Why perimenopause is one of the grave concerns affecting women’s health

Not menopause, but the phase of perimenopause is what stirs up turmoil in your body. We put together a primer to help you care for your holistic health

The female body is subjected to major transitions from time to time throughout her life. From menarche (a woman’s first period) to menopause (when a woman stops menstruating), the body goes through a hormonal reorientation—or imbalances—a couple of times. If you’re lucky enough to be hitting puberty in an urbanised setting, you will likely be provided with the fundamental information about your first period and hence menstruation; things are also gradually changing in the rural areas for good. 

However, the phases just before and after menopause are not usually given this kind of attention. Contrary to popular belief, getting rid of periods, permanently, is far from a relieving joy ride. From emotional pandemonium to physical complications, there are several unfavourable spin-offs of perimenopause, the phase just before menopause hits. We speak to health experts to find out how one can deal with this phenomenon with relative ease.

How do you identify if perimenopause has struck?

From a sudden ebb and flow in your menstrual cycle to hot flushes and night sweats, a handful of situations you may have never encountered before, hit you during perimenopause. Being mindful of what’s transpiring in your body then becomes critical. “When a woman starts to experience symptoms like changes in bleeding patterns, hot flashes, sleep disturbances and mood changes, you can tell that she has entered into the early stages of perimenopause. Other signs and symptoms may include the loss of libido, vaginal dryness, recurrent UTIs (urinary tract infections), anxiety or depression, and loss of bone health—also known as osteoporosis,” says Delhi-based obstetrician and gynaecologist Dr Amodita Ahuja. “These changes appear because of the sudden frequent rise and fall of hormones in the body,” she furthers, highlighting the head-to-toe effects of perimenopause on overall health.

Dr Yuvraj Jadeja, obstetrician, gynaecologist and medical director, Nimaaya Centre for Women's Health, Vadodara, theorises that the age between 45 to 55 is when most women are likely to experience the perimenopausal transition. However, “it could be earlier these days, considering that premature menopause is becoming common where we are seeing women in their late 30s and early 40s also transition into perimenopause,” says Jadeja, shedding light on premature menopause. “Irregular periods—especially shorter durations in the beginning followed by longer gaps later—is the most common sign, followed by vaginal dryness, mood swings, decreased libido and so forth. It’s mandatory to note here that this age group (the 30s) anyways should always have a yearly gynaecologist follow-up, to diagnose these and any other medical conditions on time and manage them. Blood tests such as AMH (anti-müllerian hormone) and FSH (follicle-stimulating hormone) also help in predicting menopause.”

Perimenopause versus menopause 

In simple terms, perimenopause is the phase that occurs just before menopause finally materialises in your body. Ajuha explains, “Perimenopause is a transition period from reproductive life to non-reproductive life. During this time the hormones are fluctuating because ovaries are producing fewer hormones. Menopause, on the other hand, is the time when ovaries have stopped their function completely due to which the hormones in the body have completely vanished; the symptoms are then produced due to hormone deficiency rather than hormone fluctuation.” To simplify things, Jadeja says that one can only classify an absence of periods as menopause if you haven’t menstruated in 12 consecutive months. “During perimenopause, you start having symptoms of menopause but still have cycles, irregular perhaps though; perimenopause can last for years altogether,” he adds.

An impact on overall health

To see your largely exuberant and gleeful mother become irritable and cranky can certainly feel anomalous, but one must cope with it, for hormonal mayhem might have taken over her. Similarly, for someone else, their oh-so-fit mother may suddenly fall prey to fatigue, body aches, headaches, anxiety or even depression. “The changes and challenges of perimenopause are rooted in hormonal alterations, particularly variations in the level of circulating estrogen and progesterone,” states Jadeja.

“Estrogen has a significant impact on neurotransmitters, the chemical messengers of the brain that regulate mood, skin health and bone health among many other things. Other hormones which are interlinked in maintaining the balance also get skewed, such as FSH, serotonin and testosterone. As women age, the production [of these hormones] decreases, thereby altering homeostasis,” he explains. According to Ahuja, the inability to grapple with perimenopause also stems from a place of unpreparedness and lack of education.

