1. Peri-menopause generally begins in the mid to late forties. It takes anything from four to ten years and the average age for the onset of true menopause (when periods cease completely) is 51 years.
2. Perimenopause, like puberty and pregnancy, is the path to a natural life transition, however when Cimons (2008) analyzed how it was portrayed in twentieth century newspapers and magazines, she found that the overall media presention of menopause was as a 'deficiency' disease.
3. In contrast, a wealth of qualitative research (research which questions women directly about their personal experience) now finds that most women perceive menopause to be a positive and natural life phase. Participants in studies by Mackey (2007), Chedraui et al (2007) and Cifcili et al (2009) emphasise wellness and portray menopause as a normal physiological event.
4. Women can experience the symptoms of perimenopause as mild, moderate, or severe, but lots of women have no significant menopausal symptoms at all. Although menopause marks the end of monthly periods, irregular bleeding patterns are one of the most problematic aspects of perimenopause. Bleeding can become more frequent, less frequent, lighter, heavier, shorter in duration, longer in duration, continual, or it can stop altogether.
5. Other symptoms of perimenopause may, or may not, include one or more of the following: hot flushes, night sweats, vaginal dryness and thinning, skin changes, fatigue, decreased libido, mood swings, depression, changes in memory and cognition, sleep disturbance, hair loss, hair growth, acne, palpitations, nausea, headaches or urinary tract infections.
6. Hot flushes and night sweats are the most predominant symptom of perimenopause. Prevalence ranges from 6% to 63% for perimenopausal women and 58% to 93% in the first two years post-menopause. Hot flushes can be aggravated by warm drinks, hot weather, stress, salt, alcohol, smoking and spicy foods. Women who have more body fat may have fewer hot flushes than leaner women. Increasing the soy foods in your diet and taking phytoestrogens such as black cohosh, dong quai, licorice and ginseng help may provide some relief.
7. Declining levels of sex hormones are also associated with decreased sexual desire and arousability. This is true for women who experience natural, or surgically induced menopause and also for male-to-female transsexuals who are administered anti-androgens and oestrogens. In some women, declining oestrogen can also cause vaginal atrophy and decreased blood flow to the genitals can reduce sensitivity and make it harder to achieve orgasm. However a flagging sex drive is not an inevitability. Women in their late forties and early fifties who suddenly encounter a new sexual partner will often find that all symptoms of hormonal decline seem to magically disappear.
8. This may be because having sex more frequently (using a good commercial lubricant) encourages genital blood flow and helps to keep the vaginal tissue healthy. If sex does irritate the vaginal lining, local oestrogen treatments such as the estradiol-releasing vaginal ring 'Estring' should be used every night, for three to four weeks, and after that usage can continue safely at sub HRT levels of twice a week ad infinitum. Results from the CLOSER study (2012) show that women who use local oestrogen report less painful sex (58%), more satisfying sex for their partner (42%) and themselves (40%), feeling closer and less isolated from their partner (33%), and having sex more often (27%). However, just 21% of menopausal women in the UK have tried a local oestrogen treatment.
9. Attitude is important. A study by Busch et al.(2003) which grouped menopausal women into 'optimistic', 'neutral', or 'pessimistic' categories found that women who scored high on pessimism reported more psychological symptoms, whereas the optimistic, or neutral, women anticipated few symptoms before or during menopause.
10. So is knowing what to expect. When Marnocha, Bergstrom, & Dempsey (2011) carried out a qualitative study with a group of highly educated perimenopausal women, they found that most of the women had only a basic understanding of the changes that their bodies were going through and they reported feeling confused, embarrassed and unable to control the experience. Other research shows that if the symptoms experienced prior to, or at menopause, have a sense of familiarity or can be explained and understood, they seem to be less disturbing and create less disruption in a woman's life. And last, but not least, research by Meyer (2003) shows that following menopause, many women have improved health, are more self-confident, and take better care of themselves than previously in their lives.