to low energy levels and fatigue.
However, I still didn’t understand what menopause, perimenopause or anything related to women’s reproductive functions could affect my body temperature or sweating. In fact, I always had this question in my mind.
My gynecologist explained to me why I was experiencing these symptoms. She told me hot flashes involve a sudden sensation of a wave of warmth or heat through the body that is usually accompanied by sweating, rapid heartbeat, and redness or flushing of the skin. The hot flashes usually last for about 1 to 5 minutes and are followed by a cold chill.
It is estimated that nearly 75% of women experience hot flashes during perimenopause.
Experts have attributed this sign to the decline in the levels of estrogen that occurs as women move towards the menopausal phase. As estrogen levels decline, the hypothalamus, a part of the brain which regulates body temperature, perceives an increase in body temperature. So, to bring the temperature back to normal, the brain releases hormones that work by increasing the heart rate and inducing dilation of the blood vessels.
This leads to a sudden surge of blood through the face and skin aimed at dissipating the heat across the body tissues. The increased blood flow is what is primarily responsible for the hot flashes most women experience every now and then during the perimenopausal and menopausal period.
Similarly, the natural cooling method triggered by the body to reduce the temperature works by increasing sweating, which explains why I was getting sweaty in spite of the weather being so pleasant.
I also wanted to know more about why women’s ability to conceive reduces with age and whether it was due to perimenopause. The doctor told me the decline in fertility is linked to both aging as well as perimenopause.
The drop in estrogen production during perimenopause inhibits the production and release of eggs from the ovaries thus causing a failure to get pregnant.
However, the gynecologist also told me that some women are able to conceive even during perimenopause, though the chances are extremely low. Even Corio had mentioned that all women need to know this.
She told me, ”Your chances of getting pregnant reduces after the age of 24. I see it often, women are just 32-year-old and 35-year-old, and their eggs are not viable for conception. The egg quality is poor. They are already in perimenopause and they do not even know it.”
Being aware of the fact that fertility can decline as age increases, especially when we enter perimenopause, can allow women to make appropriate decisions about pregnancy planning.
The decline in estrogen levels can also cause vaginal atrophy causing dryness and thinning of the vaginal tissues. This leads to a feeling of tightness, pain, and soreness in the vagina during sex. This affects women’s sexual pleasure and reduces their libido.
How long does perimenopause last?
On average, the duration of perimenopause is about 4 years. However, in some women, this phase may last just for a few months, while in others, it may begin at an early age and continue for 8 to 10 years. Perimenopause can be said to have ended when the woman has not had her periods for 12 months.
How to differentiate perimenopause from normal menstrual irregularities?
I was getting my menses regularly. However, I had noticed there were some changes in the flow. My menstrual flow was heavier than ever and I was also passing clots. I wanted to know whether these changes were also due to perimenopause and the hormonal change occurring due to it.
The gynecologist told me that most women get irregular periods during this phase. However, some women may have normal and regular periods while some may experience regular periods though with a few changes in their regular pattern.
She told me that the effect of perimenopause on your menstrual cycles depends on how the levels of two female sex hormones, estrogen, and progesterone, change during this period. During perimenopausal phase, women may develop menstrual irregularities such as:
- Heavier flow
- Passing of large blood clots
- The periods last longer than usual
- Spotting between periods
- Spotting after sex
- Periods come more frequently
Most of these abnormal changes in periods could be linked to the changes in estrogen production. At the same time, it can also be due to other causes such as the use of birth control pills, fibroids in the uterus, and blood clotting disorders.
In some cases, the spotting could also occur as a result of pregnancy. Most women do not consider pregnancy to be the cause of spotting especially after they have had kids or passed a certain age when they do not think they can get pregnant. However, it is essential to rule out this possibility as well because the ovaries are still producing eggs during perimenopause and hence, it is possible for women to get pregnant and experience spotting due to it.
In rare cases, increased bleeding, and frequent periods can also occur due to cervical, endometrial or uterine cancer. Hence, women are advised to contact a gynecologist when they experience a change in their menstrual cycles to find out if it is due to perimenopause or any other factor.
Menopause vs. Perimenopause
So far, I had a misconception that women can develop hot flashes and mood swings only due to menopause. But now that I had learned that even perimenopause can cause similar symptoms, I was obviously interested in knowing what the difference between these two phases was.
The doctor told me perimenopause is when you still get your periods whether regular or irregular. Hence, it is still considered your reproductive age. Menopause, on the other hand, marks the end of periods as well the women’s reproductive age.
You may enter perimenopause or menopause at an earlier age if you:
- Have a history of early menopause in your family
- Have had an oophorectomy or hysterectomy
- Are a smoker
- Have undergone treatment for cancer
What is the treatment for Perimenopause?
I was eager to know if there was a way to overcome the symptoms that I was being plagued with for many years.
The gynecologist told me I could get temporary relief from hot flashes by using low-dose birth control pills. However, if the symptoms are severe, it is advisable to choose other options such as birth control skin patch, progesterone injections, and vaginal ring.
She also recommended some lifestyle strategies to relieve the symptoms. Let me share them with you:
- Exercise regularly
- Get adequate sleep every day and try going to bed and waking up at the same time every day
- Stop smoking
- Limit alcohol intake
- Maintain a healthy weight
The doctor’s advice gave me insight into what was happening to/with me, I had clarity. Now, I know why I was experiencing those symptoms that were supposed to occur in a few years from now. I was in perimenopause.
The doctor asked me to do some tests including blood levels of hormones. Based on the reports, she advised me to use a birth control patch. I also followed the advice related to my lifestyle as suggested by her.
The symptoms started subsiding slowly with the treatment. The doctor had also advised me to use calcium supplements as I had a higher risk of osteoporosis. My complete health check-up had revealed my bone mineral density was low.
The comprehensive treatment offered by the gynecologist based on my specific symptoms and overall health helped me overcome this phase with ease.
It’s been 2 years since I visited the gynecologist for the first time. I am taking treatment and doing tests regularly to check my hormonal levels. Within a few more years, I suppose, I would stop getting periods and enter menopause. However, I am confident, I wouldn’t have to face any difficulties during menopause as I am seeking regular advice from my gynecologist who recommends appropriate treatment based on my symptoms and hormonal levels.
Perimenopause is a change in women’s life that occurs before the major change of menopause. Women may experience hot flashes, reduced fertility, and other symptoms during perimenopause due to the decline in the production of female sex hormones. If you are suffering from such symptoms, it is best to contact a gynecologist so that you can receive timely treatment based on the correct diagnosis.
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