Perimenopause is the transition period from your fertile time of life toward your menopausal and postmenopausal life. Perimenopause can begin approximately eight to ten years before the onset of menopause. The first years of perimenopause are hardly noticeable; in your 40s or late 30s, with the gradual variation of estrogen and progesterone, you might notice changes in your menstrual cycle, such as irregular periods. Perimenopause becomes noticeable closer to the onset of menopause, when certain noticeable symptoms start up. These symptoms include:

• Breast tenderness
• Hot flashes
• Decreased libido
• Increased symptoms of PMS
• Fatigue
• Irregular periods
• Vaginal dryness
• Mood swings
• Sleeplessness
• Urinary problems such as incontinence and urgency

For some women, perimenopause lasts only a few months. Menopause begins when your ovaries stop releasing eggs and your periods stop. Until then, any changes you experience are part of perimenopause. If you’re unsure about the symptom you are experiencing, talk to your provider. He or she will be able to appraise your symptoms and conclude if you are indeed experiencing perimenopause. When you begin to experience these symptoms, it’s very important to start keeping on top of your health to get your body ready to handle these symptoms and the symptoms that will come with menopause. One of the most important things to remember during perimenopause is that you can still get pregnant. Your fertility does begin to slightly decrease as you get into your forties, but that doesn’t mean that pregnancy can’t happen. Your ability to get pregnant will only stop after one year of no periods due to menopause. That means, use birth control if you don’t plan on having a child. Also, it’s useful to remember that as you get older, you are at increased risk for complicated pregnancies and having a child with Down’s Syndrome. Many women can continue to take their birth control pills throughout perimenopause and up until menopause. A low-dose birth control pill might also help with some of your symptoms. Using a condom or another reliable source of birth control will also help to protect against surprise pregnancies at this time in your life.

Although perimenopause is a natural progression in most women’s lives, sometimes the stage will be skipped if menopause is induced. Menopause can be induced by surgery, +/- radiation or chemotherapy. After a hysterectomy, if both the uterus and the ovaries were removed, your body will prompt menopause, and you can expect to skip perimenopause and cut right to the chase and experience the symptoms of menopause. If only your uterus was removed in the hysterectomy, then you will not have induced menopause, but your periods will stop. You may have the option of leaving one or both ovaries when you have a hysterectomy. Discuss this with your provider.