Dr. Ko Says: Perimenopause Definition, Symptoms, and Treatments

Perimenopause is the time of transition between when a woman is regularly producing eggs to the time when the ovaries shut down permanently, also known as menopause. Women start perimenopause at different ages. In your 40s, or even as early as your 30s, your may start noticing the signs.

Perimenopause is marked by change or irregularity in your periods. Your periods may become longer or shorter in duration and frequency, or lighter or heavier in flow. Other common associated symptoms include: hot-flashes, sleep disturbances, mood changes and vaginal dryness. Treatments are available to help ease these symptoms.

Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause.      

Irregular periods are a hallmark of perimenopause. Though irregular periods are expected during this phase of life, certain signs may indicate the presence of an underlying gynecologic problem that requires diagnosis and treatment. See your doctor if:

• Bleeding is extremely heavy — you're changing tampons or pads every hour
• Bleeding lasts longer than eight days
• Bleeding occurs between periods
• Periods regularly occur less than 21 days apart

Although not always conclusive, some evidence suggests that certain factors may predispose a woman to entering perimenopause at an earlier age, including:

• Smoking.The onset of menopause occurs one to two years earlier in women who smoke, compared with women who don't smoke.
• Family history.Women tend to experience menopause around the same age as their mothers and sisters, although the link between family history and age at menopause is still inconclusive.
• Never having delivered a baby.Some studies show that never having had a baby may contribute to early menopause.
• Childhood cancer treatment.Treatment for childhood cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.
• Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still produce estrogen. But such an operation may cause menopause to occur earlier than average.

Although study results have been mixed, other complementary therapies with low-risk profiles such as acupuncture, yoga and paced breathing have shown some benefit in improving menopausal symptoms.

Other therapies include:

Prescription (Rx) — Hormones, IUD, endometrial ablation

Herbal — black cohosh, phytoestrogens, DHEAs

Lifestyle — good nutrition, exercise, stress reduction

Dr. Christine Ko is a Board Certified Family Practice physician with more than 15 years of medical experience. Her interests and focus are in women's health, integrative medicine, and sports medicine, and her approach to clinical care centers on knowledge of the disease process as well as the individual. Dr. Ko is a champion of integrated and holistic medicine, and in addition to her traditional medical training, she is trained in both medical acupuncture and mesotherapy.