Dear Doctor: I’m a healthy and active 42-year-old, but I’ve been noticing a change in my periods lately. They’re not as regular as before, and they’re a lot shorter. Could this be perimenopause? What’s going on, and what else is going to happen?
Dear Reader: Perimenopause is the transitional time that leads up to a woman’s final menstrual cycle. For some women, perimenopause can last for as little as a few months or a year. More often, it lasts for several years. In some instances, the changes associated with perimenopause can take place over the course of a decade. Although the symptoms can differ from woman to woman, they arise from the same cause. That is, certain hormonal changes within the body that precede the end of a woman’s reproductive years.
Perimenopause is the period of time during which a woman’s ovaries gradually begin to produce less estrogen, which is one of the hormones involved in the complex process that signals the uterus and the breasts to prepare for possible pregnancy. Although this shift in estrogen production is most common when a woman is in her mid-40s, it can happen earlier, when she is in her 30s. Perimenopause ends when a woman has gone a full year without a menstrual cycle, which is the start of menopause.
The symptoms that you mention are consistent with perimenopause. Many women experience changes to their menstrual cycles during this time, including fluctuations in flow, duration and regularity. These can be erratic because estrogen levels often diminish at an uneven pace, both rising and falling. However, it’s important to distinguish the normal changes that accompany the transition to menopause and symptoms that may signal other causes. If the changes that you see become extreme, such as persistent heavy bleeding, the presence of blood clots, spotting between periods or after sex, or an increase in frequency of menstruation, please check with your doctor. Other conditions such as fibroids, endometriosis or, rarely, cancer may be the cause.
The final phase of perimenopause sees the sharpest drop-off in estrogen production. This is a time during which additional symptoms often appear. These can include fatigue, breast tenderness, changes to mood, hot flashes, a worsening of the symptoms of PMS, urinary incontinence, night sweats, sleep disruption, vaginal dryness and changes to sex drive. This decline in estrogen leaves women at risk of osteoporosis, a disease in which bones gradually become porous and, thus, more fragile. Women also begin to lose the protective heart effects of estrogen, which is believed to help keep blood vessels more flexible.
Considering your age, along with the symptoms that you mentioned, it’s possible that you are experiencing perimenopause. However, due to the ongoing fluctuations in hormone levels, no one test can provide a definitive diagnosis. Instead, your health care provider will evaluate your symptoms, along with your age and menstrual history. If your symptoms begin to interfere with quality of life, they may offer treatment that can include lifestyle changes, hormone replacement therapy or antidepressants. Each has risks and benefits, so be sure to have these explained to you in detail.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
