Menopause, the cessation of menstrual periods, often follows several years of tumultuous emotional ups and downs and unpleasant physical symptoms. Most women undergo menopause around age 51, the Merck Manual reports. Perimenopause, the period of time that precedes menopause by as much as eight to 10 years, is marked by hormone fluctuations that can make life an emotional and physical roller coaster for some women.
Causes
Hormone shifts cause the changes associated with perimenopause, particularly changes in estrogen levels. Estrogen, the dominant female hormone, is produced in the ovaries in response to the release of follicle-stimulating hormone, or FSH, produced in the pituitary gland. As the ovaries age, they release widely varying amounts of estrogen--one month too much, one month not enough. FSH often rises in a vain attempt to force the ovaries to produce more estrogen. If too much estrogen is produced, an egg may develop and release very early in a menstrual cycle, resulting in a short cycle. If no egg develops, the cycle will be longer than normal.
Symptoms
Low levels of estrogen result in the symptoms women associate with perimenopause and generally worsen in the last year or two of perimenopause. Irregular periods, hot flashes, mood swings, depression, night sweats, insomnia, headaches and fatigue are the most common complaints of perimenopause. Spotting and abnormally heavy bleeding can occur from imbalances between estrogen and the hormone progesterone.
Seventy-five percent of women experience hot flashes for periods of between a year and five years, the Merck Manual says. Smoking, alcohol, caffeine or hot beverages may trigger a hot flash, which lasts between 30 seconds and five minutes. Sleep disturbances occur in about 40 percent of women, and mood swings affect 10 percent to 20 percent, Harvard Health Publications reports.
Diagnosis
Perimenopause can be diagnosed by symptoms and changes in the menstrual cycle. Blood tests on Day 2 or 3 of the menstrual cycle may reveal abnormally high FSH levels. Estrogen levels may rise abnormally at the beginning of the cycle or may remain very low.
Treatment
Hormone replacement therapy, or HRT, increases the estrogen levels. This fools the body into thinking that it's not in perimenopause. HRT also includes a form of progesterone for women who still have a uterus, so that a withdrawal bleed results when the pills are stopped for a few days. This allows the lining to shed. A lining that builds up and becomes too thick is a risk factor for uterine cancer. Avoiding triggers for symptoms such as hot flashes decreases their frequency. Antidepressants may help some women with hot flashes, Harvard Health says.
Considerations
The decision whether to take medications in perimenopause is difficult, because HRT may increase the risk of breast cancer, stroke, ovarian cancer, blood clots and dementia. The risk of heart disease doubles during the first year on HRT, the Merck Manual warns, even if a woman takes other medications such as aspirin and statins to prevent it.
