Going through the perimenopausal stage

Perimenopause, or menopause transition, is the stage of a woman's reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogen. It usually starts in a woman's 40s, but can start in the 30s as well.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, this decline in estrogen accelerates. At this stage, many women experience menopausal symptoms.

How to know if I am in the perimenopausal stage?

We have different ways to discard if we are in perimenopause stage:

Age: There are no data on women younger than 45 years, even though by that age, 40% will have started or completed the menopause transition (32% perimenopausal, 8% postmenopausal). By 50 years old, 75% will have started or completed the menopause transition (38% perimenopausal, 37% postmenopausal). By 55 years old, only 2% of women are premenopausal.

Self-assessment. Several factors are associated with menopausal symptoms:

Hot flashes: 50 to 80% of North American women experience hot flashes; only 6% experience flashes that last longer than 6 minutes. There are cultural differences because only 10% to 20% of Indonesian and 10% to 25% of Chinese women report hot flashes. Night sweats are common and can interfere with sleep.

Vaginal dryness: An estimated 18% to 21% of women experience dryness.

Variable sexual interest: Most of an Australian sample of women reported no change; 31% indicated a decrease, and 7% reported an increase in sexual interest. This aspect is obviously multifactorial and could be associated to physiologic changes.

Depressed mood: Although not necessarily caused by menopause, North American and British cohorts reveal higher rates of depression among menopausal women who have previously suffered from depression. Considerable anecdotal evidence indicates vulnerability to mood changes and irritability.

Age of mother’s menopause: Women with premature (40 years) and early (45 years) menopause report that their mothers were significantly younger at menopause.

Hysterectomy status: Some evidence shows that women who have had hysterectomies with preservation of the ovaries experience more severe menopausal symptoms.

Laboratory tests: Several laboratory tests have been used to identify women’s menopausal status.

Follicle-stimulating hormone (FSH): High FSH levels indicate menopausal changes in the ovaries. These levels can fluctuate considerably each month depending on ovulation.

Estradiol: In late or postmenopausal women, estradiol levels decline, but as with FSH, values can vary greatly.

In a recent research Dr. Bastian from The Department of Internal Medicine, and Drs. Nanda and Smith from the department of Obstetrics and Gynecology of Duke University found that the prior probability of perimenopause is directly related to a woman's age. After considering age, the following yielded the greatest positive likelihood ratios are: self assessment, specifically symptoms of hot flashes, night sweats, vaginal dryness, and high follicle-stimulating hormone levels.

As a conclusion, current evidence confirms that no single item in the history or laboratory tests can definitively diagnose perimenopause. Clinicians should predict perimenopause based on patient’s age and menstrual history without relying on laboratory test results.