Climacteric or perimenopause is the transition period during which the reproductive capacity of a woman ceases.
Menopause means end of menstrual cycles. Every woman who has periods will undergo menopause one day or the other. Menopause implies end of fertility of the female as the process of ovulation stops. Physically this manifests as cessation of periods. These changes are a part of the normal process of ageing. Most woman undergo menopause between the ages of 42 years- 58 years. However menopause is not an abrupt process, it takes place gradually. This is so as the levels of the hormones don't fall abruptly. The level of hormones fall gradually over a period of time. Perimenopause is a period which can wary between 2-7 years before menopause is actually attained. This is the period when some of the changes associated with menopause start making their appearance due to gradually falling levels of estrogens (female hormones) but are not as frequent or as intense in character as in the actual menopause phase.

The first symptom of perimenopause is that the cycles might start becoming irregular. They might start coming at longer intervals. The flow during periods might start becoming scantier as the time passes. Some women might have abnormal bleeding.
A number of symptoms can be produced in a woman as a result of the falling levels of estrogen in the body. These symptoms are:

• The vaginal epithelium becomes thinner and less vascular. uterus becomes smaller in size and is replaced by fibrous tissues. The skin becomes thinner and less elastic. The breasts atrophies and the glandular tissues is replaced by fat.
• Changes in the cardiovascular system: Levels of cholesterol, triglycerides and phospholipids rise. The risk of coronary artery disease increases to such an extent in this group of women that it is the main cause of death in this group of women.
• Skeleton system: there is loss of both calcium and collagen from the bones resulting in osteoporosis.
Symptoms produced due to the falling levels of estrogens are:
• Vasomotor: 75% women complain of hot flushes.
• Emotional: lethargy, lack of concentration, irritability, aggressiveness, depression, mood swings, anxiety.
• Sexual: decreased libido, painful intercourse due to changes in the vaginal epithelium.
• Urinary: Increased urgency and frequency of urine.
• Musculo-skeletal: laxity of ligaments and decreasing muscle strength results in muscular pains and aches
These changes are seen to varying level of severity during perimenopause and become fully manifest after the complete cessation of periods.

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