Perimenopause. What’s happening and will I ever feel normal again?
Perimenopause is a transitional stage in a women’s life that occurs before the onset of menopause which begins after 1 year cessation of menstruation, marking the natural end of reproductive years.
For most women perimenopause begins in their mid to late 40’s.
This period includes hormonal changes for the preparation of menopause. Hormonal changes involve a decline in levels of hormones, including estrogen, progesterone, testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). In the perimenopausal stage, the menstrual period becomes irregular and menstrual flow is also affected.
What are the Symptoms of Perimenopausal?
The most important aspect of menopause is the symptoms that uniquely affect every woman. The severity of symptoms varies from mild to severe. Some factors may increase the severity and duration of symptoms.
The most common symptoms of perimenopause include the following:
- Disturbance in the menstrual period starts in the perimenopausal stage as the ovulation becomes unpredictable. The perimenopausal stage usually arrives when the menstrual period is disturbed up to 7 days or more. In the late perimenopause, the gap between consecutive periods becomes two months or more.
- Impairment in the elasticity and lubrication of the vagina due to a decrease in estrogen levels causes vaginal disorders and pain during intercourse. Low levels of estrogen may also cause an increase in the risk of urinary and bladder diseases, decreased bone density, and increased risk of osteoporosis.
- Sleep problems due to night sweats or hot flushes are common during perimenopause, but the frequency, intensity, and length may vary.
- An increase in the risk of depression, mood swings, and irritability due to disruption or disturbances in sleep or other causes such as hormonal changes may also occur.
- A decrease in the ability of conception due to irregular ovulation. Sexual desire may also fade away. 
- Due to changes in estrogen, stress, and metabolic activity women can start to experience abdominal weight gain that is difficult to lose.
Risk factors that Disturb the Occurrence of Perimenopause
Menopause is a physiological phenomenon, but it occurs at different times in different women. According to some researchers, perimenopause starts early due to certain factors that include:
- Smoking: perimenopause may start about two years earlier than normal.
- Family history of early menopause
- Pelvic radiotherapy or treatment of other cancers may cause the early perimenopause. 
Treatment of Symptoms of Perimenopause
Symptoms of perimenopause are sometimes difficult to bear. There are natural and pharmaceutical treatments available that can ease the symptoms of perimenopause. In women who suffer from severe hot flushes, phytoestrogenic herbs like black cohosh and red clover can help reduce symptoms. Some women have success with low dose oral contraceptive pills. Vaginal lubricants, suppositories, and bioidentical biest creams can help to resolve the problem of vaginal dryness and pain during intercourse. For treatment of fatigue adrenal supporting adaptogenic herbs such as ashwagandha, rhodiola, and eleuthero can be used. Other treatments of perimenopausal symptoms include bioidentical progesterone, estrogen patches, and vaginal rings. Many of these methods have some contraindications, so women should consult with an experienced naturopathic doctor before using any of these methods.
Lifestyle and dietary measures can help to reduce the symptoms. These measures may include:
- Regular physical activity
- Avoidance of smoking and alcohol
- Manage your sleep timing and patterns
- Maintain a healthy weight
- Eat nutrient dense foods
- Practice stress management
- Take multivitamins after consultation by the doctor 
Complications of Perimenopause
Irregular periods are suggestive of perimenopause, but in some cases, complications may occur that include:
- Heavy bleeding that requires changing of pads after two hours or more
- Bleeding for a week or more
- Bleeding between the menstrual periods
- Less than 3 weeks gap between periods
 Santoro N. (2016). Perimenopause: From Research to Practice. Journal of women’s health (2002), 25(4), 332–339. https://doi.org/10.1089/jwh.2015.5556
 Woods, N., & Mitchell, E. (2005). Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives. The American Journal Of Medicine, 118(12), 14-24. https://doi.org/10.1016/j.amjmed.2005.09.031
 Nayak, G., Kamath, A., Kumar, P., & Rao, A. (2012). A study of quality of life among perimenopausal women in selected coastal areas of Karnataka, India. Journal of mid-life health, 3(2), 71–75. https://doi.org/10.4103/0976-7800.104456