Perimenopause

What is perimenopause?

Perimenopause is when your body starts transitioning to menopause. During this transition, your ovaries begin producing less hormones, causing your menstrual cycle to become erratic or irregular. In perimenopause, your body is moving toward the end of your reproductive years. It’s a natural and normal progression, but it comes with both physical and emotional symptoms. Some of these symptoms can disrupt your life or make you uncomfortable.

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, while others are in it for several years. Even though your menstrual cycles are unpredictable and your hormone levels are declining, it’s still possible to get pregnant in perimenopause.

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

What are the hormonal changes during perimenopause?

The hormonal changes you experience during perimenopause are mostly due to declining estrogen levels. Your ovaries make estrogen, which plays a vital role in maintaining your reproductive system. As estrogen decreases, it throws off the balance with progesterone, another hormone your ovaries produce. It’s common for hormone levels to fluctuate during perimenopause — to go up and down like a rollercoaster.

When you reach menopause, your body makes so little estrogen that your ovaries no longer release eggs (ovulation). At this point, you stop having your period and you lose the ability to get pregnant.

What is the typical age for perimenopause to start?

Perimenopause begins about eight to 10 years before menopause. It usually starts in your mid-40s, but it can start earlier. Completing menopause before age 40 is called premature menopause. Some medical conditions or procedures cause early menopause. If there’s no medical or surgical cause for premature menopause, it’s called primary ovarian insufficiency.

How long does perimenopause last?

The average length of perimenopause is about four years, but it can last up to eight years. Some people may only be in this stage for a few months, while others will be in this transition phase for several years.

How do you know you’re in perimenopause?

It’s important to know that everyone’s body is different, and everyone experiences signs of perimenopause differently.

Generally, the first sign of perimenopause is irregular periods. You may go from having predictable menstrual cycles to spotting randomly or missing periods altogether. A lot of people also experience the most common signs of menopause like hot flashes and vaginal dryness early into the menopause transition.

What are the symptoms of perimenopause?

Once your estrogen levels begin to decline, your body must adjust to the changes in hormones. How your body reacts to changing hormones can be different from someone else’s, like how your friend’s body reacts. Some people don’t notice any physical changes other than skipped periods, while other people have symptoms like hot flashes and mood swings.

Even though the symptoms vary, many people experience at least one of the following:

• Irregular periods or skipping periods.
• Periods that are heavier or lighter than usual.
• Changes in mood like irritability, depression or mood swings.
• Low libido.
• Hot flashes.
• Night sweats.
• Vaginal dryness that causes discomfort during sex.
• Urinary urgency (needing to pee more frequently).
• Sleep problems (insomnia).

Because some of these symptoms resemble symptoms of other conditions, it’s a good idea to talk to your healthcare provider about what you’re experiencing. They can confirm that the symptoms are due to perimenopause and not another health condition.

What does perimenopause anxiety feel like?

There are only a few studies about anxiety specific to perimenopause. But healthcare providers do know that mental health conditions like depression are common in perimenopause. Many people also report feeling more anxious in perimenopause. Anxiety is a constant worry that may interrupt your daily life. Symptoms like sweating, nausea or muscle tension can also happen with anxiety. Perimenopause anxiety can make it hard to sleep and complete your daily routine. Talk to your healthcare provider if perimenopause is affecting your emotional well-being. They can recommend treatment with medication or behavioral therapy.

What are periods like during perimenopause?

Your body is producing less of the hormones that help you ovulate, so your periods can become irregular. Your menstrual cycle could become longer or shorter than usual. Your bleeding could also be heavier or lighter than normal. Some people also notice their premenstrual syndrome (PMS) symptoms get worse.

Do you still ovulate during perimenopause?

If you’re still getting a period, even an irregular one, you’re still ovulating. Until you haven’t menstruated for 12 consecutive months, you should assume your body is still ovulating.

How can I reduce my risk of perimenopause complications?

Irregular periods are common and normal during perimenopause, but other conditions can also cause irregular vaginal bleeding. If any of the following apply to you, see a healthcare provider to rule out other causes:

• Your periods become very heavy or contain large blood clots.
• You change pads or tampons every one to two hours.
• Your periods last several days longer than usual.
• You spot or bleed between periods.
• You bleed after sex.
• Your periods occur less than 21 days apart.

Your provider may want to rule out other causes of abnormal vaginal bleeding. Potential causes of abnormal bleeding include:

• Infection.
• Fibroids.
• Blood clotting disorders.
• Polyps.
• Cancer.

How is perimenopause diagnosed?

A healthcare provider may determine that you’re transitioning to menopause based on a physical exam and your symptoms, age and medical history.

But you don’t always need to see a healthcare provider for an official diagnosis. Many people notice the changes in their bodies but don’t have severe symptoms. Other people end up contacting their healthcare provider because symptoms become intolerable and uncomfortable.

What tests can diagnose perimenopause?

Hormone testing isn’t necessary to diagnose perimenopause. Hormone levels fluctuate so much that the tests aren’t reliable.

But certain hormone tests can tell your provider you’re in perimenopause. For example, testing your FSH (follicle-stimulating hormone) level is one to see if perimenopause is beginning. FSH is a hormone your pituitary gland produces. It stimulates your ovaries to release an egg during ovulation.

A consistently high level of FSH can indicate you’re getting near menopause. But FSH tests can be misleading because during perimenopause, your hormones rise and fall erratically. Certain medications and health conditions interfere with hormone levels and will affect the results of any hormone tests.

There aren’t any imaging tests that can confirm perimenopause, but your provider may order tests to rule out other conditions.

Can perimenopause be treated?

