Perimenopause Syndrome Causes Symptoms and Treatments

If you are a woman in your forties or early fifties, chances are you’re experiencing changes in your monthly menstrual cycle, not to mention a myriad of uncomfortable physical symptoms.

The signs and symptoms associated with menopause occur over a period of time called perimenopause, which literally means “around menopause.” For many women, the first sign of perimenopause is an erratic menstrual cycle—skipped, lighter or shorter periods. The hallmark of this countdown to menopause is a fluctuating level of the female sex hormones, estrogen and progesterone. Estrogen highs can bring on PMS-like symptoms including mood swings, fluid retention and headaches, whereas estrogen lows promise hot flashes, vaginal dryness and forgetfulness.

You’re considered to have reached menopause when a year has passed since your last period. Although it can vary, the average age at which an American woman hits menopause is 51. It’s at this time that women enter postmenopause, the phase of life in which the risk for heart disease, osteoporosis and breast cancer increases. I have devoted a separate chapter to deal with each of these health concerns associated with the postmenopausal years.

Perimenopause Syndrome Causes Symptoms and Treatments Photo Gallery

Your Menstrual Cycle

In order to understand what’s happening to your body during menopause, it helps to know how your hormones normally act during the childbearing years. During the early part of your monthly cycle, your ovaries produce estrogen. Your brain responds to this increasing estrogen level by telling your pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones, in turn, act on your ovaries. FSH causes egg follicles to develop and release estrogen. When your circulating estrogen rises to a critical level, the pituitary gland releases a surge of LH. This influx of LH causes ovulation by telling the follicle to release a mature egg.

The empty egg follicle turns into something called the corpus luteum, a gland that produces progesterone after ovulation. During the last 14 days of your menstrual cycle, progesterone prepares your body for pregnancy by thickening the lining of your uterus. If conception does not occur, the corpus luteum becomes smaller, estrogen and progesterone levels fall and your uterine lining sheds, resulting in your period. Lower levels of estrogen and progesterone signal your pituitary to release FSH and LH and the cycle continues.

What Causes Perimenopause?

As you get older, your supply of eggs and follicles dwindles. Fewer follicles means that your ovaries are producing less estrogen. Lower levels of estrogen and progesterone tell your pituitary gland that it’s time to release FSH and then LH. But now your ovaries are unable to respond to FSH and LH. They can’t produce much estrogen and release an egg and, as a result, your brain keeps telling your pituitary gland to make your ovaries ovulate. So your pituitary gland keeps releasing more and more FSH. This constant production of FSH can trigger hot flashes. With no egg being released from your ovary, there’s no corpus luteum and consequently no progesterone secretion. Without progesterone your body won’t shed its uterine lining and you’ll miss a period. With lower levels of hormones, your periods will also become shorter and eventually they will cease.



Hot flashes are, without a doubt, the most commonly reported symptom of menopause; in fact, they occur in 60 to 85 percent of North American women. It’s estimated that 10 to 15 percent of women have them severely enough to interfere with their daily life. On average, hot flashes persist for three to five years, but in 50 percent of women they last up to five years.

There is often a warning signal or aura that precedes a hot flash. A hot flash may begin as pressure in the head, a headache or a wave of nausea. A sensation of heat then starts in the head and neck, and spreads to the torso, arms and entire body. Sweating follows and is most intense in the upper body. Clothing may become soaked, particularly if hot flashes occur during sleep—night sweats are another term for hot flashes that occur during sleep. Chills or shakes may follow as a result of a drop in body temperature. The entire event can last a few seconds to several minutes, and it may take an hour for chills to subside.

Scientists believe that when estrogen levels drop, your body’s temperature control system malfunctions. It senses that you are too hot, even though your body temperature is normal, and attempts to cool you down by increasing your heartbeat and sending more blood to your skin, especially in your head and neck. Blood vessels in your skin then dilate, which causes heat to escape from your body. As a result, your skin flushes and you sweat. Hot flashes are actually your body’s way of cooling you down.


Often night sweats cause disrupted sleep. While many women have no difficulty going back to sleep, some simply cannot. Night after night of little sleep will leave you exhausted, and that’s when other perimenopausal symptoms can take over your life. Fatigue can lead to irritability, depression and forgetfulness. Many experts believe that there is something else going on to interrupt sleep, something that’s not related to hot flashes during sleep.


Most women describe the mood swings of perimenopause like those of premenstrual syndrome (PMS). They talk about crying at the drop of a hat, or blowing up at a spouse for no good reason. These feelings can be disruptive to both your personal life and work life. Not all women experience mood swings during the transition years. Studies show that if a woman has had a hysterectomy she’s more likely to feel depressed. Women who are irritable and cranky during PMS tend to experience those same mood swings during perimenopause.

Mood swings are partly due to a loss of estrogen. Although we don’t fully understand what’s going on in the body, we do know that natural chemicals in the brain, called neurotransmitters, respond to hormonal fluctuations of the menstrual cycle. Some of these chemicals stimulate nerves that make us more alert. Others interact with nerves to calm us down. The hormonal ups and downs of perimenopause may also make us more sensitive to feelings and emotions. You’ll find nutritional strategies that may help you manage mild to moderate depression presented in chapter 12, “Depression.”

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