The key struggles

“The female body is maintained and regulated by estrogen and progesterone; hence, rapid decline in these hormones affects health as a whole, with ill-effects ranging from loss of muscle, wrinkles on the face, loss of the skin’s elasticity, vaginal dryness and shortening, sagging of breasts hair loss and so on,” shares Ahuja. On the surface, perimenopause will also trigger fluctuations in your weight, metabolism, digestive health and bone health, believes Jadeja. “Mental and emotional mood swings may range from irritability to serious issues like anxiety and depression, decrease in memory, concentration and overall cognitive dysfunction.”

Some women may also notice a stark difference in their period pattern—longer cycles and heavier bleeding being common. “The ovarian function starts to decrease as you age and also its follicular reserve, which is limited since birth; the cycles start becoming anovulatory (absence of ovulation in a menstrual cycle) and irregular, which leads to fluctuating levels of estrogen and progesterone in the phase,” explains Jadeja. Ahuja blames bizarre menstrual patterns on the erratic behaviour of the ovaries and subsequently the egg formation. “As the ovaries are phasing out in their function, the egg formation and egg release becomes very erratic, leading to disbalance of oestrogen and progesterone in the body leading to irregular menstrual patterns, ranging from no periods for two to three months to continuous heavy bleeding.”

The best way forward

Visiting a dermatologist is non-negotiable and imperative, for every woman experiences perimenopause and menopause differently. From symptoms to pain points, the phase can spell entirely different for two women, even those belonging to the same age group. “While your body is adapting to a deficiency of various hormones, it is important to consider supplementing hormones in the form of hormone replacement therapy and have regular screening of cancers, bone health and heart health, for which you must pay your gynaecologist a visit,” says Ahuja. She enumerates a few tips. “I believe every woman should resort to healthy eating habits after the age of 40. Taking supplements like calcium, vitamin D, omega-three fatty acids and vitamins B and E will help reduce the severity of [perimenopause] symptoms,” suggests Ahuja. Both doctors agree that a healthy and balanced diet, regular physical activity, stress management and sleep hygiene make tackling the symptoms much easier.

Protecting your mental and emotional well-being

Accepting that you will come across emotional and mental health challenges is the first step in the right direction. Don’t suppress what you’re feeling, but don’t succumb to it either. “Do not be ashamed of what you feel and have honest conversations with your partner regarding what you expect during this phase of transition,” advises mental health professional Dr Madhura Samudra. “Look for trusted resources to understand what problems you are facing, engage in activities that help you de-stress and find comfort in sharing your experiences with a loved one. Community-building and sharing your thoughts with like-minded women who are going through something similar will help you feel understood and less alone. You may also indulge in recreational activities like meditation, sign up for hobby classes or start journaling to find a proper channel for your emotions,” recommends Samudra.

Having said that, mood swings are almost inevitable. “They can be even worse if you’ve had a tough time with PMS (premenstrual syndrome) all your life,” says Ahuja. It is okay to take a step back and allow yourself some downtime when you feel easily irritated or particularly sensitive, prompts Samudra. “Learn your triggers and try to work on them gradually. Do not label these emotions as 'good' or 'bad'; believe that these are transient feelings and shall pass. When at leisure, look for things that help you ground yourself—be it taking a long bath, watching your favourite rom-com, catching up with your best friend or just taking a nap. It is absolutely recommended that you find time for yourself throughout the day to reset and rejuvenate,” she furthers. 

Samudra also encourages women’s family members to stay informed. “Look for resources where you can learn about signs of perimenopause or menopause. Ask questions related to how they are feeling or what is going on in their minds; be kind to them, even if they do not seem like their former selves. Most importantly, try to remind them that you support and love them and that it is okay for them to lash out sometimes. Create a safe environment for them to feel what they are feeling without shame, try to take over responsibilities and allow them to rest on particularly worse days,” concludes Samudra.

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