Perimenopause typically begins around the age of 45 when women may experience changes in their menstrual cycles, characterized by variable lengths ranging from 14 to 50 days. However, not all women exhibit noticeable cycle changes before reaching menopause. Alongside menstrual irregularities, various symptoms emerge, such as headache, joint pain, night sweats, hot flashes, and difficulty concentrating. Breast tenderness is common but tends to decrease with progression towards the final menstrual period. Severe vasomotor symptoms (VMS) affect up to 30% of women during perimenopause, with the intensity usually peaking in late perimenopause before subsiding 1–3 years after menopause.

The decline in ovarian follicles, a key aspect of perimenopausal pathophysiology, is central to the overall experience. Ovarian reserve, measured by antral follicle count (AFC), reflects this decline. The menstrual cycle, regulated by complex neuro-endocrine processes, is disrupted as primordial follicles decrease. Symptoms can extend beyond reproductive aspects, impacting bone density and cardiovascular health. Management strategies, including hormonal therapies, may be considered based on symptom severity, with universal preventive measures such as assessing blood pressure, thyroid function, Vitamin D levels, and cardiovascular risk.

Per the review, internationally recognized staging systems like STRAW provide a consistent framework for understanding and classifying the stages of female reproductive aging. The decision to implement hormonal therapies during perimenopause depends on individual symptoms, while general preventive measures play a crucial role in overall health management during this transitional phase.

Link: https://www.sciencedirect.com/science/article/abs/pii/S0960076013001581