There are a lot of misconceptions and misinformation about perimenopause and menopause. Let’s get to the facts!
What is Perimenopause?
It’s also known as menopause transition or climacteric, and is the gradual change from getting periods, to not getting them.
Contrary to popular belief, this doesn’t happen immediately, but there’s a normal transition period where you have symptoms of menopause, but also still have periods.
As far as hormones go, the ovaries gradually rebalance their estrogen and progesterone production in preparation menopause. Basically, it’s a serious drop in estrogen.
What are the Symptoms of Perimenopause?
- Changing periods (period length, time between cycles, intensity, etc)
- Skipped periods, with a longer duration of time between them until they eventually stop (Menopause)
- Spotting, including brown blood
- Changes in discharge, including intensity, duration and time of cycle
- Hot flashes and night sweats
- Fatigue or anxiety
- Decreased sex drive, vaginal dryness, and breast tenderness
- Increased symptoms of Pre Menstrual Syndrome
- Mood swings including depression and anxiety
- Hormone related headaches
- Urine leakage
- Aches and pains
- Weight gain
- Changes in menstrual cramps (including all month)
Signs of Perimenopause
Here some of the common symptoms or signs that may indicate you’re going through a perimenopausal transition:
One of the most common signs of perimenopause is a changing menstrual cycle.
When your ovulation becomes more inconsistent, the length of your menstruation cycles may be longer or shorter. You may also skip some periods and your flow may be either light or heavy.
Spotting is also another thing that can occur during perimenopause. It’s sometimes normal, and sometimes not. We recommend checking with your doctor to make sure there aren’t any problems. Spotting can also be a sign of early pregnancy, so please keep this in mind.
If your periods have a persistent change of 7 days or more, it means you’re in the early stages of perimenopause. If the length is 60 days or more, you could be in late perimenopause.
Signs of Premenopausal: Missed Periods
One of the most popular menopause myth is that your periods will go from normal, to suddenly stopping one day. This isn’t true.
When you begin to miss periods, you’re probably approaching menopause. It’s actually one of the most comon signs of pre menopause. Officially, menopause begins when you’ve gone one year without menstruating.
Of course, missed periods can also signal pregnancy, so if you suspect this might be the case, please take a home pregnancy test, or check with your doctor.
Some people experience an increase in menstrual cramps during perimenopause. Or, you may start to get them when you’ve never really had them before. This is because of fluctuating hormones.
During normal menstrual cycles, the breasts are able to retain more fluid before the next period arrives. This is due to the estrogen production that is taking place.
However, the ovarian estrogen production becomes more erratic when a woman reaches the perimenopausal phase. This actually leads to a greater volume production of estrogen. This as a result, leads to fluid retention causing the breasts become more tender.
Signs of Pre Menopause: Hot Flashes
This is one of the most well-known signs of perimenopause, and is the one that you’ll most often hear people complain about.
Hot flashes are feelings of warmth that are strongly felt in the neck and facial areas of a woman’s body. This is usually followed by intense sweating or flushing and can last between 30 seconds to several minutes.
Hot flashes are incredibly disturbing and can even make it hard for one to concentrate. They can last for years even after menstruation has stopped.
Night Sweats: Signs of Premenopausal
This is technically hot flashes that happen at night. Night sweats may occur once an hour and can disturb a woman’s sleep. This in turn leads to insomnia, which could also lead to irritability and depression. Women are likely to incur night-sweat-induced insomnia which keeps them from performing daily tasks at home.
The overall estrogen production, according to some studies is shown to increase during perimenopause, although this tends to be unpredictable. Sometimes, when the estrogen production is high, a woman may likely experience nausea. And in some cases, this could be extreme to the point where one require may medical treatment.
You can get pregnant as long as you still have a period. This means that during perimenopause, you can certainly get pregnant. Please use protection if this is not what you want!
Every woman is born with a certain limit of eggs in her ovaries and after reaching a certain age, the ovaries eventually run out of eggs. This makes the chances of getting pregnant very difficult for the woman who wishes to conceive.
To make matters worse, the quality of the egg diminishes with time, so even if the woman were to become pregnant, there is a greater percentage of miscarriage. This is due to the eggs becoming chromosomally abnormal that can lead the body to reject an otherwise defective embryo.
