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Most women don’t even know what perimenopause is, but they definitely know how to tell if something strange is happening to them.

Perimenopause is the interval in which a woman’s body begins its transition into menopause, showing specific symptoms characteristic neither to normal fertility nor to the menopause period. Experts consider perimenopause to be a period of several years leading up to menopause, anywhere from 2 to 8 years, plus the first year after the woman’s final period. 
Perimenopause isn’t anything pathological or abnormal. It is simply a natural part of aging that signals the ending of a woman’s reproductive years. It is all, of course, caused by hormone fluctuations, as the levels of reproductive hormones, estrogen and progesterone rise and fall unevenly during perimenopause. 
The start and total duration of perimenopause vary from person to person, but a woman will probably notice signs of impending menopause, such as menstrual irregularities, at some point during her 40s, although some notice changes as early as their mid-30s.

Signs and symptoms

Perimenopause is a strange period characterized by subtle and not-so-subtle changes of the body. Some of the most characteristic symptoms include the following.
Menstrual irregularities: One of the first signs of perimenopause may be a change in a woman’s menstrual cycle. Many women start having less regular periods, while some have a lighter flow than normal. Others have a heavier flow and may bleed profusely for a number of days. The upside to all this is that women who have had problems with heavy menstrual periods and cramps will find relief once menopause starts.
Hot flashes and sleep problems: A hot flash is a sudden feeling of heat in the upper part of the body. It is an extremely unpleasant condition characterized by, a woman’s face and neck becoming flushed, or red blotches appearing on the chest, back, and arms. All this can be accompanied by heavy sweating and cold shivering. These flashes can be as mild as a light blush or severe enough to wake you from a sound sleep. Most flashes last between 30 seconds and 5 minutes.  
Mood changes: A great majority of women experience mood swings, irritability, or depression during perimenopause. Although the cause may be sleep deprivation or other menopausal symptoms, a possible cause could also be hormonal changes resulting from perimenopause.
Vaginal and bladder problems: When estrogen levels are depleted, a woman’s vaginal tissue may lose lubrication and elasticity, making intercourse painful and almost impossible. Not only that, research has confirmed that this loss of tissue tone may contribute to urinary incontinence.
Decreasing fertility: The logical consequence of irregular ovulation is a decreased ability to conceive. However, keep in mind that as long as a woman is having periods, pregnancy remains a possibility. 
Changes in sexual function: Although this is not necessarily a sign of perimenopause, most women find that their feelings about sex change as menopause draws near. Some experience  dryness of the vagina that makes sexual intercourse painful, while others feel freer and sexier because menopause will prevent possible pregnancies.
Loss of bone tissue: Because of declining estrogen levels, women start to lose bone tissue more quickly than they can replace it. Of course, this increases the risk of osteoporosis.
Variable cholesterol levels: The depletion of estrogen may also lead to unfavorable changes in blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol – the bad kind of cholesterol. This could be a serious complication because it contributes to an increased risk of heart disease.  

Risk factors

Although menopause is a normal part of a woman's life, it is known to occur earlier than expected. This is why women are interested in the risk factors associated with an earlier onset of menopause. Although this has not been proven yet, there is evidence suggesting that certain factors may contribute to perimenopause at an earlier stage in life. 
Family history: Most women experience menopause around the same age as their mothers and sisters. Experts are unable to explain this fact.
Never delivered: If woman has never given birth, this could be considered as a risk factor, but it could also be related to the hormone fluctuations present during pregnancy.
Heart disease: Recently conducted studies show that there is a connection between a history of heart disease and early menopause. This could be explained easily, as an increased risk of heart disease (elevated cholesterol, high blood pressure) and early menopause are usually connected.

Perimenopause and medical interventions

Menopause may be induced at any time after your first period by medical intervention.
Total hysterectomybilateral oophorectomy: The radical way of causing menopause is an operation called total hysterectomy and bilateral oophorectomy, in which both the uterus and the ovaries are removed. Hormone production stops suddenly, so there's no perimenopausal phase, and periods stop immediately.
Chemotherapy and radiation therapy: Research into radiation side effects have proven that these cancer therapies can cause the symptoms of menopause, such as hot flashes and cessation of periods, during the course of treatment.

Is there any treatment for perimenopause?

Oral contraceptives: Anti-baby pills can help! Women have experienced relieve of perimenopausal symptoms after taking oral contraceptives. These pills can be used for other reasons than birth control. The mechanism is simple – treatments with combined estrogen and progestin can help keep periods regular, plus ease all the symptoms.  
Menopause hormone therapy: If a woman reaches menopause and still needs treatment for perimenopause symptoms, she should switch from birth control pills to menopause hormone therapy (HT) because they are a lot safer. This therapy contains much lower doses of hormones.
Useful life-style changes: If a woman makes certain changes in her life, she can ease her symptoms and keep herself healthy.
Eat only healthy foods
A healthy diet is most important in relieving perimenopause symptoms,  counteracting specifically the high risks of osteoporosis and heart disease. A woman should eat whole-grain food, vegetables, and fruit, as well as calcium-rich food (milk, cheese, etc.), or take a calcium supplement to obtain recommended daily intake.
Get moving and exercise
Everyone knows that regular exercise can help keep a woman’s weight regulated and make her sleep better, but it can also make her bones stronger, and improve her mood.  
Other useful life style changes
  • Quit smoking and drink less
  • Get more sleep; try going to sleep and waking up at the same time each day
  • Reach a healthy weight and try to stay there
  • Take multivitamin supplements and ingest enough calcium
  • Drink at least eight glasses of water each day

Perimenopause and pregnancy issues

Make no mistake, a woman can indeed get pregnant in perimenopause, unless she has gone 12 consecutive months without a period. That’s why she should talk to her doctor about birth control options. A woman at this age should be aware of the fact that no method of birth control is foolproof, and some of them offer no protection against STDs.