What is perimenopause?

Perimenopause is the transitional time around menopause. Menopause is when a woman’s periods stop. It’s marked by changes in the menstrual cycle, along with other physical and emotional symptoms. This time can last 2 to 8 years. During this time, your body:

• Releases eggs less regularly

• Makes less estrogen and other hormones

• Becomes less fertile

• Has shorter and more irregular menstrual cycles

What causes perimenopause?

Perimenopause is a natural process caused when your ovaries gradually stop working. Ovulation may become erratic and then stop. The menstrual cycle lengthens, and flow may become irregular before your final period.

Symptoms are caused by the changing levels of hormones in the body. When estrogen is higher, you may have symptoms like you might have with PMS. When estrogen is low, you may have hot flashes or night sweats. These hormone changes may be mixed with normal cycles.

What are the symptoms of perimenopause?

No two women will experience perimenopause in the same way. These are the most common symptoms:

• Mood changes

• Changes in sexual desire

• Trouble concentrating or with memory

• Headaches

• Night sweats

• Hot flashes

• Vaginal dryness

• Trouble with sleep

• Joint and muscle aches

• Heavy sweating

• Having to pee often

• PMS-like symptoms

The symptoms of perimenopause may look like other health conditions. Always talk with your healthcare provider for a diagnosis.

How is perimenopause diagnosed?

Sometimes it’s hard to tell if you are having symptoms of perimenopause. Your symptoms, health history, age, and a physical exam may help your healthcare provider with the diagnosis. You may also have blood tests to measure your hormone levels.

How is perimenopause treated?

Perimenopause doesn't need to be treated unless symptoms are bothersome. Treatments may include:

• Hormone therapy using estrogen or estrogen and progestins to level out hormone levels

• Selective estrogen receptor modulators (SERMs)

• Antidepressants

• Gabapentin

• Clonidine

• Cognitive behavioral therapy

• Plant-based therapies

Your healthcare provider may suggest other lifestyle changes:

• Eat a healthy diet with fruits and vegetables and whole grains.

• Get at least 1,000 mg to 1,200 mg of calcium each day through your diet or supplements.

• Exercise regularly.

• Find what triggers your hot flashes by keeping a record. For example, alcohol, coffee, or tea may be a trigger.

Discuss other treatments for easing symptoms with your healthcare provider.

You may hear about herbal supplements that claim to help manage hot flashes. It’s important to remember that the FDA does not regulate these supplements. They are not tested like traditional medicines to prove that they work and are safe to take.

Talk with your healthcare provider before using any herbal supplements.

Key points about perimenopause

• Perimenopause is the time around menopause when your ovaries gradually stop working.

• This is a natural process that causes physical and emotional symptoms.

• It does not need treatment, but treatment can help ease symptoms.

• Treatment includes hormones, antidepressants, and lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.