During perimenopause, you may have difficulty getting pregnant, but you are not yet infertile. If you postponed pregnancy until your career was well established, you can still become pregnant, but may require assistance from a fertility expert. Irregular periods are a clue that you are subfertile. No periods mean you are infertile.
You may skip menstrual periods. Your flow changes, and may become either heavier (menorrhagia), or lighter, or irregular and infrequent (oligomenorrhea). Iron deficiency anemia from excessive blood loss causes chronic fatigue, withdrawal, cognitive problems and irritability. You may find you are unsuccessful at work or school because you have difficulty concentrating when your anemic blood cannot deliver sufficient oxygen to your brain.
As your ovaries become less efficient, you will not produce an egg each and every month. Anovulatory cycles that do not produce an egg do produce heavy periods, often with pain (dysmenorrhea). Your likelihood of having an anovulatory cycle is only 2% to 7% during your peak fertility (mid-20’s to mid-30’s), but jumps to 33% percent of cycles in women over 50.
Three of the most bothersome menstrual irregularities in perimenopausal women are:
- Menorrhagia, which means heavy bleeding more than 80 ml per cycle, or 16 soaked sanitary pads per cycle. Menorrhagia is serious because it eventually leads to iron deficiency anemia.
- Metrorrhagia, which means irregular uterine bleeding between expected menstrual periods
- Menometrorrhagia, which means heavy and irregular uterine bleeding.
The woman with menometrorrhagia bleeds excessively during her expected menstrual period and also at irregular intervals, usually around two weeks apart, instead of the normal cycle of 28 – 35 days.
Women with menorrhagia, metrorrhagia, or menometrorrhagia are very likely to develop anemia from excessive blood loss. Most of the time, these three problems occur because of a hormonal imbalance.
They can also occur due to:
- Benign (non-cancerous) uterine tumors, called fibroids
- Endometriosis (the womb’s lining grows outside the uterus)
- A genetic bleeding disorder, like von Willebrand’s disease
Sleep, Headaches and Brain Function
You may develop night sweats and disturbed sleep from low progesterone and varying estrogen levels during perimenopause. Insomnia is common. You may not achieve deep slumber, and probably awaken feeling tired.
During the day, your fluctuating hormones create hot flashes, depression and irritability. Low progesterone levels lead to lack of concentration, irritability, mood changes and poor short term memory. Migraine headaches begin or worsen because hormones affect blood vessels in the head. Combined with your lack of restful sleep, these fluctuations can leave you tired to the point where your usual high performance degrades.
You could leak urine when you cough, sneeze or laugh. You may have more bladder infections as your urethra becomes less flexible and more easily damaged, due to hormonal deficiency. Your vagina is more prone to itchy yeast infections (candidiasis).
If you are lean, you may have lowered lung function.
Your bones may thin out (osteoporosis). Consequently, your joints and back may ache.
You may feel a sensation like ants crawling over your skin, called formication. Your skin may thin, dry out, and become inelastic. Your breasts will probably sag.
Your chances of developing heart and blood vessel diseases increase, so that by the time you are 65, your risk is as high as a man’s.
You will lose muscle mass and your fat distribution will concentrate in your abdomen. Expect your waist to thicken, whereas in your prime childbearing years your weight probably concentrated around your hips. Your metabolism will slow, leading to weight gain, even though you stick to your usual diet.
Your interest in sex may diminish (low libido or hypoactive sexual desire disorder, HSSD) and you may develop a dry vagina, so that intercourse is irritating (dyspareunia). A less resilient vagina is more easily traumatized by penetrative sex. You may have difficulty achieving an orgasm. You may feel too tired for sex due to chronically disturbed sleep, lack of testosterone and iron deficiency due to menstrual irregularities.