Perimenopause- the rollercoaster to menopause


Are you in your 30s or 40s?

Are you experiencing night sweats, irregular periods, dry itchy skin or other strange symptoms?

Are you confused about what might be causing it?

You might be wondering, isn't it too early for menopause? Could these symptoms be caused by something else?


You aren’t totally wrong. You might just be experiencing perimenopause.




What’s the difference between menopause and perimenopause?


Menopause, the end of the menstrual cycle, is a topic that has attained a fair degree of familiarity around the world. The average age of menopause in India is 46 years. However, there is yet another important stage experienced by women which need to be talked about too – the “perimenopause”.

“Peri” meaning “around” is the transitional stage that occurs before menopause. Menopause is just one day, the anniversary of your last period. Perimenopause is the 4 to 10 year lead-up to that day.


Read Related - Perimenopause: I felt like I was losing my mind until I discovered this


What exactly is perimenopause?


Perimenopause is your ovaries’ way of preparing for menopause. The ovaries gradually decrease their secretion of estrogen, the hormone that regulates the menstrual cycle. The fluctuation in estrogen results in irregular menstrual cycles, usually the most noticeable marker of looming menopause. The drop in estrogen escalates in the last one or two years before menopause when many women start to experience typical menopausal symptoms. It’s important to note that the ovaries continue to release eggs through the perimenopause period, so perimenopausal women can get pregnant


There are two stages of perimenopause – the early transition stage with relatively fewer interruptions in the menstrual cycle and the late transition stage, where the cessation of the menstrual cycle could last even up to 60 days.




How do you know if you have entered perimenopause?


Watch out for these symptoms if you feel you are going through perimenopause:


  • Hot flashes – Hot flashes are experienced by 30 to 70% of perimenopausal women. They are characterized by sudden sweating (or flushing) lasting for 5 to 10 minutes. The intensity and duration vary from one person to person. Some simply feel warm, while others sweat profusely.


  • Sleep disturbances – When hot flashes occur at night, they are called night sweats. As one can imagine, they can disturb sleep.


  • Vaginal dryness – During the late perimenopause stage, estrogen levels decline drastically. This may cause the vaginal tissue to become thin and dry, which leads to irritation and itching. It might cause pain during intercourse and lead to reduced sexual desire.


  • Mood changes – The body goes through numerous changes during perimenopause. Whether due to the lack of sleep and discomfort associated with perimenopausal symptoms, or the decline in estrogen’s effect on mental health, irritability, anxiety and depression may be symptoms of perimenopause. This guide by the Women’s Health Organisation offers a comprehensive understanding of depression during perimenopause.


Pan-India studies on menopausal symptoms are lacking but this study done in Uttarakhand discussed the prevalence of various symptoms. The most prevalent symptom was muscle and joint pains (55.81%), followed by feeling tired or a lack of energy (51.19%) and feeling unhappy or depressed (36.43%). Discuss with your physician if you experience these changes. You might also be required to do a blood test to check your hormone levels.


Read Related - Living and coping with Perimenopause symptoms


Why is perimenopause important to be aware of?


Estrogen does more than just regulate the menstrual cycle. It is a hormone that has functions all over the body! Thus, the changes that accompany perimenopause need to be taken note of so that problematic health effects do not occur.


  • Increase in cholesterol - Estrogen plays an important role in cholesterol regulation. Due to the decreasing estrogen, perimenopause may lead to an increase in low-density lipoprotein (LDL) cholesterol levels, which is referred to as “bad cholesterol.” Regular blood tests will become your best friend!


  • Heart disease - Along with monitoring cholesterol levels, estrogen helps maintain the flexibility of blood vessels. What this means is that estrogen aids the relaxation and constriction of blood vessels to accommodate a proper blood flow. An increase in cholesterol levels and decrease in flexibility increases the risk for heart ailments. Studies have shown that the first myocardial infarction attack occurs in 4.4% of Asian women at a younger age than in European women.


  • Diabetes – Metabolism begins to slow down during perimenopause which results in lesser calorie burning efficiency. The resulting weight gain may make the body insulin resistant. This leads to an increase in blood glucose levels. Checking your gut health with a registered nutritionist may help you find ways to counteract these effects. In India, type 2 diabetes occurs a decade earlier than in Caucasians.


  • Alzheimer’s disease – Estrogen regulates glucose transport within the brain. Glucose is vital for the brain to produce energy. Estrogen dysregulation during perimenopause could alter this mechanism, leading to cognitive decline which in turn increases the risk of developing Alzheimer’s disease.




How are perimenopausal symptoms treated?


  • Hormone Replacement Therapy (HRT) to counteract the body’s dropping estrogen. Alleviates menopausal symptoms and counteracts early-onset osteoporosis for those who go through early menopause.

  • Some types of antidepressants, in particular selective serotonin receptor inhibitors, can help alleviate mood swings

  • Topical estrogen creams to reduce dryness in the vagina





How do I effectively take care of myself during this transition period?

  • Regular exercise may stabilise mood swings. Avoid exercising before bed as this can disturb sleep further by leading to night sweats.

  • Smoking, caffeine intake, and spicy foods are some hot flash triggers. Cut back on them to feel more comfortable

  • Join a menopause support group.

  • We, at Miyara, have one too! We discuss symptom treatments and have regular online sessions on menopausal health. Join our WhatsApp group by clicking on this link or join our inclusive community on FB .


Please consult your physician for personalized medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition.


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Edited by Aishwarya Viswamitra


About the author


Niranjana S. Rajalakshmi is a veterinary microbiologist turned science journalist, currently based in India. After her under graduation in Veterinary Medicine, she was curious to study diseases at a molecular level which led her to pursue a Master’s in Veterinary Microbiology. When the pandemic struck, she being a microbiologist felt the need to communicate about the hitherto unknown virus and its possible implications to a large audience. Subsequently, she produced several pieces on COVID-19 and other topics related to health, which are being published in leading news outlets in India.

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