A woman reaches menopause when for 12 consecutive months she does not get her menstrual period after the last period. However, this period does not occur overnight. The woman initially goes through a transitional phase from fertility to menopause and this transitional phase is referred to as perimenopause.

In perimenopause, the body reduces the production of estrogen and progesterone, the two hormones required for reproduction. This is a natural process and occurs as the women age. However, perimenopause can be induced earlier if the ovaries are removed through a surgical process.

The estrogen and progesterone are the hormones that regulate the menstrual cycle in a woman. These 2 hormones are secreted by the ovaries. Estrogen helps in to thicken the lining of the uterus making it ready for the implantation, while the levels of progesterone tend to rise after ovulation takes place. In the ovum does not get fertilized by the sperm, the levels of estrogen and progesterone fall, and this results in the uterus shedding its lining and resulting in the onset of menstrual period.

As a woman ages, the quality of the eggs diminish. In addition, the follicles that carry the eggs slowly begin to disappear. These follicles hold the eggs until they get matured and they also contain the cells that are responsible for secreting estrogen. So, as the follicles disappear, the eggs cannot mature and thereby ovulation as well as menstruation does not take place or it takes place irregularly. In addition, with the disappearance of the egg follicles, the levels of estrogen tend to reduce and this prompts the pituitary gland in the brain to work harder to ensure that the hormone levels in the body are maintained. Hence, during perimenopause, there is fluctuation in the hormone levels and the woman experiences all the associated symptoms, like tenderness of the breasts, hot flashes, lack of sexual desire, mood swings, depression, vaginal dryness, irregular or missed menstrual period, night sweats, and soreness of the joints.

Usually, perimenopause begins when a woman reaches her mid-40s. However, it can even begin much earlier. This transitional phase can last anywhere from 2 years to 8 years.

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