Many feel that because their periods are erratic, they are unable to conceive, which is why they do not opt for contraception. But if these women do eventually become pregnant, it would be in a time where they are not prepared to go through child-rearing.
Weight Gain: One of the Most Common Signs of Pre Menopause
To reiterate, erratic estrogen production in large quantities leads to fluid retention. This is a bad sign for the body because fluid retention may lead to body swelling.
It is a likely contributor to weight gain as estrogen production can affect the higher brain centers that control appetite, which can boost hunger urges. This is a common phenomenon for perimenopausal women.
Mood swings like anxiety and depression happen quite frequently during perimenopause. The main underlying problem for this is the night sweat-induced insomnia which break the body’s intrinsic diurnal rhythm.
Because of this phenomenon, women have difficulty in doing the many things of their daily lives. This can also affect interpersonal relationships if the woman is unable to make sense of her surroundings. She can even verbalize her concerns to other people presently with her. Transient loss of memory is also common.
Decreased Bone Density
Estrogen is also responsible for the metabolism of bone in a woman’s body. Typically,the calcium in the bones is equally balanced. This means the calcium that leaves the bone is replaced by the calcium that enters the bone.
Unfortunately, when the estrogen production becomes more erratic during perimenopause, it ruins the balance that results in an increase of calcium that leaves the bone.
If the calcium goes to decline like this, it could lead to a common condition known as osteoporosis or loss of bone density.
Low Sex Drive
Many women experience a reduced desire for sexual intimacy when they approach menopause. Some of the major problems that lead to this include altered sleep IQ patterns and chronic fatigue.
Along with estrogen, the ovary – which normally produces the hormone testosterone necessary for sex drive – diminishes, leading to a decreased libido.
Differing Blood Cholesterol Levels
Low estrogen levels lead to low density lipoprotein (LDL) levels, which are also known as ‘bad cholesterol.’ This also leads to a drop in high-density (HDL) lipoprotein, otherwise known as ‘good cholesterol.’
These are the changes that could potentially cause a woman to develop heart disease.
The urethra (the tube that directs urine from the bladder) and the bladder respond to the presence of estrogen. And when its production shrinks, it may lead to:
- Frequent urge to urinate (urinary urgency).
- More susceptibility to urinary tract infections (UTIs).
- Losing the ability to hold back urine along with a boost in intra-abdominal pressure that is accompanied by coughing, sneezing and heavy lifting. This is partially due to the lowered pressure in the urethra caused by decreased estrogen production.
Headaches in Perimenopause
Do you suffer from Perimenopausal headaches? Keep on reading to find out why they happen, and what you can do about them.
There are a number of factors that lead to headaches in both male and female, especially when it comes to migraines. However, it is reported that migraines affect women more than men to a greater extent with a female to male ratio of 3:1.
Hormonal fluctuations during a woman’s reproductive cycle may indeed influence a woman’s migraine intensity and occurrence, both in a good and bad way. For instance, those women who experience hormonal headaches can get relief when they have reached menopause. But other women have reported to have a 60% increase in these migraines during perimenopause or at times leading up to menopause.
How is Perimenopause Diagnosed?
Your doctor is likely to make a diagnosis based on your age and symptoms.
Or, a blood test can be done to check your hormone levels. However, hormone levels vary considerably from day to day so this isn’t really the most accurate measure.
Perimenopause: When to See a Doctor?
When you start to notice symptoms of perimenopause, it’s a good idea to check in with your family doctor. You can discuss the severity of things like hot flashes, and changing periods and find out if things like Hormone Replacement Therapy are right for you.
In addition, just because you’re approaching menopause, doesn’t mean that every single change that happens with your period is related to that. It is still entirely possible to have a wide range of other medical conditions, some serious, some not.
If you notice your period getting longer or shorter, heavier or lighter, or your cycle length changing, check in with your doctor. Or, if something just seems not quite right.
What Age Does Perimenopause Occur?
According to research, it can take place several years before menopause. Because the average age of menopause is around 50, it often takes place in the mid 40’s.
For early menopause, perimenopause can happen in the late 30’s or early 40’s.
How Long Does Perimenopause Last?
Most people find that they have symptoms for 4-8 years before menopause, although it can stretch as long as 10 years.
It officially ends when you’re gone 12 months without having a period. Congratulations! You’ve now reached menopause.
