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Perimenopause means literally "around menopause" and is a transitional stage of two to ten years before complete cessation of the menstrual period. Perimenopause usually appears in women from 35 to 50 years of age. This stage of menopause is characterized by hormone fluctuations, which cause the typical menopause symptoms like menstrual irregularity.

Perimenopause is defined as the transitional time between the first irregular menstrual periods to the last one. As seen in the previous chapter (premenopause) the “normal” menstrual cycle is the hormonal balance between estrogen, progesterone, FSH and LH. The fluctuations of these hormones cause the symptoms of perimenopause.

These hormonal fluctuations vary among women, and consequently, each woman will get to know perimenopause differently. It is said that a woman usually has an experience similar to her mother's, but no woman can predict which symptoms she will experience or when she will experience them.

Pregnancies, birth control pills, the age when a woman began to menstruate, and breast-feeding have no impact on the beginning of perimenopause. The only reliable factor is smoking. If a woman smokes, she can count on starting perimenopause 1-2 years earlier than women who don't.
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The follicles remaining in the ovaries of a perimenopausal woman become less sensitive to stimulation of FSH than they were during the child bearing age. There will occasionally be abnormal cycles, in which the follicle does not fully develop.

When a follicle does not develop properly, it secretes less estrogen and FSH levels rise. Insufficiently low estrogen levels may fail to trigger the LH surge, which is supposed to rupture the follicle. Consequently, the egg isn't released and there will be a cycle without ovulation ( termed an anovulatory cycle).

Meanwhile, progesterone cannot be released at the appropriate time, and the lack of estrogen gives rise to all the familiar perimenopause symptoms.

In perimenopause the number of such abnormal cycles without a mature follicle increases. Finally, there will be cycles in which no follicle develops at all.

The decline of progesterone and estrogen results in a general shortening of the length of the cycles. These irregular cycles are often the first signs that perimenopause has started.

Normal cycle:


Anovulatory cycle:

  In summary, perimenopause can best be described as the time when a body gets
ready for menopause.
Premenopause >>> Perimenopause >>> Menopause >>> Postmenopause

REFERENCES:  Pat Camillo. "Your Inner Estrogen: An Individualized, Natural Approach to
Understanding and Balancing Your Hormones before and after Menopause!".
Neil B. Shulman. "Healthy Transitions: A Woman's Guide to Perimenopause,
Menopause, & Beyond".
Nisha Jackson. "The Hormone Survival Guide for Perimenopause: Balance Your
Hormones Naturally".
Ann Louise Gittleman. "Before the Change: Taking Charge of Your Perimenopause".
Nancy Lee Md Teaff. "Perimenopause--Preparing for the Change,
Revised 2nd Edition: A Guide to the Early Stages of Menopause and Beyond".

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Providing information on: Menopause Stages, Premenopause, Perimenopause, Menopause, Postmenopause.