Premenopause - When does it occur, Symptoms, Treatments

What is premenopause?

Premenopause literally means ‘before menopause’. This is a time in a woman’s life when she has just begun entering a stage where estrogen levels have started dropping and her fertility is in its earliest stages of decline, even though she is still considered to be in her fertile years.

How is it different from perimenopause and menopause?

Perimenopause means ‘around menopause’. This usually begins around two to four years before menopause, even though the timeline can vary from just a few months to around eight years in some cases. Usually, this period is marked by distinct symptoms and a female enters her last stages of fertility.

After the perimenopausal phase, which marks the transition to menopause, when a person has not bled for 12 consecutive months, it marks the official arrival of menopause. But before both the menopause and the perimenopause phases, the period where hormonal shifts begin is termed premenopause. This stage is normally harder to identify.

When does it usually occur?

This phase can start off with minor hormonal changes around 8 to 10 years before menopause. So on average, the age bracket is around 38. Though the word is sometimes used to describe any menstruating phase in a woman’s life before menopause, usually premenopause indicates the time when hormonal changes begin to occur.

Are there any symptoms of premenopause?

Unlike perimenopause, premenopausal women usually do not show symptoms. However, sometimes, females can begin to experience some perimenopausal symptoms, although not as severe as when they actually enter the perimenopausal arch.

These symptoms may include:

  • Irregular periods or unpredictable ovulation owing to a reduction in the levels of estrogen.
  • Hot flushes or night sweats causing sleep disruptions.
  • A drop in the urge to have sex coupled with vaginal dryness.
  • Mood swings, irritability or anxiety due to fluctuating levels of hormones.
  • Declining fertility at its earliest stages.

How does premenopause impact fertility?

Fertility begins to decline after the age of 30, especially after hitting 35, even though it varies from person to person and it is very much possible to get pregnant still. However, when we talk of a decline in fertility, it usually means that the ovaries start producing fewer eggs

Sometimes, family history of early menopause can impact the rate at which fertility declines. So, if you are planning to start or complete your family planning, it is advisable to go for a check-up with a doctor.

How can premenopause be detected?

Due to the lack of symptoms in most cases, it is harder to detect premenopause. But, running fertility tests can provide an indication of the phase. There are a number of methods by which fertility can be tested:

  • Endometrial Thickness - Endometrium is the uterine lining that changes considerably throughout a cycle during the fertile years. In premenopausal women, the thickness of the lining varies between 2-4 mm, as opposed to 6-8 mm for fertile women, during menstruation and can go up to 16 mm at the point of ovulation which is the same as in their fertile years.
  • Blood Tests - Hormones can be tested through blood tests to determine fertility. For people with regular periods, progesterone levels can be checked which the ovaries usually produce right after ovulation. For females facing irregularities in their cycles, hormones like the Follicle Stimulating Hormone (FSH) can be measured.
  • Checkup of the Ovarian Reserve - Women are born with their ovaries containing all the eggs they will ever have throughout their lifetime. This number is around 3 lacs and the sizes are usually comparable to a grain of sand when they are babies, increasing as they age. But, the number starts to fall as a woman enters her premenopausal years and tests can be run to find out how many eggs are present to determine if she has entered premenopause.

What are the premenopause treatment options?

Usually, there are no outward symptoms of premenopause and thus treatment is not required. However, when some females show a few of the perimenopausal symptoms, the treatment options vary according to the type of symptoms they are displaying.

These can be in the form of hormone treatments, medication or home remedies.

Premenopausal women and breast cancer

Even though breast cancer can occur at any stage of a woman’s life, statistics have shown to reveal that around 7% of all women who have been diagnosed with the disease are under 40 and usually in their premenopausal years.

This is comparatively much lower than post-menopausal women where the chances are much higher. Even the reasons leading up to the disease vary between pre and post-menopausal women.

Should I visit a doctor if I have entered premenopause?

First of all, usually, it is very hard to identify if a female has entered her premenopausal years due to the lack of symptoms. And even then, a doctor’s assistance is commonly not required. However, if you show symptoms that start to bother you, you may want to opt for expert guidance.

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