Learn more here: Perimenopausal Stages.
When do periods stop? The average age is 51.5, but it largely depends on when your mother went through menopause.
When does perimenopause end, and menopause start? It’s a great question, but there’s no easy answer because everyone is different! Some people experience only a couple years of perimenopause, while others have 10 years worth of it.
However, one of the surest signs that menopause is approaching is when you start to have periods that are further and further apart. Menopause officially begins when you don’t have a period for a year.
Signs that Menopause is Approaching
Is there a Way to Prevent Periomenopause?
Is there anything I can do to prevent menopause? The easy answer is no! There really isn’t much you can do because it’s a natural thing. It’s the same as how you have no control over when you get your period.
What you can do is manage your symptoms when they do happen.
For most people, it’s just a natural process and not something that needs to be medically treated.
However, around 10% of people experience some terrible symptoms such as extreme hot flashes and require HRT (hormone replacement therapy). But, this is only for the exceptional cases and shouldn’t be the norm. Most people are able to make this transition without medical intervention.
Medical Treatment Options
Some of the treatment options include:
- Low-dose birth control pills (for a short time)
- Birth control skin patch
- Vaginal ring
- Progesterone injection
Natural Treatment Options
There are some things you can do to help yourself feel better, without HRT:
- Not smoking
- Sleeping more, and more regularly
- Less alcohol
- Maintaining a healthy weight
- Enough calcium in your diet
Natural Remedies for Perimenopause
There are a number of natural treatment options you could consider to deal with perimenopausal symptoms. They include:
- Ginseng, which has been shown to improve sleep
- Black Cohosh is a popular natural remedy that people have been using for years to deal with menopausal symptoms
- Soy, which contains estrogen can help you deal with the decreasing amounts your body is now making
- Vitamin D. When your body stops producing as much estrogen, you’re at a higher risk of Osteoporosis. Vitamin D helps to make your bones stronger
- Wild yam, which helps to mimic the effects of estrogen in your body
- Dong Qua, a Chinese medicine which is reputed to help with hot flashes
Learn more about natural treatment options here:
Periods During Perimenopause
Can I still get my period during perimenopause? Yes! You will get them, but they will probably be more irregular than you’re used to. You’ve officially begun menopause when you haven’t had a period for 12 months.
Although irregular periods are normal during this phase of life, there are some things that can indicate a more serious problem. They include:
- Periods are very heavy, or include blood clots
- They last several days longer than normal
- Spotting between periods
- Spotting after sex
- The length between cycles gets shorter
- The actual period length gets shorter (3 days instead of 5 for example)
More information about this here: Everything you Need to Know about Perimenopausal Periods.
What Period Protection Should I Use?
If your periods start to become very light, or irregular, tampons may not make the best choice. You might consider switching to a menstrual cup, cloth pad or pantyliners. Here are a few reasons why:
- You can use a menstrual cup before your period
- Menstrual cups can be left in for up to 12 hours
- They come with a lower risk of toxic shock syndrome than tampons
- They contain no toxic chemicals, unlike some popular brands of tampons
More information about menstrual cups here:
Or, just check out our top-rated cup, the Lena Cup over on Amazon:
What about Perimenopause and Weight Gain?
Many people gain some weight during the period before menopause. Part of it is the natural aging process, but part of it is related to changing hormonal levels.
Find out more here: Weight Gain and Perimenopause.
Can I Get Pregant During Perimenopause?
The ovaries are still producing eggs during this life phase, so you can get pregnant. It’s recommended that you use birth control, or other form of protection for at least a year after getting your last period.
The general rule? You still have a period? You can still get pregnant! Learn more here:
Getting Pregnant in Perimenopause.
Are Perimenopause and Premenopause the Same?
A common question that people have is whether perimenopause and premonpause are the same things. We mean, aren’t they just two words that describe basically the same thing? Let’s find out!
What is Premenopause?
This stage of life is when you may have some hormonal changes going on in your body, but you’ll have no noticeable changes or symptoms.
You’ll still have periods that are similar to what they have been in the past, and are still able to get pregnant
What is Perimenopause?
Perimenopause is when changing hormones cause you to have symptoms such as hot flashes, mood swings, insomnia, etc.
You will still have periods, and are able to get pregnant, but it will be quite difficult.
