Many of us know about menopause; it marks the end of the reproductive journey for a woman. But do you know about the final leg towards it, the transition? Perimenopause is the transitory period of menopause. It is a milepost when the path towards the final menstrual period begins. This menopausal transition is marked by extreme changes in hormonal levels, changes that wreak havoc on the female body. The average age of menopause is between 45 to 52 years old; perimenopause can begin ten years before the final menstrual period.
Perimenopause is divided into two stages, early and late. During the early stage, there is an increase in Follicle Stimulating Hormones (FSH), which results in shorter intervals between the menstrual cycles. The rapid decline in estrogen marks the late stage. During this stage, the menstrual cycles become progressively irregular with longer intervals in between. The fall in estrogen levels is responsible for most of the symptoms experienced by women in perimenopause or menopause.

The symptoms of perimenopause are:
Changes in the menstrual cycle, heavier periods, longer intervals between cycles
Vasomotor symptoms: hot flashes and night sweats
Vaginal dryness and pain during sex
Fatigue, pain in muscles and joints
Dizziness, headache, palpitations
Changes in the skin: dryness, itchiness, hair loss or thinning
Depression and anxiety: perimenopausal women are more likely to experience depression than premenopausal women.
Insomnia: insomnia is more prevalent in women going through this transition
Worsening of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Most of the symptoms of perimenopause are that of menopause. However, owing to whatever estrogen remains, these symptoms are mild and less severe during the transitory period. Regardless of the inevitable fall of estrogen, there are ways to reduce the severity of symptoms or even deal with them before they manifest. Consuming a healthy balanced diet and maintaining a normal body weight reduces the severity of vasomotor symptoms. Avoiding or quitting cigarette smoking before perimenopause will lower the severity of symptoms. Vitamins also aid in easing the symptoms of perimenopause. Vitamin E reduces vasomotor symptoms and improves the quality of sleep. Vitamin D and calcium prevent bone loss and also reduce the risk of osteoporosis. Vitamins B, C, and zinc support healthy skin and hair. And magnesium lowers mood symptoms, especially in those women who experienced PMS in their earlier years.
Hormone Replacement Therapy (HRT) is commonly prescribed to manage the symptoms of perimenopause. Bioidentical hormones are a natural plant-derived alternative to HRT. These hormones contain naturally occurring hormones that mimic the action of endogenous hormones. They restore the levels of estrogen and decrease the symptoms of perimenopause and menopause. However, not every woman is well-suited for hormonal therapy; therefore, risk factors and contraindications should be assessed before initiating therapy.
Menopause is unavoidable, and the travels towards it is not an easy one either. What is within one's control is how we can reduce the rigors of this experience. It is necessary to be aware of the changes our bodies undergo when hormonal levels fluctuate. By being aware of the impending circumstances, one can reduce their risk of experiencing them and live a good quality of life.
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