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Understanding perimenopause



This information is provided by the Consumer Education Committee of The North American Menopause Society (NAMS)

Menopause is a natural biological process, not an illness. It is associated with hormonal, physical, and psychological change. Menopause occurs because the ovaries stop producing estrogen and progesterone. Menopause isn't the end of your sexuality or your youth.  Most women will live at least one-third of their years past menopause. Menopause has occurred when you have not had a menstrual cycle for 12 months.

The average age for menopause is 51 years. It will take most women seven to 10 years to complete the process. This process is called perimenopause. The signs and symptoms vary from woman to woman:

  • Irregular menstruation. Your cycle may stop suddenly, or gradually get lighter or heavier and then stop. The unpredictability of your periods may be your first clue that menopause is approaching. Seek medical attention if you spot between menstrual cycles or with sexual intercourse.
  • Decreased fertility. When ovulation begins to fluctuate, you're less likely to become pregnant. Until you haven't had a period for a year, however, pregnancy is still possible. If you don't smoke, you can use low-dose birth control pills. The pills will regulate your menstrual cycles.
  • Vaginal changes. As your estrogen level declines, the tissues lining your vagina and urethra — the opening to your bladder — become drier, thinner and less elastic. With decreased lubrication you may experience burning or itching, along with increased risk of infections of your urinary tract or vagina. These changes may make sexual intercourse uncomfortable or even painful. To increase comfort, wear cotton underwear and practice good hygiene of wiping front to back after urination. To make sex more comfortable, use a water-based vaginal lubricant or moisturizer and empty your bladder before and after intercourse. The leaking of urine is not normal; talk with your physician if this occurs.
  • Hot flashes. As your estrogen level drops, your blood vessels may expand rapidly, causing your skin temperature to rise. This can lead to a feeling of warmth that moves upward from your chest to your shoulders, neck and head. You may sweat, and as the sweat evaporates from your skin, you may feel chilled, weak and slightly faint. Your face might look flushed, and red blotches may appear on your chest, neck and arms. Most hot flashes last from 30 seconds to several minutes, although they can last much longer. The frequency, as well as the duration, of hot flashes varies from person to person. You may have them once every hour or only occasionally. They can occur any time during the day or night. They may be a part of your life for a year or more, or you may never have them.
  • Sleep disturbances and night sweats. Night sweats are often a consequence of hot flashes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have difficulty falling back to sleep or achieving a deep, restful sleep. Lack of sleep may affect your mood and overall health.
  • Changes in appearance. After menopause, fat may settle above your waist and your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin. If you previously experienced adult acne, it may become worse. Although your estrogen level drops, your body continues to produce small amounts of the male hormone testosterone. As a result, you may develop coarse hair on your chin, upper lip, chest and abdomen.
  • Emotional changes. As you go through menopause, you may experience mood swings, be more irritable or be more prone to emotional upsets. These symptoms may be attributed to hormonal fluctuations. Other factors that can contribute to these changes in mood include stress, insomnia and life events that can occur in this stage of adulthood — such as the illness or death of a parent, grown children leaving home and retirement.


Change of life. . .change of lifestyle?
Change is good. Or at least it can be. According to the majority of women interviewed in a North American Menopause Society (NAMS)-sponsored Gallup Survey, menopause provides an excellent opportunity to make a lifestyle change or two or six, if you choose to incorporate all of the following helpful hints:

  • Eat well. Choose nutrient-dense foods, eight to 10 servings of fruits and vegetables, whole grains, lean meats, foods that provide calcium. Drink water, take a multivitamin, decrease consumption of processed and refined food. Proper nutrition is the basis for sustaining good health over time. It can reduce the risk of heart disease, osteoporosis, and cancer.
  • Maintain a healthy weight. Higher levels of body fat and weight increase the risk of cardiovascular disease, diabetes, and arthritis. Healthcare providers can help devise a plan for attaining and maintaining a healthy body weight. For women, having a waistline of less than 35 inches decreases the risk of stroke.
  • Exercise. Regular exercise tones muscles, improves balance, sense of well-being, decreases stress and improves sleep. Regular exercise tones the heart, muscles, and is important for strong bones. It's also crucial for weight management. Choose an activity you enjoy (walking, dancing or yoga) and do it for 30 minutes per day even if it means dividing it into three 10-minute segments.
  • Practice stress management techniques. Find healthy ways of dealing with stress, such as exercise, practicing meditation, play and deep breathing. Take the time to relax. It can be as simple as listening to soft music, practicing meditation or enjoying a hobby or time with friends.
  • Stop smoking. Increased risk of osteoporosis and bone fracture, heart and lung disease, and premature death make smoking a most unhealthy habit. Smoking results in an earlier onset of menopause (up to two years earlier than non-smokers) and is a major cause of facial wrinkles. Smoking cessation or never smoking is a major component of a healthy lifestyle. If you smoke, talk to your healthcare provider about strategies that can help you quit. Remember, it's also important to avoid second-hand smoke.
  • Avoid alcohol. Due to the way women's bodies process alcohol, it has more of a detrimental effect on their health. Death rates from alcohol abuse are 50 to 100 percent higher for women than for men. Women who drink higher levels of alcohol are at higher risk for stroke, cancer and liver damage. (Higher levels of alcohol use is defines as more than seven drinks per week; one drink equals 12 oz. beer, 4 oz. wine or 1 oz. liquor.) Even a small amount of alcohol triggers hot flashes in many women and, for some, that is reason enough to avoid it.


Whichever way you look at it, healthy living makes sense. Make the most of any opportunity to lower your risk of disease and to make sure that your postmenopausal years are truly golden ones.