Are Perimenopause and Menopause the Same?
A common question that people have is whether or not the terms, Perimenopause and Menopause can be used interchangeably.
Technically, they are different things. Perimenopause is the periods of time before menopause. It’s characterized by fluctuating hormones and symptoms resulting from this. It generally lasts for 4-10 years.
Menopause is when menstruation ceases. Periods will get further and further apart during perimenopause. Once they stop for 12 months, you’ve officially entered into menopause.
Is it Possible to Delay Perimenopause?
Okay, so you’re trying to get pregnant, and want to delay menopause as long as possible. Is there any way to delay perimenopause, and eventually menopause?
In general, no. Although some things like smoking have been shown to cause a slightly early menopause. However, genetics plays a far bigger factor in this than anything you can do, or not do.
There are even some people who go through menopause far earlier than normal. Find out more here: Early Menopause FAQs.
Do Men Go Through Perimenopause and Menopause?
It all seems so unfair! Women have to go through perimenopause with hot flashes, weight gain and moodiness, but men don’t have to.
But, there is a well documented phenomenon known as Andropause, or more commonly known as Male Menopause.
You can learn more about it here:
Perimenopause and Depression
What is Perimenopausal Depression?
There have been numerous studies that associate perimenopause with depression, in addition to the depreciation of existing depressive symptoms.
According to the studies from the early 2000s, that were published in the Archives of General Psychiatry, it was documented that women undergoing the transition to menopause were twice as likely to be diagnosed with major depressive disorder (MDD) than the ones who did not enter this phase yet.
In the same batch of studies, it was found that perimenopausal women were four times more likely to develop depressive symptoms than those not going through perimenopause.
Hot Flashes? You’re More Likely to Experience Depression
Those women who have had constant hot flashes were reported to have an increased likelihood of depressive symptoms. Other women who are at a higher risk for depression include those who:
- Have been having antidepressants
- Haven’t given birth
There are even more studies that have determined the link between perimenopause and depression.
Perimenopausal Depression Signs And Symptoms
Even though MDD is a grave condition, it is possible to manage it with the right treatment. Whether you’re going through perimenopause or something else, the symptoms of the disorder may include:
- Reduced cognitive function
- Lack of energy or fatigue
- Decreased interest in hobbies or other activities
- Feelings of helplessness, hopelessness or worthlessness.
Other symptoms associated with perimenopausal depression may include:
- Tearfulness or crying without reason
- Mood swings
- Intense despair
- Elevated anxiety
- Night sweat or hot flash-related insomnia
Learn more about Anxiety and Depression During Perimenopause
Risk Factors for Depression Before Menopause
There are some studies that one of the risk factors of depression include the fluctuation of the female hormone estradiol. But, there are various other factors that result in perimenopausal depression.
In 2010, several studies concluded that perimenopausal women with no previous history of depression were two or four times more likely to develop depression than women in the premenopause phase.
Other symptoms in the review included impact on sleep patterns and hot flashes.
During the perimenopause phase, women go through a number of common stressful life events such as job loss, divorce or the death of a loved one. As such, these events serve as triggers to depression.
Numerous other factors that are associated with perimenopausal depression may include:
- A previous history of violence or sex abuse.
- A family history of depression
- Severe menopausal symptoms
- Negative feelings regarding menopause and aging
- Social isolation
- A sedentary lifestyle
- Sadness in not being able to have more children
- Low self-esteem
Mood And Hormones During Perimenopause
Lots of perimenopausal women experience a slew of mood swings during their phase and can be linked to fluctuating hormone levels.
For instance, when the estrogen fluctuate, the brain’s norepinephrine and serotonin levels are affected. Dopamine, serotonin and norepinephrine are essential brain chemicals that have a direct affect on your mood. They can reduce anxiety, make you happy, improve your sleep and more.
When the chemicals are balanced, you experience a general state of calm and well-being.
Hormone imbalances, like when your progesterone levels are falling whereas estrogen is rising can limit the ability of norepinephrine and serotonin to function as effective neurotransmitters.
Eventually, this leads to mood swings that result in depression.
The Effect Of Depression On Perimenopause
The relationship between depression and perimenopause is complex at best.
Apart from the effects of perimenopause causing depression, a 2003 study revealed that depression itself can lead to an early start to perimenopause.
