Irregular periods. Night sweats. Vaginal dryness. What gives?  If you’re in your 30s or 40s, you could be in perimenopause – that two-to-10-year period before the onset of  menopause. Our grandmothers called it “the changes.”
During the transitional years leading up to menopause our hormones begin going whacky. The times between periods may get shorter or longer, and blood flow may be lighter or heavier. We suddenly feel hot or flushed for no apparent reason and may exhibit odd mood swings. Extra pounds begin to pile on in our abdomen and hips, and it’s harder to lose weight.

These and other symptoms, such as insomnia, fatigue, low sex drive and headaches, are the result of fluctuating and decreasing hormone levels, including estrogen, progesterone, melatonin and growth hormone. Fertility decreases (although you can still get pregnant), and we begin to lose estrogen’s protective properties against osteoporosis, heart disease and stroke.

Most women start feeling the effects of perimenopause in their early to mid-40s, but those who will reach menopause at 40 can begin to experience these symptoms at 30. (A personal note: My mother began “the changes” at 34 and reached menopause at 41.)

What’s normal?

The normal range for the onset of menopause (defined as the absence of a period for 12 consecutive months) starts at age 40, but the average age for American women is 51. About 2 percent to 3 percent of women become menopausal before age 40, which is referred to as premature ovarian failure.

When you will begin to experience perimenopausal symptoms and reach menopause mostly depends on genetics. Your biological clock is likely to approximate your mother’s. Besides heredity, factors that researchers say increase the risk for early menopause include smoking, alcohol abuse, and never having delivered a baby. Early menopause is also more common in women who have undergone chemo or radiation therapy or have had their uterus removed.

Perimenopause is a normal part of the reproductive process as it winds down. Many women do not find the symptoms severe enough to see a doctor. However, the Mayo Clinic advises women to call their gynecologist if bleeding is extremely heavy (you’re changing tampons or pads every hour); bleeding lasts more than eight days or occurs between periods; or periods regularly occur less than 21 days apart.

HRT: Yes or No?

Various treatments have been touted to relieve severe symptoms associated with perimenopause. Hormone replacement therapy (HRT), which consists of estrogen alone or estrogen and progesterone combined, is very effective for relieving hot flashes and other symptoms and for preventing osteoporosis.

However, various studies have shown that the risks may outweigh the benefits. These therapies are associated with increasing the risk for one or several of the following: heart attack, stroke, breast cancer and endometrial cancer.

Other hormonal treatments include vaginal estrogen creams and the vaginal estrogen ring to alleviate vaginal dryness, itching and burning as well as urinary problems. The estradiol vaginal ring is also used to treat hot flushes. These products deliver a lower dose of hormones than pills, patches and injections. Nevertheless, they should be used for the shortest amount of time necessary.

Some physicians prescribe oral contraceptives. The hormones in the pill can help to regulate periods and can provide relief from hot flashes as well. Oral contraceptives are themselves not without controversy and have been associated with health risks. A new review of the medical literature, however, which was published in the Journal of Clinical Endocrinology and Metabolism online Feb. 2, 2011, found no link between progestin-only birth control pills and a higher risk of heart disease. However, the authors admit study results are based on limited data and that further investigation is needed, particularly in those women already at high risk for heart disease.

It’s important to talk to your doctor about your symptoms and whether or not any hormonal treatments are appropriate for you based on your medical history and risk factors.