There isn’t any treatment to stop perimenopause. Perimenopause is a natural part of life. It ends when your periods stop entirely, and you reach menopause.

But your healthcare provider may recommend ways to help ease uncomfortable symptoms. Many people don’t need medication and find that their symptoms are mild enough that lifestyle changes alone make a big difference. Still, other people find that taking medication relieves their symptoms and improves their quality of life.

Your provider may recommend the following medications:

• Antidepressants: These medications help with hot flashes, mood swings, anxiety or depression.
• Birth control pills: These medications stabilize your hormone levels and typically relieve symptoms.
• Hormone replacement therapy (HRT): HRT uses estrogen or estrogen and progesterone to increase your hormone levels if you’ve gone into menopause before age 40.
• Hormone therapy (HT): Similar to HRT, this therapy uses estrogen or estrogen and progesterone to increase your hormones. Providers use this term when referring to people going through menopause at a more natural age (any time after age 45).
• Gabapentin (Neurontin®): This medicine is a seizure medication that also relieves hot flashes for most people.
• Oxybutynin: A medication for overactive bladder that can also relieve hot flashes.
• Fezolinetant (VEOZAH™): This is a newer treatment for severe hot flashes.
• Vaginal creams: Your provider can tell you about prescription and over-the-counter options. Treatment with vaginal creams and lubricants can decrease pain during sex and relieve vaginal dryness.

Your healthcare provider will discuss the risks and benefits of perimenopause treatment with you and recommend the best option based on your needs.

What lifestyle changes can I make to manage perimenopause symptoms?

You may be able to manage perimenopause symptoms at home without needing medication from your provider. Some tips for treating your symptoms without medication include:

• Eat lots of fruits, vegetables, whole grains, lean protein and healthy fats.
• Perform weight-bearing exercises like walking, hiking or strength training.
• Dress in layers so you can remove clothing if you begin to sweat or get hot flashes.
• Use a fan or keep your house at a cooler temperature.
• Improve sleep hygiene by avoiding TV and computer screens and doing relaxing activities before bed.
• Limit alcohol and caffeine.
• Practice meditation or other stress management techniques.
• Quit using tobacco products like cigarettes.
• Maintain a weight that’s healthy for you.

What makes perimenopause worse?

There isn’t one specific thing that makes perimenopause worse. Everyone is different. You may find that certain activities or specific foods make your symptoms worse. In general, the following factors can make perimenopause symptoms worse:

• Eating unhealthy foods like sugary drinks and desserts or foods high in saturated fat. Eating more nutritious foods can help with weight changes and hot flashes from perimenopause.
• Avoiding exercise or staying sedentary. Getting regular exercise has been shown to improve energy, mood swings and sleep problems.
• Smoking cigarettes or using tobacco products. Studies show that smoking can lead to early menopause and decreased bone density, as well as worsen vaginal dryness.

Talk to your healthcare provider about your lifestyle and any symptoms you have. They can work with you on a treatment plan and recommend ways to improve your overall well-being.

What can put you into perimenopause early?

Certain factors are linked to early perimenopause. These include:

• Smoking or using tobacco products. People who use these products regularly tend to go into menopause about one to two years earlier than people who don’t.
• A family history of early menopause.
• A history of cancer treatment.
• If you’ve had surgery to remove your uterus (hysterectomy) or ovaries (oophorectomy).

Are there any health risks associated with perimenopause?

There are health risks associated with menopause, which happens right after perimenopause.

Estrogen plays an important role in preserving your bones. Osteoporosis is a condition where the insides of your bones become less dense and more fragile. This increases your risk for bone fractures. Your healthcare provider may recommend a multivitamin, calcium supplement, extra vitamin D or more weight-bearing exercises. People in menopause are also at an increased risk for heart disease and other cardiovascular (heart and blood vessel) health conditions.

Can I get pregnant if I am in perimenopause?

Yes, you can still become pregnant. 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.

When your periods are irregular, you may be more likely to get pregnant unexpectedly. If you don’t want to expand your family, use birth control until your healthcare provider tells you it’s safe to stop.

What questions should I ask my healthcare provider?

Discuss your perimenopause symptoms with your healthcare provider. It might help to keep a journal of your menstrual cycles, including when they start and stop and the amount of bleeding.

Some questions you should ask are:

• Are these symptoms of perimenopause?
• What can I do to relieve my symptoms?
• How long do you think I will have these symptoms?
• Would hormone therapy be an option for me?
• Do I need to start taking medication or vitamins?
• Are there any tests that should be done?

When should I call my provider?

If your perimenopausal symptoms are unbearable or interfering with your quality of life, it might be time to contact a healthcare provider. They can recommend a treatment to reduce the intensity of your symptoms and get you feeling better.

Can perimenopause affect my sex life?

Possibly. Certain symptoms of perimenopause like vaginal dryness and discomfort during sex can make having sex less desirable. Vaginal lubricants can help with dryness. Speak with your healthcare provider if you have issues with your sex drive so they can recommend ways to help you.

Does perimenopause affect my sleep?

Yes, perimenopause can affect your sleep. People in perimenopause may experience insomnia and interrupted sleep due to night sweats or other menopausal symptoms.

What do hot flashes feel like during perimenopause?

A hot flash feels like a sudden warmth all over your body. It’s often accompanied by sweating and a red, flushed face. Low estrogen levels cause hot flashes, and they can last months or years.

Why am I gaining weight during perimenopause?

The shift in hormones slows down your metabolism. It’s very common to gain weight once your estrogen levels start to decline. Eating healthy and nutritious foods and getting regular physical activity can help prevent weight gain during the transition to menopause.