What Is Perimenopause? Symptoms and Pregnancy Possibility

By (gynecologist), BSc (embryologist), BSc, MSc (embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 07/01/2020

Perimenopause, commonly referred to as premenopause, is the natural transition period of a woman towards the end of her fertile years: the menopause.

During this stage, which usually begins around age 45-50, a woman's menstrual cycles begin to alter and menstrual irregularities appear, along with other characteristic symptoms.

Despite this, women still experience ovulation during perimenopause and therefore pregnancy could occur if the necessary precautions are not taken.

Perimenopause or premenopause?

The terms perimenopause and premenopause are normally used in a different manner to describe the same process: the pre-menopausal stage.

However, the two concepts don’t mean exactly the same thing. We will explain the differences here:

Premenopause
This is the stage before the last menstruation of a woman and can last various years. Generally, premenopause begins when a woman’s ovarian reserve begins to decrease. Most women experience this follicular depletion from the age of 40 onwards.
Perimenopause
This is a shorter and more specific phase, ranging from 2-3 years before the last menstruation to 1 year after the last period bleeding. This phase is characterized by the appearance of pre-menopausal symptoms.

It should be reminded that the menopause itself refers to the last menstrual bleeding in a women’s life, a fact that occurs from 51 years onwards on average.

12 months in a row must pass without any further bleeding to confirm that this menstruation is definitely the last one. This moment means the end of the perimenopause and is the beginning of the postmenopausal stage of a woman.

Fertility issues

The onset of the pre-menopausal stage is determined by the hormones that regulate the menstrual cycle: estrogen and progesterone. These hormones are produced by the ovaries since the beginning of puberty.

As menopause approaches, the amount of these hormones secreted progressively decreases due to ovarian aging, which causes fluctuations in the menstrual period.

The reduction of estradiol is the main cause of pre-menopause and what causes the most characteristic symptoms.

Other changes which happen in the female reproductive system with the start of perimenopause, in parallel to the decrease in hormone production, are as follows:

  • Ovaries release eggs less regularly.
  • Fertility decreases.
  • Menstrual cycles become shorter.
  • There is also a decrease in testosterone.

If you want to know more about how the menstrual cycle works and female fertility, you can read on here: What happens in the menstrual cycle?

Symptoms

There are multiple and different symptoms a woman may have when menopause starts. However, the following are most characteristic symptoms of perimenopause, that is, the previous fase to menopause:

  • Irregular menstruation: menstrual cycles are altered, both in their length and in the amount of bleeding. There are two types of perimenopause: early, when menstruation is more than seven days early or late; and late, when at least two periods are missed and there is a 60-day interval between periods.
  • About 65% to 75% of women experience hot flashes, with hot flashes being most intense during late perimenopause.
  • Sleep disorders caused by hot flashes and night sweats, resulting in fatigue, irritability, insomnia, etc.
  • Loss of sex drive due to lack of estrogen, resulting in vaginal dryness, irritability and itching in the intimate area.
  • Mood changes: the hormonal disturbance also leads to a very strong emotional imbalance. This can lead to sadness, depression and irritability in women.
  • Symptoms similar to those experienced in PMS, such as breast pain, abdominal swelling, and headache
  • Urine leaks when coughing or sneezing due to a weakened pelvic floor

It must be taken into account that each woman can manifest these symptoms in a different way, more or less intensity.

Treatment

In view of the appearance of the pre-menopausal symptoms mentioned in the previous section, it is recommended that the woman makes a visit to the gynecologist to start taking the appropriate measures.

In case it is necessary, and if the woman is still young or the symptoms are very strong, the doctor will apply a hormone replacement therapy (HRT) to supply the hormone deficit and to alleviate the discomfort associated with this pre-menopausal stage.

On the other hand, it is also recommended that women make some small variations in their lifestyle to feel better at this new phase. We will discuss them below:

Nutrition habits
A balanced diet with fibre, low-fat meals, antioxidant foods and foods rich in vitamin C, vitamin B, potassium, magnesium, iron and calcium. Some of the most recommended foods are: mango, fish, eggs, nuts, milk, yogurt, broccoli, spinach, apple, banana, and pineapple.
Sports
Staying active is very important to avoid depression, help a woman fall asleep and help her get enough rest. It is also recommended to do exercises to strengthen the pelvic floor and avoid urinary incontinence.
Natural Remedies
Some plant foods or legumes contain natural phytoestrogens, such as soy and hops, which help balance hormone levels. Many of them are herbs that can be taken as an infusion or as a supplement, such as ginseng, wild yam, soy isoflavones, Valerian root, dong Quai, or black cohosh.

Before starting any vitamin complex or herbal treatment, it is important to consult the doctor, as he or she can best guide the patient on how to improve her quality of life.

Pregnancy in perimenopause

As we have already indicated, the entry into menopause cannot be confirmed until at least 12 months have passed without menstruation.

