Most women reach menopause — or the end of menstruation and female fertility — in their early fifties, after a transitional phase called perimenopause. The hormonal changes that drive the passage toward this natural “change of life” typically begin in a woman’s forties.
In this month’s blog, Dr. Rania Ibrahim and our women’s wellness team at New Beginnings OB/GYN take a look at how your reproductive hormones change during perimenopause — and how those changes can give rise to shifts in gynecological health as a result.
Perimenopause is the “rocky road” to menopause, or the end of your reproductive years. Marked by gradually declining levels of key female hormones, this transitional stage of life can affect individual women in vastly different ways.
Perimenopause frequently begins in a woman’s early- to mid-forties, but can start as early as your mid-thirties or as late as your mid-fifties. This natural transition lasts an average of three to four years before periods stop completely, but it can also be over in a few months — or it can last as long as a decade.
Perimenopause causes your ovaries to gradually produce less estrogen and progesterone. Progesterone levels typically decline earlier and more consistently than estrogen, leading to an imbalance. Overall estrogen levels trend downward, but can also unpredictably surge higher than normal before reaching one final, steep drop-off.
Your hormone levels don’t decline smoothly in perimenopause. Instead, they fluctuate wildly — sometimes spiking and sometimes crashing. This uneven “hormonal chaos” is what can cause widespread physical and emotional shifts in many women.
Erratic hormone levels may trigger vasomotor symptoms (hot flashes, night sweats), mood changes (anxiety, depression, irritability), cognitive effects (brain fog), physical effects (dry skin, thinning hair), sleep disruption, slowed metabolism, weight gain, accelerated bone loss, and higher blood pressure.
The gynecological shifts of perimenopause are wide-ranging, too, encompassing everything from changes in menstruation and fertility to genitourinary health impacts on pelvic support as well as urinary, vaginal, sexual well-being. These include:
Erratic hormone levels can make your periods erratic, too. They may become shorter, longer, heavier, or lighter; they may also become less frequent, or you may skip some months entirely. While such fluctuations are normal, excessive heavy bleeding should always be evaluated.
Pregnancy is still possible in your forties, and as long as you’re getting your period, you should continue to use contraception if you don’t want to get pregnant. However, this is also when ovulation becomes less predictable, the quality and quantity of your eggs decline significantly, and your natural fertility drops.
Lower estrogen can weaken the pelvic floor “muscle sling” that supports your urinary tract, bladder, and other pelvic organs. Urinary stress incontinence, or leaking when coughing or sneezing, is a common consequence of this perimenopausal change.
At the same time, declining estrogen can also destabilize your urethra and bladder tissues, leaving you more vulnerable to urinary tract infections (UTIs), urinary urgency (feeling the need to go immediately), and occasional leakage.
Estrogen loss can also weaken the connective-type tissues that make up your vaginal canal, leaving them thinner, drier, and less “elastic.” This is what makes pain or discomfort during intercourse (dyspareunia) more common among women in perimenopause.
Declining estrogen also alters the vaginal microbiome, increasing the likelihood of UTIs and other infections, such as bacterial vaginosis (BV).
Major shifts in estrogen and progesterone, as well as androgens, can coincide to reduce sexual desire and arousal during perimenopause. Vaginal dryness and sexual discomfort can further exacerbate low libido problems.
Because hormone levels can fluctuate greatly during perimenopause, standard blood, urine, or saliva hormone tests aren’t reliable indicators of this transitional phase. Instead, Dr. Ibrahim diagnoses perimenopause based on your age, period changes, symptoms, and medical history.
If perimenopausal symptoms are disruptive, you have options: You may benefit from healthy eating, regular exercise, and other lifestyle changes, a symptom-specific treatment like vaginal estrogen or moisturizers, or systemic hormone replacement therapy (HRT).
For expert help in perimenopause management, schedule a visit with Dr. Ibrahim at New Beginnings OB/GYN in Shenandoah, Texas, today.