PERIMENOPAUSE
The transition phase leading up to your final period, or ‘menopause’, is known as perimenopause.
Generally, this is a time when the ovaries begin to produce less oestrogen due to declining egg numbers. The gap between periods initially shortens before periods 'space out' and eventually stop altogether. The perimenopause usually starts in your forties but can occasionally begin earlier. Symptoms vary between women and can last for a few months or even years before periods finally stop. The average length of the perimenopause is five years (ranging from one to ten years). Once you have not had a period for one year, you are menopausal.
Tests such as blood tests or ultrasound scans are generally not indicated, as perimenopause can be diagnosed from your history alone. Furthermore, it is impossible to predict when your last period is going to be.
In perimenopause, ovarian function is intermittent and unpredictable. Normally, regular ovulation produces a hormone called Progesterone in the second half of the cycle. Progesterone stabilises the lining of the womb and stops it from building up. When ovulation becomes less frequent, the lining can build up in the absence of progesterone, leading to erratic, unpredictable and occasional heavy bleeding.
If you are experiencing symptoms of perimenopause that are interfering with your work or wellbeing, then you should see your GP, who can discuss this further with you. Perimenopause symptoms include abnormal uterine bleeding, hot flushes and night sweats, sleep disruption, mood disturbance, vaginal dryness, reduced sex drive (low libido), or sexual dysfunction. It is worth mentioning that sometimes these symptoms may be caused by other conditions, such as thyroid disease. Some women may not realise their symptoms are connected to the menopause transition and tolerate the changes. It is important to see your GP if the pattern of your bleeding deviates from the normal perimenopausal change.
Although some women opt not to have hormonal support during perimenopause, this is a very useful treatment to consider, especially if your symptoms are interfering with your quality of life. In perimenopause, as the ovaries still have some function, unpredictable bleeding can occur. Your GP, however, can discuss options that can help manage the bleeding, such as a levonorgestrel-releasing intrauterine system.
In women where unpredictable bleeding is a troublesome symptom of perimenopause and menopausal hormone therapy (MHT) is not required, a range of hormonal, non-hormonal, and surgical options (such as endometrial ablation, a minimally invasive surgical procedure designed to remove the endometrial lining) may be considered.
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