What is perimenopause and what happens to women when this process begins

With more than 30 symptoms, the list is so extensive that we could write an entire article dedicated to it.

And while most women are familiar with the most common problems associated with menopause (like hot flashes or irregular periods), they are unaware of many other possible ones, like the feeling of having bugs crawling under your skin or burning in your mouth.

In addition, many find it a real surprise to discover that all of these conditions can begin to manifest many years before menstruation ends.

This is because the symptoms do not begin with menopause – a term used to define the milestone in a woman’s reproductive life, which is officially reached when a year has passed since the last period – but during the transition to it.

Clinically, this transition is called perimenopause.

“The average woman starts (this process) around age 47 and ends at 51, but it can start much earlier,” explains Nanette Santoro, professor of obstetrics and gynecology at the University of Colorado, USA, to BBC News Mundo, the BBC’s Spanish-language news service.

“In my clinical practice, I’ve seen women in their 30s or 40s who have clear symptoms of menopause, although objective tests (egg counts, etc.) the symptoms of perimenopause and menopause.

Hot flashes and vaginal dryness

The symptoms Santoro refers to are some of the most classic, which can appear during the transition period and last for years after menopause.

The ones that appear most often are:

Irregular menstruation: menstruation can be spaced, occur more often, with more or less bleeding, until it finally disappears.

heat waves: a kind of sudden intense heat in the face and head that spreads to the rest of the body and lasts for a few minutes before disappearing quickly.

night sweats: They make a woman wake up in the middle of the night drenched in sweat.

Urogenital atrophy: a problem that, as Paula Briggs, a specialist in sexual and reproductive health and president of the British Menopause Society, explains to BBC News Mundo, “80% of women suffer” and “affects the quality of genital tissue”. This symptom causes dryness in the vagina, as well as pain and irritation during intercourse, as well as an increased need to urinate and urinary tract infections.

Decreased fertility

Bone density loss: The body loses bone mass faster than it regains it, increasing the risk of osteoporosis.

Weight gain and change in fat distribution: “There is weight gain without increasing intake or decreasing physical exercise. And the distribution of adipose tissue is more similar to the way it is distributed in men, accumulating in the central area of ​​the body”, Nicolás Mendoza tells BBC News Mundo , professor of Obstetrics and Gynecology at the University of Granada, Spain, and president of the Spanish Association for the Study of Menopause. “It’s apple-like fat, when women’s fat tends to be pear-like.”

Other symptoms: Many women also notice hair loss, brittle nails, headaches, muscle aches, palpitations and cramps.

lack of estrogen

All these changes are the result of hormonal fluctuations and, above all, the decrease in estrogen, a crucial hormone in the monthly reproductive cycle, whose levels do not recover after menopause.

The decline in estrogen levels does not occur gradually and progressively. The opposite. Levels rise and fall unsteadily, Mendoza says, and it’s these uneven swings that lead to the aforementioned symptoms.

While some symptoms are associated with excesses of this hormone, others respond to its deficiency. For this reason, some women suffer more in perimenopause than in postmenopause, as hormone levels tend to stabilize from then on.

But hormonal volatility doesn’t just lead to physical changes and symptoms; it has a profound effect on the mood and brain of a woman who goes through it.

Impact on mood and brain

Pauline Maki, professor of psychiatry, psychology, obstetrics and gynecology at the University of Illinois at Chicago, in the United States, and former president of the American Menopause Society, explains that there is a “decline in mood in perimenopausal women” and, in many cases, , a “vulnerability to depression, similar to that experienced by women after pregnancy to postpartum depression”.

“We know that there are certain women who are very sensitive to a negative emotional response when they experience sudden changes in their estrogen levels,” she tells BBC News Mundo.

Irritability, anxiety, lack of sexual desire, memory loss, and so-called brain fog (a mixture of confusion and decreased verbal and cognitive skills) are other characteristics of this stage.

Although they are caused by hormonal factors, they are also closely linked to other physical symptoms of perimenopause.

“There is a very intuitive relationship between hot flashes and sleep disturbances and moodiness the next day. Research has shown that hot flashes one day predicted bad moods the next day,” says Maki.

“That’s partly because (nocturnal) hot flashes interrupt sleep, and I don’t know about you, but when I’m chronically sleep deprived, I get a little irritated,” she adds.

It is difficult for a woman to know what to expect when perimenopause starts to loom on the horizon, as the individual variation is immense.

Past menstruation experience (regular or irregular, painful or mildly uncomfortable, heavy or light bleeding, long or short periods) is not an indicator of what is to come.

Starting talking to the mother can be a starting point, Santoro says, as “there is some evidence that it could be something familiar, although the genetic influence of the father should also be considered.”

Treatment

As hormones stabilize after menopause, some of the symptoms (especially short-term ones like hot flashes or difficulty sleeping) become more acute at first and then improve. But not always and not in all cases.

That’s why experts consulted by BBC News Mundo agree that hormone replacement therapy (HRT) is, in the vast majority of cases, and under medical supervision, the best treatment to follow.

“A lack of estrogen can result in a 1% annual loss of bone mineral density and this has a cumulative effect, increasing the risk of fractures, osteoporosis and chronic pain. In addition, a lack of estrogen is a cardiovascular risk factor.” , explains Briggs, who fully believes in the benefits of HRT.

Many women are still hesitant to opt for this treatment, largely due to a study from the early 2000s that some experts said was misinterpreted. It contained several errors and amplified cancer risks from the treatment.

“I understand that it’s not what everyone wants and that’s ok, but I believe that at least every woman should be informed of all things related to menopause. I think that very few women will go through this without consequences, without following a treatment”, she says. Briggs, adding that the sooner you start, the greater the benefits.

Santoro, in turn, clarifies that there are no proven benefits of this therapy if there are no symptoms.

“From what we know about hormone replacement therapy, it’s not exactly like diabetes or hypothyroidism, which is the analogy that’s often made (when the missing hormone is replaced). HRT is only given if you have symptoms, it doesn’t seem to work to lower the risks (of lack of estrogen).”

Lifestyle changes

In addition to HRT, there are many other things a woman can do to improve her general condition in the perimenopause phase.

“Yoga and cognitive behavioral therapy have shown some improvements for sleep problems and hot flashes,” says Santoro.

“You have to be kind to yourself. Have self-compassion. Recognize that these are very normal experiences, that you are not alone, and that today’s research validates your experience. (In the case of depression), it is as normal as postpartum depression. -birth”, says Maki.

According to the expert, day-to-day changes can also be of great help.

“Exercise is very important because it has been shown to change brain chemistry,” she points out, who also recommends yoga and meditation to reduce irritability and anxiety.

“It’s important to limit your alcohol intake. Many women, when feeling irritable and stressed, will have a glass or two of wine, when it’s really counterproductive.”

“There is evidence to show that with the impact of these hormonal changes on the brain, there is an adverse mood response after alcohol consumption.”

Also, when someone feels down, they tend to avoid contact with people, and that’s not good for the brain, adds Maki.

“We have to force ourselves to engage in social activities with people who give us energy. This is very important.”

In short, either way, it’s essential to keep an eye on the symptoms.

“We can’t just tell women that this is a natural phenomenon – we don’t tell them, for example, about the pain of menstruation – and that it soon passes. If the symptoms affect the quality of life, they should be treated without condescension”, concludes Mendoza. .