Understanding Perimenopause

What is perimenopause? Perimenopause represents the period of time that lasts about four to seven years before a woman actually undergoes menopause. It typically occurs around ages 40 to 55, but may even occur earlier. During this time, menstrual cycles may become irregular, shortened, lengthened, or even not occur for up to one year.

How is it different from menopause? It typically occurs earlier than the average age of natural menopause, age 51. While menopause marks the end of ovarian estrogen production secondary to the loss of eggs present in the ovaries, perimenopause marks a period during which functional eggs may be diminished in number, but are still present. During perimenopause, maturing ovaries often do not respond as easily as when a woman was in her 20s and may need additional stimulation from the brain and its command centers so that existing eggs may develop, produce estrogen and undergo ovulation. While estrogen levels are very low after menopause, they actually can undergo huge fluctuations during perimenopause secondary to changes in stimulating factors from the brain and its command centers. My mentor, Dr. Nanette Santoro, has shown that ovarian estrogen production does not gradually decline with age. Instead, the perimenopausal ovary has great fluctuations in its estrogen production with very high highs and very low lows. This resulting estrogen “roller coaster” can cause symptoms such as tremendous hot flushes, sleep disorders etc.