The study showed that women with certain symptoms of depression in their late 30s and early 40s have an increased chance of entering perimenopause before their 45th birthday than women without any prior depressive symptoms.
However, the research could not conclude whether early perimenopause led to early menopause, or if it simply extended the duration of perimenopause.
In both perimenopause and menopause, lower estrogen levels are linked to other health risks such as:
- Heart attack
- Impaired cognitive functioning
According to the study, women who took antidepressants were three times more likely to enter early perimenopause than those who did not.
Other Side To Antidepressants and Perimenopause
Even though antidepressants are associated with an early start to perimenopausal depression, they can also help relieve one of its most uncomfortable symptoms.
According to a 2011 study, escitalopram (Lexapro) lowered the severity of hot flashes as well as their occurence by half compared to a placebo.
Escitalopram belongs to selective serotonin reuptake inhibitors (SSRIs), which is a group of drugs.
Lexapro, according to the study, is three times effective for relieving depressive symptoms as compared to hormone replacement therapy (HRT). Also, only 31% of women who received HRT, were said to have been relieved of their hot flashes while there was a 56% relief for those who took lexapro alone.
This finding brings a positive light for those who were worried about the 2004 study that found HRT increases the risk of stroke and heart attack.
Even though it is not known why escitalopram works, the findings reported no “serious adverse effects” on the woman who participated for the study.
Side-Effects of Antidepressants
Still, antidepressants have their own side-effects, like:
- Stomach problems
Home Remedies for Perimenopausal Depression
Other than antidepressants, various home remedies and lifestyle changes may help deal with perimenopausal depression.
It is crucial to get an appropriate amount of sleep between 7-9 hours. So be sure to adopt good sleeping habits such as going to bed at the same time in a cool, dark and quiet room. Also, avoid using electronics or they will keep you from sleeping.
Regular physical activities or exercise can release endorphins and serotonin into the body.
When these chemicals increase, they can help those who currently have depression or prevent it before it takes a hold of you.
The valerian plant has also been very useful in dealing with perimenopausal depression. It may reduce hot flashes and also help you sleep better.
Mindful breathing exercises like meditation or yoga can help reduce anxiety. One of the most useful techniques involve being attentive about your body’s response to natural relaxation as you breathe in slowly from the abdomen and then exhale.
Doing this routine for 15 minutes a day can reduce your stress levels.
B vitamins are essential for the emotional and mental well-being of perimenopausal women:
- B-1 (thiamine)
- B-3 (niacin)
- B-5 (pantothenic acid)
- B-6 (pyridoxine)
- B-9 (folic acid)
- B-12 (cobalamin)
There are some studies which show some promising results for supplements to help deal with symptoms related to fluctuating hormones during perimenopause.
Perimenopause and Anxiety
Perimenopause refers to the transitional phase in which the body undergoes several physical changes before the final menstrual period. These changes lead to factors such as hormone changes, sleep problems, life stresses, irregular periods, and infertility that contribute to a number of issues including anxiety.
Menopause usually occurs when a woman hasn’t had a period in the last 12 months. Some symptoms of perimenopause carry over to menopause but occur less frequently.
How Common is Anxiety During Perimenopause?
Some studies indicate that 23% of women experience anxiety during perimenopause and that anxiety symptoms are not the same as depression.
While it is normal to feel depressed or anxious when perimenopause starts, frequent and severe feelings of panic attacks or anxiety are not usual symptoms of menopause.
Menopause And Anxiety
Because of experiencing the loss of fertility during menopause, some women feel troubled or sad. On the other hand, some women feel relieved that they are no longer have to bear the burden of pregnancy.
Apart from that, women may undergo several other life changes during their perimenopausal years, such as their children leaving home, their parents or husbands becoming unwell due to aging. These are potential factors that eventually lead to accelerated feelings of anxiety.
During perimenopause, hormonal changes can also contribute to feelings of anxiety. This includes changes in the levels of estrogen and progesterone which can have an impact on a woman’s mood swings.
However, these symptoms may leave at the end of perimenopause and when women enter postmenopause, the hormones become more balanced.
Anxiety and Depression Before Menopause
Treatment for Anxiety During Perimenopause
There are a number of treatment options you might consider. Consult with your doctor for the best option for your specific situation.
