Perimenopause explained by Dr Vinu Sahlén

What does perimenopause mean?

Perimenopause means “around menopause.” It is a phase in a woman’s life marked by alterations in the quantity and frequency of oestrogen production, which is the main female hormone produced by the ovaries. As the ovaries become depleted of eggs and bleeding episodes become more erratic, the perimenopausal woman may encounter numerous physical manifestations.

When does it happen?

Perimenopause occurs well before officially hitting menopause. In fact women enter this stage up to 8 to 10 years ahead of menopause. Women are most commonly in their 40s, but this can start as early as the late 30s.

Perimenopause has the potential to become a difficult period in a woman’s life. It is important that each woman attempts to understand the alterations that her body is undergoing and attempt to proactively manage these physiological changes. These symptoms can at times be intense, thus interfering with everyday activities and relationships.

Menopause officially marks the end of female reproduction and is recognized when a woman has not had a period for 12 consecutive months.

What are the symptoms?

  • Irregular periods. Due to irregular production of oestrogen, periods tend to be heavier or lighter than normal as well as erratic.
  • Hot flushes is an episodic sensation of heat rising over the neck and facial areas of a woman’s body, followed by profuse sweating. It is commonly thought to be due to transient dilation of the blood vessels near the surface of the body due to estrogen deficiency.
  • Breast tenderness. Oestrogen-induced fluid retention in the breasts increases due to the increased interval between ovulations.
  • Can be caused by night sweats. Disturbed sleep leads to irritability and fatigue during the day.
  • Weight gain. The erratic production of oestrogen can lead to fluid retention as well as increased appetite leading to women gaining a significant amount of body fat.
  • Fertility issues. There is a higher rate of miscarriages and difficulties conceiving. As a result of erratic menstrual cycles, women tend not to use contraception, leading to unwanted pregnancies and increased rates of abortions.
  • Loss of bone density. Oestrogen is involved in bone metabolism. Diminished levels increases the risk of osteoporosis.
  • Mood changes such as mood swings, depression and anxiety can be at times caused by insomnia. This can put a strain on interpersonal relationships.
  • Alterations in cholesterol levels may predispose a woman to heart disease.
  • Decreased libido is usually due to diminished levels of testosterone produced by the ovaries.
  • Vaginal pain during intercourse. The lining of the vagina tends to thin and dry out when oestrogen levels diminish. When the underlying blood vessels are exposed, vaginal bleeding occurs during intercourse.
  • Bladder problems including urinary frequency, incontinence and an increased rate of urinary tract infections.

What can you do?

Management of the perimenopause is largely dependent on the severity of symptoms. Both Primary Care Physicians as well as Gynaecologists may be consulted as to possible treatment options.  These may vary from conservative measures to pharmacological treatment.


Dr Vinu Sahlen is a graduate of the University of Aachen, Germany. Dr Vinu speaks German and Swedish and is based in our Camden Clinic. If you would like to book an appointment with Dr Vinu please call: 6733 4440 or book online: 


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