13 Causes of perimenopause
1. Irregular vaginal bleeding or menses
The ovaries are responsible for the production of the hormone estrogen in a reproducible pattern. As the ovaries become deficient in eggs (ova), the production of estrogen becomes less precise. Estrogen is the hormone that, when produced in the normal sequence and concentration, results in the orderly shedding of the uterine lining. If the estrogen production is not regular, the uterine lining or endometrium maybe shed off in small amounts, resulting in irregular vaginal spotting. The time interval between ovulatory events may lengthen. During that long interval, the endometrium continues to grow and may become quite thick. When the ovary finally releases another egg and subsequent shedding of a thickened uterine lining occurs, the menstrual flow may be extremely heavy and associated with severe cramps.
2. Hot flashes or flushes
Hot flashes are episodic sensations of heat rising over the neck and facial areas of a woman's body, followed by profuse sweating. They can be extremely disturbing and may result in difficulties with concentration. Hot flashes are thought to be due to transient dilation of the blood vessels near the surface of the body due to estrogen deficiency. They frequently persist for years after menstruation has ceased (i.e. a woman has experienced menopause).
3. Breast tenderness
With normal menstrual cycles, the female breasts tend to retain fluid as the next period approaches. This is in response to ongoing estrogen production, which continues throughout the cycle, but tends to diminish with approaching menstruation. As a woman nears perimenopause ovarian estrogen production becomes erratic. The breasts may become tender due to estrogen-induced fluid retention. The fact that the interval between ovulation tends to increase means that estrogen continues to be produced in large amounts between periods, and fluid retention continues until the next menstrual flow begins.
Many studies have shown that during perimenopause, the overall estrogen production by the ovaries increases, but day-to-day production may be unpredictable. On some days when estrogen production is high, a woman may experience nausea. In some individuals, this can be sufficiently severe enough to require treatment with medication.
5. Night sweats
The term night sweats refer to hot flushes that occur at night. They may occur as frequently as once an hour, and they tend to awaken women from sleep. Insomnia is a frequent accompaniment of night sweats that can, in turn, lead to irritability and depression. Difficulty carrying out normal daily tasks may occur due to the fatigue incurred because of night sweat induced insomnia.
6. Weight gain
As previously mentioned, estrogen produced erratically and in large concentrations tends to cause fluid retention. This may lead to overall swelling of the body swelling due to fluid accumulation. This fluid may contribute to transient weight gain, which may be transient. In addition, estrogen production can affect the higher brain centers, which control appetite, so as to increase hunger. It is not uncommon for women in perimenopause to gain a significant amount of body fat.
7. Decreased fertility
As a woman ages and her ovaries begin to run out of eggs, and pregnancy will become more difficult to achieve. In addition, the quality of the remaining eggs diminishes as they age. If a pregnancy is achieved, the chance of miscarriage is increased because a higher percentage of the remaining eggs is chromosomally abnormal, leading the body to reject what would otherwise be a defective embryo.
Many women feel that when their menstrual cycles become erratic they cannot conceive. Thus they do not practice contraception. As a result, these women may find that they are pregnant at a time in their life when they are not prepared to begin the odyssey of child-rearing. Many studies have shown that the elective abortion rate is highest in women who are over forty years of age, and they are faced with an unwanted pregnancy.
8. Loss of bone density
Estrogen is intimately involved in the metabolism of bone. Normally, calcium in the bones is in a state of equilibrium, in which the calcium leaving the bone at any given time is being replaced by calcium entering the bone. As estrogen production diminishes and becomes more erratic, this equilibrium is altered to result in a net outflow of calcium from bone. Over time, the bone calcium may become severely depleted, leading to the common condition known as osteoporosis or decreased bone density. Osteoporosis in elderly patients is a national epidemic, with billions of dollars being spent each year on the diagnosis and treatment of this disease.
9. Mood changes
Mood swings, depression, anxiety, and irritability occur frequently during perimenopause. A common denominator for these issues is undoubtedly the night sweats, which can cause insomnia, and disrupt the body's intrinsic diurnal rhythm. Many women find that day-to-day activities that previously could have been accomplished without difficulty become major challenges. Interpersonal relationships may suffer, particularly if the woman is unable to understand what she is experiencing and verbalize her concerns to those around her. Transient memory loss is also common.
10. Alterations of blood cholesterol levels
Low estrogen levels tend to favor an elevation of so-called low-density lipoprotein (LDL) levels. These are commonly referred to as "bad cholesterol". In addition, declining estrogen tends to also favor a decrease in high-density (HDL) lipoprotein, so-called "good cholesterol". These lipid changes may predispose a woman to heart disease.
11. Low sex drive (decreased libido)
As menopause approaches, many women find that they experience a diminished desire for sexual intimacy. Undoubtedly, chronic fatigue and altered sleep patterns play major roles in causing this problem. In addition to estrogen, the ovary normally produces testosterone, which is largely responsible for sex drive. As the woman ages, the amount of testosterone that the ovary produces diminishes, thus contributing to a decreased libido.
12. Vaginal pain during intercourse
The vagina is an organ that responds to estrogen. Normally, the vagina is lined by cells that contain water, which allows it to expand properly. This contributes to pliability that facilitates vaginal expansion during intercourse. If a woman is estrogen-deficient, the cells lining the vagina lose their hydration and become dried out. The vagina begins to shrink in diameter and length, which can result in painful intercourse. As the walls of the vagina become thinner and underlying blood vessels are ultimately become exposed, vaginal bleeding may occur when intercourse is attempted.
Blood flow to the vagina is also altered by the presence or absence of estrogen. If the estrogen levels are decreased, normal lubrication of the vagina may also be inadequate, and sexual arousal may become difficult.
13. Bladder problems
The bladder and the urethra (the tube that conducts urine outward from the bladder) are responsive to the presence of estrogen. Women with low systemic estrogen levels:
- are more likely to be susceptible to urinary tract infections (UTIs)
- may feel the need to urinate more frequently (urinary urgency)
- may have a loss of the ability to hold back the flow of urine with increased intra-abdominal pressure, such as occurs with sneezing, coughing, and heavy lifting This is due, in part, to a decrease in pressure within the urethra caused by local estrogen deficiency.