Hormone Replacement Therapy
It is quite common for women who are going through menopause to receive hormone replacement therapy (HRT) as well as other treatments for menopause symptoms. However, it is important to consult a doctor first before opting for this treatment as it may not be suitable for some women.
If a perimenopausal woman is experiencing high levels of anxiety, her doctor may prescribe her medication to treat it. However, this is not always necessary. Sometimes, a doctor may also recommend counselling.
A popular type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs) may be prescribed for women who have moderate-to-severe levels of anxiety.
Even though SSRIs are quite effective in treating symptoms of anxiety, North American Menopause Society states that half of those who use these antidepressants experience side effects that may affect their sex life. These side effects include trouble maintaining arousal or achieving orgasm and reduced libido.
That’s why there are antidepressants for women who experience sexual SSRI side effects, like newer ones such as duloxetine and bupropion.
Older antidepressants such as monoamine oxidase (MAO) inhibitors and tricyclic antidepressants have no link to sexual dysfunction. But they can still cause other side effects.
To reduce the side effects of the antidepressants for those who experience sexual dysfunction, it is recommended they take lower doses. But before doing this, women must consult their doctors first as stopping medication can have severe consequences.
Lifestyle Changes to Treat Perimenopausal Anxiety
Doctors have recommended women with perimenopausal anxiety to follow a healthy lifestyle in order to reduce the symptoms of anxiety and panic attacks.
One of most suitable ways of reducing anxiety significantly is regular and gentle exercise. Those with perimenopausal anxiety should pick out their favorite type of exercise and make a daily routine out of it. It doesn’t matter whether it’s walking, running, yoga or swimming, exercising on a regular basis can burn away nervous energy and improve symptoms of anxiety.
Drinking too much caffeine or alcohol is not advised as the former can trigger nervousness and anxiety, while the latter is a depressant that can aggravate the underlying causes of anxiety.
Acupuncture can also be effective in reducing as well as treating other symptoms of menopause. Check with your extended health plan. You’ll often find that this kind of treatment is covered.
Get Enough Sleep
A good long uninterrupted sleep is also useful in reducing anxiety. But women going through menopause may have troubles because of night sweats caused by surges in hormones.
During these times, women may find keeping a ‘pre-sleep journal’ can help improve their sleep. With these journals, the women can write down any of their nervous thoughts so that their minds can rest easier.
Support groups for women going through perimenopause and menopause can also be helpful. Women with similar problems can get together to discuss and share the problems that they’re going through to better cope with their anxiety.
Even if a woman who is going through menopause does not want to join a support group, then talking about it with her closest friends can also be very helpful.
Take Time for Yourself
It is important for perimenopausal women to take time out for themselves. To be frank, we mean engage in what they usually do in their leisure time like reading, gardening, meditating and yoga are all great examples to attain relaxation and self-awareness.
Supplements During Perimenopause
There are some supplements that you might consider taking to help you deal with mood swings due to hormonal changes during perimenopause.
However, studies are a bit inconclusive, so also be sure to check in with your doctor instead of relying solely on them.
How to Deal With a Panic Attack
Women who have had prior panic attacks are more likely to experience panic attacks during perimenopause. Doctors assume that panic attacks are a reaction to instead of being a symptom of menopause.
When a person experiences a panic attack, they harbor intense feelings of anxiety or “doom.” These feelings are usually followed by physical symptoms such as:
- Shortness of breath
- Heart palpitations
- Tingling sensations
Panic attacks usually last for about 10 to 30 minutes but they can also last for hours if they recur in a series of episodes.
Many who experience their first ever panic attack worry that they might be having a nervous breakdown or even a heart attack. It goes without saying that panic attacks are one of the worst experiences of a person’s life.
What to do if you have a Panic Attack
If you have a panic attack, go see your doctor right away. They may be able to prescribe some appropriate medication for you or refer you for mental therapy, which may also help.
Practising mindfulness techniques can also help prevent panic attacks for some people. With these techniques, practitioners are able to focus on the symptoms and thoughts that bring about a panic attack so they can be properly managed.
Irregular breathing can trigger panic attacks, which is when you breathe more than your body lets you or breathing too quickly. That is why you should learn breathing exercises as they can help lower your chances of a panic attack.
Have your Say about Perimenopause!
And questions or thoughts? Leave a comment below and let us know. We’d love to hear from you.