Perimenopause And Irregular Periods

Introduction

Perimenopause and irregular periods are associated with each other. Perimenopause is a natural transition from menstruation to menopause in a woman's life. These changes occur due to fluctuations in hormones. Perimenopause begins between 45 and 55 years (8-10 years before menopause). Symptoms vary from person to person. In some cases, perimenopause can last for just a few months, while others may have it for four years or so. Women are only considered to have experienced menopause after not having a menstrual period for twelve consecutive months after the end of perimenopause.¹

What is perimenopause?

The irregularity of menstruation results from a decrease in oestrogen levels which causes women to experience symptoms such as hot flashes, mood swings, night sweats, vaginal dryness, inability to concentrate and infertility.² This can be considered as perimenopause. The process of perimenopause is stretched for several years, and it also bridges the gap to menopause. 

Fluctuations in hormonal levels during perimenopause can have a varied impact on physical, emotional, and mental changes. Women may experience feelings of anxiety, stress or even depression. Many experience complications with sleeping, like insomnia and disturbed sleep. This fuels other symptoms like irritability, inability to concentrate and anxiety. These above-mentioned symptoms can affect the personal and professional lives of women. Physical changes like overweight or obesity can affect many women the way they feel about themselves, their confidence and their self-esteem.³

Misconceptions about perimenopause and menopause

In general, there are misconceptions about perimenopause and menopause that are as follows:

• Weight gain is typical but cannot be prevented

Indeed, unwanted weight gain occurs during menopause. However, it is preventable through proper activities and eating habits. Good nutrition always helps balance the hormones and combat menopause weight.⁴

• Bones become weak

It is a natural phenomenon for women to lose and gain bone mass until they reach a point of maximum. If body systems are applicable in their case, it would not be a significant bone mass loss. Most women have an ample amount of bone mass to compensate in most cases. However, the loss of bone mass beyond the sufficient amount can be rapid due to risk factors, such as a poor diet, family history, and lifestyle.^4,8

Overview of the menstrual cycle and hormonal changes

A regular menstrual cycle is a controlled, repetitive process that occurs once every month at regular intervals. It includes the release of GnRH hormone from the hypothalamus, the secretion of follicle-stimulating hormone and luteinising hormone from the pituitary, and the ovary's reaction to these hormones. The menstrual cycle ordinarily lasts 28 ± 7 days. Fewer than 33% of individuals have their cycles every 28 days, while 82% of individuals have variances from 22 to 32 days.⁵

Key hormones involved

The hypothalamus releases a hormone called gonadotropin-releasing hormone (GnRH). This hormone stimulates the anterior pituitary to release two other hormones: follicle-stimulating hormone (FSH) and luteinising hormone (LH). GnRH, feedback from sex hormones, and other factors control the levels and timing of these hormones. These hormones stimulate the ovary to produce oestrogen or progesterone. The ovarian hormones then stimulate the lining of the uterus to grow and affect other parts of the body. The menstrual cycle processes such as follicle development, ovulation, and changes in the uterus are influenced by these hormones.⁶

Symptoms of perimenopause

During perimenopause, women undergo a decrease in oestrogen levels, resulting in various hormonal changes and symptoms. These symptoms can  vary among women and may include:

• Irregular periods- changes in the menstrual cycle, such as heavier or lighter periods and skipped periods
• Hot flashes and night sweats - sudden waves of warmth throughout their bodies, particularly during the night (referred to as night sweats)
• Incontinence- lower oestrogen levels can weaken the bladder, urethra, and vagina, potentially leading to an increased risk of urinary tract infections
• Disturbed sleep- hot flashes and night sweats can disrupt sleep patterns during perimenopause
• Mood swings- sudden bouts of irritability or depression are common during this stage
• Lower oestrogen levels can affect bone density, leading to osteoporosis⁸
• Cardiovascular diseases may increase due to low levels of oestrogen in women in their mid-40s and beyond⁷

Causes of irregular periods during perimenopause

During perimenopause, the level of oestrogen, the primary female hormone, fluctuates irregularly. Menstrual cycles can become longer or shorter, and women may start experiencing cycles without the release of an egg from the ovaries. Additionally, women may have symptoms similar to those of menopause, including hot flashes, sleep disturbances, and vaginal dryness.⁷

Diagnosis of perimenopause

Perimenopause is a gradual transition, and blood tests are not usually needed for diagnosis. Healthcare professionals will consider the woman's age, menstrual history, and any symptoms or body changes they may be experiencing. Some doctors may order hormone level tests, but apart from checking thyroid function, hormone testing is rarely necessary to evaluate perimenopause. The following conditions can be diagnosed in otherwise healthy women over 45 years old with menopausal symptoms.

