Perimenopause

Overview

What is perimenopause?

Perimenopause is when your body starts transitioning to menopause. During this transition, your body’s hormone levels and reproductive activity may become more erratic. Another name for perimenopause is the menopausal transition.

Perimenopause may begin as early as your mid-30s or as late as your mid-50s. Some people are in perimenopause for only a short time. But for many, it lasts four to eight years. The term perimenopause simply describes the time when your cycles are no longer predictable. At this time, your body is moving toward the end of your reproductive years.

What is the difference between perimenopause and menopause?

Perimenopause is a transitional time that ends in menopause. Menopause means your periods have ended. When you have no menstrual cycle for a full 12 months, you have officially reached menopause.

Can I still get pregnant during perimenopause?

Yes. You may be less likely to get pregnant during perimenopause, but it's still possible. As long as you have a period, you can still get pregnant. If you want to expand your family during this time, speak with your healthcare provider about your health, fertility and possible fertility treatment options.

When your periods are irregular, you may be more likely to get pregnant unexpectedly. If you don’t want to expand your family at this age, continue using birth control until your healthcare provider tells you it’s safe to stop. Continue to practice safe sex to prevent sexually transmitted diseases (STDs) throughout your life.

When does perimenopause start?

Most women notice signs of perimenopause in their mid-40s. Some women start perimenopause symptoms in their mid-30s.

Completing menopause before age 40 is premature menopause. Some medical conditions or procedures cause early menopause.

How does perimenopause affect my body?

During perimenopause, estrogen levels decrease. Estrogen is a key female hormone. It plays a role in maintaining many body systems, including the female reproductive system. Estrogen levels may continue to be irregular throughout perimenopause.

When you reach menopause, your body makes so little estrogen that your ovaries no longer release eggs. At this point, you stop having your period.

Symptoms and Causes

What are the symptoms of perimenopause?

During perimenopause, most women have menopause-like symptoms. You might have:

The decrease in estrogen also can lead to bone thinning or changing cholesterol levels. During perimenopause, your risk for osteopenia and heart disease increases. Continue to have regular checkups with your healthcare provider to keep an eye on your health. Your provider may recommend lifestyle changes or treatment options to lower your health risks.

Diagnosis and Tests

Do I need to go to my healthcare provider for a perimenopause diagnosis?

You don’t always need to see a healthcare provider for a perimenopause diagnosis. Many women notice and tolerate the changes in their bodies without a formal diagnosis. If you have symptoms that interfere with your daily activities, see a healthcare provider.

You should reach out to your healthcare provider right away if you have:

  • Blood clots in menstrual discharge.
  • Spotting between periods.
  • Vaginal bleeding after sex.
  • Emotional symptoms interfering with your ability to function on a daily basis.

Management and Treatment

How is perimenopause treated?

There isn’t any treatment to stop perimenopause. Perimenopause is a natural part of life. The “cure” for perimenopause occurs when your periods stop and you enter menopause.

But your healthcare provider may recommend over-the-counter or prescription perimenopause treatment to help ease symptoms. Your provider may recommend:

  • Antidepressants: These medications help with mood swings or depression.
  • Birth control pills. These medications stabilize your hormone levels and typically relieve symptoms.
  • Estrogen therapy: This treatment stabilizes estrogen levels. You may take estrogen therapy as a cream, gel, patch or swallowable pill.
  • Gabapentin (Neurontin®): This medicine is a seizure medication that also relieves hot flashes for some women.
  • Vaginal creams: Your provider can tell you about prescription and over-the-counter options. Treatment can decrease pain related to sex and relieve vaginal dryness.

Is estrogen therapy a good treatment for me?

For many women, estrogen therapy relieves symptoms of vaginal dryness, night sweats and hot flashes. It can also reduce the risk of osteoporosis.

But hormone therapy isn’t right for everyone. Estrogen and hormones have been linked to an increased risk of heart problems and some types of breast cancer.

Hormone therapy has fewer risks for younger women. In general, healthcare providers recommend that women who opt to use hormone therapy start it within 10 years of beginning menopause symptoms and use it for less than five years.

Can I treat perimenopause at home?

You may choose to manage perimenopause symptoms at home. To relieve symptoms, you can:

  • Eat a diet full of fruits, vegetables, whole grains, lean protein and healthy fats.
  • Exercise regularly.
  • Improve sleep hygiene by avoiding screens and doing relaxing activities before bed.
  • Limit alcohol and caffeine.
  • Practice meditation or other stress management techniques.
  • Quit smoking.
  • Lose weight if indicated. Weight loss reduces hot flashes and night sweats and improves your energy level.

Prevention

What are the risk factors for early perimenopause?

Some risk factors can lead to early perimenopause. You may start perimenopause earlier than usual if you have:

How can I reduce my risk of perimenopause complications?

Irregular periods are the most common symptom of perimenopause. But it’s important to know when to talk to your healthcare provider about your periods. Sometimes, irregular bleeding can point to an underlying problem.

You can lower your risk of complications by seeking treatment when necessary. Talk to your healthcare provider if you:

  • Bleed for more than seven days in a row.
  • Bleed between periods.
  • Change pads or tampons every one to two hours.
  • Have periods more frequently than every 21 days.

Outlook / Prognosis

How long does perimenopause last?

The length of perimenopause can vary. The average length of perimenopause is four years.

Some women are in perimenopause for only a few months. Others have perimenopause that lasts longer than four years.

Living With

What else should I ask my healthcare provider?

You may also want to ask your healthcare provider:

  • How long should I expect perimenopause to last?
  • What can I do to decrease symptoms naturally?
  • Am I a candidate for hormone therapy?
  • What are the signs perimenopause is ending?
  • What do I need to do to take care of my health through this transition?
  • Am I up-to-date on all my health screening tests such as a pap smear and mammogram?

A note from Cleveland Clinic

Perimenopause is the transition to menopause. During perimenopause, you may start having menopause-like symptoms, such as hot flashes, mood swings or vaginal dryness. Most perimenopause symptoms are manageable. But if you need help managing symptoms, medications and other treatments are available. For some people, estrogen therapy may be an option. Perimenopause can last from a few months to several years. Perimenopause ends when you’ve had no period for a full year. At that point, you enter menopause.

Last reviewed by a Cleveland Clinic medical professional on 06/25/2021.

References

  • American College of Obstetricians and Gynecologists. . Accessed 7/6/2021. The Menopause Years (https://www.acog.org/womens-health/faqs/the-menopause-years)
  • National Health Service UK. . Accessed 7/6/2021.Menopause (https://www.nhs.uk/conditions/menopause/)
  • The North American Menopause Society. . Accessed 7/6/2021. Hormone Therapy: Benefits & Risks (https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks)
  • The North American Menopause Society. . Accessed 7/6/2021.Menopause 101: A primer for the perimenopausal (https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal)

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