During perimenopause, sporadic and random ovulations occur that are difficult to predict. Therefore, natural pregnancy is not yet 100% excluded if the couple has unprotected sex.

However, due to the low ovarian reserve and the aging of the reproductive system, it is difficult for women to become pregnant. In fact, those women who seek a fertility clinic to become mothers at an advanced maternal age or entering perimenopause must resort to egg donation in the vast majority of cases.

IVF with donor eggs is probably the most confusing of all fertility treatments, and oftentimes, a misleading one. Transparency is one of our strict selection criteria when it comes to recommending fertility clinics to our readers. You can create your Fertility Report now to filter clinics based on our selection criteria and get an individual report based on your preferences with answers to your queries and most importantly, to prevent potential frauds.

Thanks to egg donation and hormonal treatment to thicken the endometrium, today many women become pregnant at an age close to 50 years. You can read more about this here: Can I become a mother at 50?

FAQs from users

Is pregnancy possible during perimenopause?

By Dra. Elisa Pérez Larrea (gynecologist).

Perimenopause is the period around menopause, which starts at 12 months without a period. During this period, a woman may notice some symptoms, including menstrual irregularities, with a general tendency for cycles to be longer. In addition, other symptoms may appear such as hot flashes, insomnia or vaginal dryness, among others, due to the decrease of estrogen levels in the blood.

As far as fertility is concerned, we consider that women have the possibility of spontaneous pregnancy until the definitive arrival of menopause, although it is true that the chances of a spontaneous pregnancy decrease considerably as the woman's age advances and she approaches menopause. The reason for these difficulties in conception is due to the decrease in the number of eggs, which is accompanied by a worsening of egg quality and an increasingly high percentage of aneuploidies or genetic alterations in the remaining eggs. All these factors make spontaneous pregnancy and even pregnancy with Assisted Reproduction techniques extremely difficult.

In many cases, the possibility of pregnancy with one's own eggs is so low that the only option for achieving it is egg donation. This technique solves the main factor that makes pregnancy difficult during perimenopause, which is the oocyte factor, offering many possibilities of pregnancy to women who are in this period.

How long does premenopause last?

By Zaira Salvador BSc, MSc (embryologist).

The pre-menopausal stage can be longer or shorter depending on the woman. Some start before age 40 and can be as long as 10 years with pre-menopausal symptoms. Others only stay a few months and never have their periods again.

However, perimenopause usually lasts 2 or 3 years for women.

What are the symptoms of premenopause?

By Zaira Salvador BSc, MSc (embryologist).

The most common symptom in perimenopause is the alteration of the menstrual cycle caused by a decrease in female sex hormones, estrogen and progesterone.

On the other hand, hot flushes, a heat wave on the face and torso that lasts about 2-4 minutes, are also very common.

Can you get pregnant with donor eggs after menopause?

By Rebeca Reus BSc, MSc (embryologist).

Yes, it is possible to have a baby after menopause, a phenomenon known as postmenopausal pregnancy. Menopause is defined as the cessation of menstruation, which means the loss of ovarian activity. However, this does not affect the uterus, which is still functional, and able to carry a pregnancy. This is perfectly possible with either donor eggs from a young girl, the woman's own previously frozen eggs, or the couple's frozen embryos, if any.

At what age does pre-menopause start?

By Zaira Salvador BSc, MSc (embryologist).

Most commonly, pre-menopause appears at age 45-50, since the average age of menopause (last period) in women is 51.

What are the hormonal values of women in premenopause?

By Zaira Salvador BSc, MSc (embryologist).

The hormones used to measure ovarian reserve and help determine if a woman is nearing menopause are FSH and AMH (anti-müllerian hormone).

In general, FSH values above 10 mIU/ml correspond to a decrease in ovarian reserve. For AMH, a value below 0.6 ng/ml indicates a low ovarian reserve.

You can obtain more detailed information on this subject in the following article: What Is the Function of Anti-Müllerian hormone?.

Suggested for you

Menopause is a new stage in a woman's life that marks the end of her reproductive years. For more information related to this topic, you can read more here: Menopause in women.

If you want to get pregnant but have premenopausal symptoms, the best treatment for you is egg donation. If you want to know what this treatment consists of, we invite you to read on here: Egg donation-IVF.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

Dra. Elisa Pérez Larrea
Dra. Elisa Pérez Larrea
Gynecologist
Dr. Elisa Pérez Larrea is a graduate in Medicine and Surgery from the University of Zaragoza and a specialist in Obstetrics and Gynecology from the University of Oviedo. She also has a Master's degree in Human Reproduction from the Complutense University of Madrid. More information about Dra. Elisa Pérez Larrea
Licence number: 203311163
 Laura Rollán Guilén
Laura Rollán Guilén
BSc
Embryologist
Bachelor's Degree in Biology from the University of Valencia (UV). Specialist in Human Assisted Reproduction. Writer of scientific contents. More information about Laura Rollán Guilén
 Rebeca Reus
Rebeca Reus
BSc, MSc
Embryologist
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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