What Is Perimenopause?

Perimenopause, also called the “menopausal transition,” refers to the time in your life during which your body makes the natural transition to menopause. Menopause is defined as the moment when your periods have stopped for 12 months. On average, perimenopause begins in your mid-40s and lasts about four years. However, it may start earlier or later and last much longer–sometimes even over a decade.

The hormonal fluctuations associated with the menopausal transition can cause a variety of symptoms, from reduced sex drive to hot flashes. Learn more about perimenopause, including its symptoms, causes, diagnosis, and treatment options.

Symptoms

Contrary to popular belief, not everyone experiences adverse symptoms during perimenopause. Some people only become aware that they’re entering menopause when their menstrual cycles come to a permanent halt.

However, for many people, shifting estrogen levels during the menopausal transition can lead to a variety of symptoms, such as:

• Menstrual changes, such as irregular periods, heavy cycles, or spotting 
• Vaginal changes, including dryness, itching, and pain 
• Hot flashes, which are sudden episodes of heat, sweating, and flushing that last anywhere from 30 seconds to 10 minutes  
• Sleep disruptions, such as insomnia and night sweats
• Reduced libido 
• Loss of bladder control
• Weight gain
• Changes in fat distribution
• Dry skin
• Increased urinary tract infections (UTIs)
• Joint pain
• Muscle pain
• Mental health symptoms, such as mood swings, anxiety, irritability, and depression
• Heart palpitations
• Migraines

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Causes

Our hormones affect many aspects of our physical and mental health. As our hormones fluctuate, so do our moods and physical symptoms. Perimenopause symptoms are caused by changes in your body’s levels of certain hormones, especially estrogen. 

As you get older, your ovaries stop producing as much estrogen. The rise and fall of estrogen and progesterone help to regulate your menstrual cycle. They’re intricately involved in the production of both follicle-stimulating hormone (FSH), which causes your eggs to grow inside your ovaries, and luteinizing hormone (LH), which surges just before ovulation. 

When your estrogen doesn’t rise as much, you may not ovulate, which can lead you to skip a period. That’s why the first sign of perimenopause is often a missed period or irregular cycles.

Diagnosis

There’s no specific way to diagnose perimenopause, as it’s not a health condition that always requires treatment. Instead, it’s part of a natural transition into your next stage of life. You’ll have reached menopause when it’s been a year since your final menstrual period (FMP).

Still, you may want to approach a healthcare provider to discuss any symptoms that are bothering you. Your primary care provider might perform blood tests and a physical exam in addition to discussing your current symptoms, medical history, and menstrual cycles. They may also refer you to other specialists, such as an endocrinologist or OB-GYN, for further diagnostic testing.

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Treating Perimenopause

If you don’t have any symptoms associated with perimenopause, you may not require treatment. However, many people seek out healthcare providers for help with unwanted symptoms, such as vaginal dryness and hot flashes. 

Here are some of the treatment options for symptoms of perimenopause, including hormone therapy, other medications, lifestyle changes, and mental health treatment.

Hormone Therapy

Hormone therapy, also known as hormone replacement therapy (HRT), is a common way of treating the symptoms of perimenopause–especially vaginal dryness, hot flashes, night sweats, mood swings, and joint pain. It can also help to protect against bone loss and reduce the chance of colon cancer, both of which become more of a risk as you enter menopause.

HRT typically involves taking a synthetic form of estrogen. This can be delivered via pills, skin patches, implants, gels, or sprays. Combined HRT also involves taking progestin, a synthetic form of progesterone. Taking both at the same time can reduce the risk of uterine cancer. Synthetic progesterone is delivered via pills or patches, often in combination with estrogen. 

Some people entering perimenopause may also be prescribed testosterone to increase their sex drive.

Other Medications

In addition to hormone therapy, your healthcare provider may prescribe other medications to help treat any symptoms of perimenopause. These may include:

• Medicines to treat hot flashes, such as selective serotonin reuptake inhibitors (SSRIs), clonidine, and Neurontin (gabapentin)
• Over-the-counter (OTC) vaginal moisturizers and lubricants for vaginal dryness and pain during sex 
• Oral contraceptives for irregular periods

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Lifestyle Changes

In addition to taking medication, there are many lifestyle changes that can help you relieve any symptoms you experience during the transition into menopause. These can include:

• Eating a calcium-rich diet
• Exercising regularly
• Getting enough rest
• Practicing mindfulness, i.e., through yoga and meditation 
• Connecting with a community of supportive peers
• Quitting smoking
• Avoiding excessive drinking

To prevent and manage hot flashes:

• Avoid common triggers, such as spicy foods, heat, caffeine, alcohol, smoking, and hot drinks
• Manage your weight
• Use fans
• Wear loose, comfortable clothing
• Sleep in a cool environment
• Take cool showers
• Manage your stress levels

Mental Health Treatment

Perimenopause is associated with a variety of mental health symptoms, including mood swings, anxiety, and depression. Talk to your healthcare provider about your treatment options, such as cognitive-behavioral therapy (CBT), antidepressants, or both.

A Quick Review

Perimenopause is when your body makes the natural transition into menopause. On average, it starts in your mid-40s and lasts about four years, but this widely varies person to person.

The hormonal fluctuations associated with the menopausal transition can cause a variety of symptoms, from reduced sex drive to hot flashes.

While it is not a health condition that requires treatment, speak to your healthcare provider if you want to discuss any symptoms that are bothering you. Treatments to help with perimenopause can include hormone therapy, other medications, lifestyle changes, and mental health treatment.