Perimenopause can be identified by vasomotor symptoms and irregular periods. Menopause is confirmed when a woman has not had a period for at least 12 months and is not using hormonal contraception. Menopause can also be diagnosed in women without a uterus based on their symptoms.⁹

Management and treatment 

Perimenopause is a natural part of life and does not have a specific treatment to stop it. Treatment depends on the bothersome symptoms.

Hormone replacement therapy (HRT)

The conventional treatment for perimenopausal symptoms is HRT. The most standard medical remedy for signs of menopause is replacement hormonal therapy (often ethinylestradiol in combination with gestates, or a way fewer used drug, 17 alpha-estradiol and progesterone). The main indication of HRT in women is relief from vasomotor symptoms consequent to perimenopause. Other beneficial effects, such as protection from bone loss and ischemic heart disease, are evidenced. Nonetheless, there is also some evidence that HRT might increase the risk of breast cancer, heart attack (especially among older postmenopausal women), coronary attacks, and stroke.¹⁰

Here are some top tips for managing menopause symptoms: 

• Sleep routine, not less than 7 hours
• Weight management
• To ease hot flashes, limit caffeine, alcohol, and spicy foods 
• Use fans or air conditioning, drink cool beverages, and dress in layers to manage hot flushes
• Vaginal dryness can be managed by using lubricants¹¹

When to seek medical advice with perimenopause or menopause symptoms 

• Periods become significantly heavier or are accompanied by blood clots
• Periods last several days longer than usual
• Spotting or bleeding after the period has ended
• Notice spotting after having sex
• Periods occur earlier or delay

Psychological and emotional considerations

Perimenopause, the transitional phase before menopause, involves significant hormonal changes that can affect a woman's psychological and emotional well-being. Understanding these considerations is essential for managing this period effectively and maintaining mental health.

• Hormonal changes can lead to mood swings and emotional instability, often managed with mindfulness practices and counselling
• Perimenopause can lead to heightened anxiety and depression, necessitating professional assistance and lifestyle adjustments for effective management
• Sleep disturbances like insomnia and night sweats can be managed by improving sleep hygiene and considering hormone replacement therapy (HRT)
• Cognitive changes, including memory issues, can be addressed with mental exercises and adequate rest, with healthcare provider involvement
• Physical changes during perimenopause may affect body image and self-esteem, requiring self-care practices and support groups for management
• Emotional and physical changes during perimenopause can impact relationships, necessitating open communication and couples counselling, if needed
• Building a strong support system of friends, family, and healthcare providers is crucial during perimenopause

Long-term health considerations 

Bone health- Osteoporosis risk changes during menopause. It is the most common disease in menopausal women and strongly affects their quality of life. When menopause begins, the normal bone turnover cycle is disrupted by a lack of oestrogen. This may be because oestrogen receptors are present in certain bone cells. Some of these cells increase bone breakdown, while others decrease bone formation. This leads to a net loss of bone. The overall increase in bone breakdown is due to a weakened inhibitory effect caused by the reduction of available oestrogen on the formation and activity of the bone breakdown cells.

Preventive measures

• Regular exercise
  • Engage in aerobic activities such as brisk walking and cycling for at least 150 minutes a week. Incorporate muscle-strengthening exercises, yoga, pilates, and flexibility training for overall health
• Balanced diet
  • Include fruits and vegetables in every meal. Choose whole grains, lean protein and healthy fats 
• Weight
  • Have a weight check and maintain a healthy body weight
• Smoking
  • Quit smoking
• Alcohol consumption
  • Limit or avoid alcohol
• Stress
  • Remember to manage stress by practising stress-reducing techniques such as mindfulness, meditation, and deep breathing exercises
• Sleep
  • Set a sleep routine, and practice going to bed early to rise

Conclusion

In summary, women can easily move through the transition of menopause and maintain their overall health by being aware of the symptoms, managing them, and engaging in preventive measures. Implementing a proactive approach towards health management will contribute to overall wellness while reducing the risk associated with perimenopause.