What Is Perimenopause?

During this later stage of perimenopause, shifting hormone levels can also trigger a variety of symptoms like hot flashes and night sweats. Perimenopause ends, and full menopause begins, when you stop having your period for 12 consecutive months.

Signs and Symptoms of Perimenopause

• Early Perimenopause The start of your period is off by seven or more days compared with when it usually begins. 
• Late Perimenopause You go 60 or more days between periods.

• Hot flashes, or a sudden feeling of warmth that spreads across your body
• Night sweats, or hot flashes that occur when you’re trying to sleep
• Vaginal dryness and discomfort during sex
• A frequent need to pee
• Sleep problems like insomnia
• Changes in mood like irritability, depression, or mood swings

Causes and Risk Factors of Perimenopause

• Smoking People who smoke may experience menopause one or two years before those who don’t.
• Family History If the women in your family went through early menopause, you have a higher risk of it.
• Cancer Treatment Receiving pelvic radiation therapy or chemotherapy to treat cancers may have links to early menopause.
• Hysterectomy Although your ovaries will still make estrogen and you won’t go through menopause immediately after a hysterectomy, having the procedure can sometimes cause menopause to occur earlier than usual.
• Oophorectomy The removal of both ovaries causes instant early menopause.

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   Having one ovary removed might mean the remaining ovary stops working earlier than expected.

Two hormones regulate estrogen levels in the body. One is follicle-stimulating hormone (FSH), which stimulates the fluid-filled sacs in the ovaries that contain eggs to produce estrogen. The other is luteinizing hormone (LH), which stimulates the ovaries to release eggs from their follicles, or sacs. This follicle then makes both progesterone and estrogen to prepare the body for pregnancy, and levels of FSH and LH decline. When there’s no pregnancy, progesterone levels decline again, and the menstrual cycle starts.

How Is Perimenopause Diagnosed?

Instead, the best way to diagnose perimenopause is by seeing a health care professional. By taking a detailed medical history and asking questions about your menstrual cycle and menopause symptoms, physicians can often figure out if you’re going through the transition.

Treatment and Medication Options for Perimenopause

Many of the same therapies used to manage menopause symptoms can also help with perimenopause symptoms. Women can get pregnant up until 12 months after their last menstrual cycle, so they need to be aware of contraception during this period.

Several medications, including hormone therapy, can help relieve symptoms. Some may also choose to use hormonal contraception as a treatment of perimenopausal symptoms along with its usually contraceptive purpose.

Medications

• Menopausal Hormone Therapy Systemic estrogen therapy, or hormone therapy, is available in pills, skin patches, sprays, creams, and gels. It’s considered the most effective way to relieve symptoms like hot flashes.

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   People who still have a uterus will need to take progesterone along with estrogen. This type of therapy can help reduce your risk of bone loss, but has possible links to stroke, blood clots, and breast cancer. Discuss the benefits and risks with a healthcare professional.
• Vaginal Estrogen Applying hormones directly to the vagina by inserting a ring or applying a cream can release a smaller amount of hormones that only gets absorbed by the surrounding tissue. This helps mainly with vaginal dryness, pain during intercourse, and urinary symptoms, as well as helping to reduce the risk of urinary tract infections.
• Antidepressants Some antidepressants in a family of medicines known as selective serotonin reuptake inhibitors (SSRIs) can help reduce hot flashes. These medicines can also help people who experience mood disorders during perimenopause. They are not as effective as hormone therapy for treating hot flashes and night sweats, but are helpful for those who cannot or choose not to use hormones.
• Gabapentin (Neurontin) This anti-seizure medication has been used to treat hot flashes. It can also benefit people who suffer from migraines or sleep disturbances during perimenopause.
• Fezolinetant (Veozah) This newer hormone-free medication can help treat hot flashes.

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• Oxybutynin This medication is primarily a treatment for an overactive bladder, but can also reduce hot flashes.

Complementary and Integrative Therapy

• Black Cohosh Some people have used this herb to manage hot flashes and other perimenopause symptoms, but evidence for its safety and effectiveness is limited. Some research suggests that it may harm the liver, and it’s unclear whether this medication is safe for women with or at risk of breast cancer.
• Phytoestrogens These are estrogens that naturally occur in some plant foods, including isoflavones and lignans. Soybeans, some other legumes, and red clover provide isoflavones, while flaxseed, whole grains, and certain fruits and vegetables contain lignans. Some plant compounds also act like estrogen in the body. However, the impact of phytoestrogens on perimenopause symptoms — and also breast cancer risk — is unclear.
• Dehydroepiandrosterone (DHEA) This is a precursor to sex hormones in the body, meaning it later becomes estrogen. Your body naturally makes DHEA, but it’s available as a supplement. DHEA products claim to help with painful sex due to menopause-related vaginal dryness. However, research on its effectiveness is mixed, and its link with cancer needs more research.
• Bioidentical Hormones These products are still lab-made, but the word “bioidentical” means the hormones they provide are the same as those your body makes. The U.S. Food and Drug Administration (FDA) has approved some bioidentical hormone products, transdermal estradiol and oral micronized progesterone, for use in perimenopause management. However, you’ll also see products known as compounded bioidentical hormone products available, often marketed as “natural” — but that doesn’t mean they’re safer. These differ from those with FDA approval in their regulation, product consistency, and the level of evidence supporting them.

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• Acupuncture This may reduce hot flashes, although more evidence is needed.
• Relaxation Techniques These can reduce stress, which might help with symptoms. Options might include yoga, tai chi, or mindfulness meditation.
• Cognitive Behavioral Therapy (CBT) This is a type of talk therapy that can empower people with coping skills to support improved mood and well-being during perimenopause. CBT might also support better sleep and comfort during sex.
• Hypnotherapy Some studies have shown that an induced state of deep relaxation and altered consciousness can help reduce hot flashes and improve sleep during perimenopause.
• Weight Loss People with obesity might find that losing body weight improves hot flashes and night sweats early in the menopause transition period.

Lifestyle Changes for Perimenopause

You can’t prevent perimenopause, but taking certain steps can help make it a more comfortable transition into menopause and beyond.

Use Water-Based Lubricants or Moisturizers to Improve Vaginal Comfort

Stay Sexually Active

Eat a Nutritious, Balanced Diet

Get Regular Exercise

This can help prevent weight gain, improve mood, and support better sleep during perimenopause. Try to exercise for at least 30 minutes daily on most days, avoiding it just before bedtime. Resistance training with weights can also help protect your bones against fractures during aging.

Complications of Perimenopause

• Heart Disease Estrogen helps maintain healthy blood vessels and normal cholesterol levels. When estrogen levels decline, cholesterol and other fatty deposits can build up on blood vessel walls, making these channels stiffer and harder and increasing the risk of heart disease. Cholesterol buildup in blood vessels leading to the brain also increases the risk of stroke.
• Osteoporosis Declining estrogen levels starting during perimenopause can cause bones to become brittle, weak, and more prone to fractures.
• Urinary Incontinence Lower estrogen levels can also weaken the urethra, resulting in leaking urine and difficulty holding in urine.

The Takeaway

• Perimenopause is the transition period leading up to menopause that typically begins in your forties and lasts between four and eight years.
• You can manage common symptoms like irregular periods, hot flashes, sleep problems, and mood changes through lifestyle adjustments or medications like hormone therapy or antidepressants.
• More high-quality research is needed to confirm the safety and effectiveness of many herbal remedies, supplements, and bioidentical hormones.
• Because declining estrogen levels can increase your risk for serious conditions like heart disease and osteoporosis, discussing your symptoms and long-term health risks with a healthcare professional is vital.