Perimenopause, What is it and What are the Signs?


As women age, you often hear references to the almighty biological clock.  One of funniest scenes on this topic came from the movie “My Cousin Vinny.”  As Joe Pesci is engrossed in studying legal books, Marisa Tomei anxiously paces back and forth across the porch.  When Joe Pesci finally inquires as to the cause of her anxiety, Marisa Tomei reveals her impatience with the fact that they have not gotten married yet.  As Marisa Tomei makes her point, she methodically stomps her foot against the wooden porch to show that her biological clock is “ticking like this.” 

Indeed, a woman’s biological clock seems to tick faster and faster with each passing birthday.  The biological clock metaphor is directly linked to perimenopause, or the natural transition to menopause.  Perimenopause means “around menopause” and commonly begins a few years before the onset of menopause, which marks the end of a woman’s childbearing years.  Perimenopause is sometimes called the menopausal transition and generally starts in a woman’s 40s.  However, perimenopause can begin in a woman’s 30’s or even before that time.

Perimenopause lasts for approximately 4 years, but can vary widely across women.  Some females experience perimenopause for a few months, while others experience it for years.  During perimenopause, the level of estrogen fluctuates up and down as the ovaries steadily produce less and less estrogen.  A woman’s menstrual cycles may increase or decrease and there may be certain cycles where the ovaries do not release an egg.  When a woman has not had a period in 12 months, perimenopause is officially over and menopause has begun.  During menopause, a woman’s ovaries stop releasing eggs altogether. 

There are several common signs and symptoms that can signal the onset of perimenopause.  Women can experience intensified premenstrual symptoms and irregular periods, as ovulation becomes more erratic.  Women may experience an increased or decreased length of time in between periods, changes in their menstrual flow, or can skip periods all together.  A duration of 60 days or more without a period can signal a late perimenopause phase.

Women may experience hot flashes that vary in intensity, duration, and incidence.  Hot flashes often instigate sleeping difficulties, as women can experience night sweats.  Sleeping may become more difficult even without hot flashes due to other hormonal changes.  Mood swings and irritability during perimenopause are widespread and women may be at higher risk for depression.

Women can experience changes to sexual functioning, as arousal and desire may change.  Women may have a lower libido or sex drive and can also experience discomfort during sexual intercourse.  As estrogen decreases, vaginal tissues become less lubricated and elastic, making intercourse painful at times.  These changes can also trigger vaginal and bladder problems.  Women may experience the need to urinate more frequently in addition to leaking urine while coughing or sneezing.  Urinary incontinence can be linked to a lower tissue tone, while also leaving women more susceptible to urinary or vaginal infections.

Perimenopause is diagnosed by a physician based on a woman’s symptoms.  As hormone levels greatly vacillate during this time period, periodic blood tests can be useful for comparison.  It is important to note that a woman can still become pregnant during the perimenopause stage, despite a decline in fertility. 

There are interventions and treatments that can help to alleviate the symptoms of perimenopause.  Low dosage birth control pills can help to mitigate hot flashes.  Exercise, improved quality and duration of sleep, and healthy nutritional habits can help as well.  Increasing calcium, consuming less alcohol, and taking a multivitamin may also help women to feel better and to improve overall well being.  Antidepressants or professional counseling may be recommended for women struggling with significant mood swings or bouts of depression.    

As women pass through perimenopause and finally hit menopause, the clock stops ticking and a woman’s child bearing days have officially concluded.  “My Cousin Vinny” utilizes humor to convey Marisa Tomei’s anxieties about entering perimenopause.  Marisa Tomei felt the pressure of her biological clock “ticking like this”, which most women at one point or another can likely relate to. 

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Tracy is a Licensed Professional Counselor and is a clinical supervisor for the Community YMCA, Counseling & Social Services branch. Tracy has over 12 years of experience working in many settings including partial care hospitalization and intensive outpatient programs, community agencies, group practice, and school-based programs. Tracy works with clients of all ages, but especially enjoys working with the adolescents. Tracy  facilitates groups using art therapy, sand play and psychodrama.
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