Understanding Perimenopause

Perimenopause is a natural time of change for people who have a menstrual cycle. It is the phase that leads up to menopause. During this time, your body begins to make less of certain hormones. These changes can affect how you feel every day. Understanding this transition helps you take care of your health.¹

Perimenopause basics

Perimenopause means "around menopause." It is the bridge between your reproductive years and menopause. Your ovaries start to produce less estrogen. Estrogen is a key hormone that controls your period. As these levels go up and down, your cycle may change. This is a normal part of aging for the body.^1-4

When does perimenopause occur?

Most people start perimenopause in their 40s. Some may notice changes in their late 30s. The length of this phase varies for each person. It often lasts about 4 years. However, it can last for only a few months or up to 10 years. Perimenopause ends when you have gone 12 months without a period. At that point, you have reached menopause.^1-4

What are the signs and symptoms of perimenopause?

You may notice many different signs during perimenopause. These signs often come from shifting hormone levels. Common symptoms include:^1-4

• Irregular periods that are heavier or lighter than usual
• Periods that happen more or less often
• Hot flashes or sudden feelings of heat in the body​​
• Night sweats and trouble sleeping
• Vaginal dryness
• Low libido
• Changes in mood, such as irritability, depression, or mood swings
• Having to pee more often or having small amounts of leakage
• Weight gain or changes in metabolism

Every person has a unique experience with these symptoms. Some people have very few signs. Others may find these changes more difficult to manage.

How is perimenopause diagnosed and treated?

There is no single test to prove you are in perimenopause. Healthcare providers usually determine that you are in perimenopause based on a physical exam, your age, and menstrual history. They may also ask about symptoms like hot flashes. Sometimes, doctors use blood tests to check hormone levels, but these can be less accurate because of hormone changes throughout perimenopause.^1-4

You do not need a healthcare provider to give you an official diagnosis. Many people only reach out to their provider when perimenopause symptoms become intolerable and are looking for ways to reduce them.^1-4

Perimenopause is a normal life transition like puberty, not a disease or disorder. Treatment focuses on improving symptoms and quality of life. Some common options include:^1-4

• Hormone therapy to balance out estrogen levels
• Low-dose birth control pills to steady hormone shifts
• Antidepressants to help with mood changes or hot flashes
• Herbal supplements to help with hot flashes
• Lifestyle changes like regular exercise and healthy eating
• Vaginal moisturizers or vaginal estrogen to treat vaginal dryness, pain during sex, and urinary symptoms
• Vitamins or drugs to strengthen your bones

When to speak with a doctor

If symptoms become intolerable or start to interfere with your life, talk to a healthcare provider. They can recommend treatment options that can reduce the severity of symptoms. They can also recommend necessary screening tests, like bone density scans, to assess your risk of certain conditions.

You should also see a provider if you notice:^1-4

• Very heavy bleeding during your period
• Periods that last longer than 7 days
• Bleeding between your periods
• Periods that happen less than 21 days apart
• Any bleeding or spotting that occurs more than 12 months after your last episode of bleeding

Your doctor can help you find ways to manage these changes. Tell your doctor about all your health conditions before starting treatment. This includes any drugs, vitamins, or supplements you take.

A major life transition

Perimenopause is a major life transition. It brings changes to your body and your daily life. While these changes are normal, you do not have to manage them alone. By learning the signs and talking to your healthcare provider, you can navigate this time with ease.