Perimenopause is a stage in the menstrual cycle that marks the end of the reproductive years and makes the body enter the natural transition to menopause. This is a natural stage in the aging process, which comes with its own set of hormonal complications that can linger for long or short periods than usual. Other symptoms are similar to menopause. Let’s look at the signs and management of perimenopause in detail.

Phases of female fertility
Female fertility is divided into three phases which include:

• Pre-menopause
  This is the stage in which the female has full ovarian function and is regularly ovulating and producing estrogen.
• Perimenopause
  This is an unpredictable stage in which the periods can be irregular, the ovulation cycle may fluctuate, and there could be changes seen in the production of estrogen. Even the symptoms of the menstrual cycle may be disrupted.
• Menopause
  After the fluctuation period, there comes a stage where the ovaries stop producing eggs. During this time, a woman does not get regular periods for about twelve months.

Noticing first signs
It is observed that perimenopause signs and symptoms are experienced about four years before menopause. Since the average age of menopause is around 51 years, most women start experiencing perimenopause in their 40s. Usually, getting an idea about the perimenopausal stage can be done by speaking to the mother, as the female child may also follow the same timeline for it. However, if the mother got a hysterectomy or the female had any cancer treatment during their childhood that involved chemotherapy and radiation in the pelvic area, then the symptoms may appear sooner than usual. Unhealthy lifestyle choices, too, can lead to early menopause, an average of two years earlier.

Symptoms of this stage
There are several signs and symptoms, and it is not necessary that every female will experience them all together. Due to the declining estrogen levels in the body, several complications arise, and they are:

• Deflated libido
  Sexual desire decreases in both men and women as they age. However, it is much higher in women due to the drastic decrease in hormonal levels. Due to lower estrogen levels, the females also experience dryness in the vagina, which makes it extremely uncomfortable and painful to have intercourse; this also leads to a decreased libido.
• Hot flashes
  Almost 80 percent of menopausal women going through this stage experience hot flashes anytime during the day or night. It is a condition in which the brain is unable to regulate the internal temperature of the body; this is a response to the decreased estrogen levels leading to this lack of temperature adjustment. Hot flashes usually feel like a sudden burst of increased temperature in the body, leading to sweat and dizziness. Some can also experience this at night while sleeping and wake up drenched in sweat – these are called night sweats. This is a common symptom of perimenopause; hence, make sure to visit a doctor to rule out any other conditions like a thyroid disorder.
• Mood swings
  This can be extremely frustrating and hard to manage. Since there is a drastic drop in estrogen hormone levels, the body goes through a withdrawal of sorts. This leads to mood swings like feeling irritable, anxious, depressed, or sudden bouts of happiness and contentment. The body goes through a shock to re-adjust to lower hormone levels.
• Sleepless nights
  This is also a common symptom for those experiencing perimenopause. Hot flashes, night sweats, and mood swings can all cause emotional and mental discomfort. This can lead to complications like sleepless nights and other mental health illnesses like depression or anxiety. It is important to have a good support system to help deal with the transition to get holistic care.

While bleeding unexpectedly or experiencing longer period cycles is usual, it is advised to see a doctor and rule out other diseases like uterine cancer or fibroids, which also have similar symptoms.

Treatment options
Since there is no definitive way to stop perimenopause, there are only management options that can help ease the discomfort in some women. The doctor can suggest specific treatment plans depending on the symptom and their effects on the body. This can include:

Hormone therapy
This helps regulate the estrogen levels in the body and can by itself manage uncomfortable symptoms.

Vaginal estrogen treatments
This can be helpful for vaginal dryness and discomfort, which also leads to decreased libido.

If you are experiencing any severe mental health complications, the doctor may suggest you seek professional help through a psychiatrist and a therapist. A gynecologist may also help if the bleeding is too erratic and persistent.

Management options
Certain lifestyle choices may help deal with the symptoms. An exercise plan can help reduce irritability. Movement classes like yoga or even dance help stabilize the mood and the overwhelmed mind during natural changes that occur in the body. Join a support group, if needed, to help feel recognized.